Another pillar of this is the unique vulnerability of an agency whose primary impact is overseas. I think USAID is a national security agency that keeps Americans safe, keeps diseases at bay, and builds partnerships that help keep the world a secure place. The benefits don’t just happen overseas, but many people around the country question the idea of spending money there when we have real problems at home. And I think that that allowed USAID to be vulnerable in a way that maybe the Social Security administration wouldn’t be.To add to that, there was the problem of visibility. I pay close attention to the news and politics, and before all this happened, I didn’t have a great grasp on what USAID actually did. I knew about PEPFAR and I knew they were doing lifesaving work, but if you had asked me about specifics, that would probably be about it.
You’re 100 percent right. And in all the sad postmortem circles I participated in of former colleagues, that’s definitely one of the things we said we could have done differently, is tell our story better.
It felt like an unfair fight, where Elon would be spouting off, and nobody was really pushing back that hard. Probably in part because it was such a shock to the system to be dismantled so suddenly, and partly because USAID workers weren’t PR professionals. They were policy people and analysts.
And you’d have to dig into these long and tedious reports about data to understand the enormous impact that USAID had. For me, one thing that’s been really weird about all this is that before, people didn’t know what USAID was. I would tell them what my job was, and they’d be like, “Okay, so that’s the State Department❓” Close friends and family didn’t get it. And then this six-week period happens and I’ve got my head down. I’m panicking every day. The world is falling apart for me, and I actually wasn’t paying that much attention to the news.
Then I come out of it and suddenly, everybody has heard of USAID, and there’s protests in all 50 states to try to save us. I’m like, Where did this come from? And when I released these memos about what was actually happening at USAID, and how we were prevented from doing the lifesaving activities that Rubio was saying he had created this waiver for, I thought I was just compiling a record for my colleagues to protect ourselves from when we ended up getting blamed. I was really surprised that I was contacted right away by national media. And they seemed to care about it for the first time that I was aware of.
So you had these DOGE people who had no idea what the agency did and just wanted to smash it up. You had Musk, who believed all these conspiracy theories about it. Then you had people who are maybe a bit more sophisticated, like Jeremy Lewin, who was the administrator for policy and programs for USAID — though also affiliated with DOGE — and has an impressive pedigree. I heard him do a long interview with Ross Douthat a few months ago. His whole spiel was that many countries have become dependent on the U.S.; it’s an endless cycle of aid and nothing really gets better. We’d prefer to put the responsibility in those countries’ hands. This probably sounds reasonable to a lot of people, even if cutting off aid suddenly is cruel. Did Lewin’s justification, or others like it, make any sense to you?
I thought Lewin’s interview was infuriating, partly because there were kernels of truth in it. But before I can talk about whether there are ways to make aid better, more efficient, and less likely to foster dependency, it’s really important to recognize that that is not why they destroyed USAID. They destroyed USAID to satisfy the ego of Elon Musk, and the people who were tasked with destroying it were not aid reformers. You said that maybe Jeremy Lewin was somewhere in between the bozos and the conspiracy theorists, but the reality is he had absolutely zero experience in international development; he’s just good at picking up talking points later.
There were some interesting and valid points he made in that interview, but that was all put together after the fact. And the people who were there were not trying to improve to more tightly align foreign aid with the president’s agenda or to make it less likely to foster dependency and become more self-sustaining. They were tearing it down.
And so to me, especially for an agency called the Department of Government Efficiency, to come in and talk about and tear down an agency that was allowing us to maintain global stability at a tiny fraction of the cost of what it costs to try to police the world via coercion and force … USAID had operated on less than one percent of the federal budget. And we created trading partners, lasting partnerships, with countries like Korea, Brazil, that didn’t exist before. We’ve saved 92 million lives over the last two decades alone. The return on investment is insanely efficient, especially when compared to other government agencies. To tear down that agency in the totally false name of eliminating waste and creating efficiencies is especially infuriating. I can feel the anger coming through. It still feels pretty raw for you, clearly.💥💢
Well then, I’m portraying my message correctly. Yes, I’m very angry. I actually wrote this book hoping it would allow me to put some of these feelings to bed, but I’m not sure when I’m ever not going to be angry anymore. I think that obviously there’s the personal piece — I lost my job and my career, and so did my colleagues. And watching an agency’s expertise be hollowed out and replaced by a group of completely incompetent and unqualified buffoons, then having to listen to them talk about how they’re actually improving things, when it’s just lies — it’s very, very upsetting.
It’s difficult to get an exact picture of what’s going on on the ground in many of the most affected countries, and local organizations are trying to fill the gap left by USAID. But of the programs that were cut, which ones have been particularly devastating in your eyes?
That’s a really big question. The first thing I’ll say is we don’t really know, because they have not reduced any of the data they’re required to by Congress. And I think that alone is a little bit nerve-racking and telling. In terms of what keeps me up at night, it’s the way that we have exposed ourselves in the United States to the spread of infectious diseases in ways we weren’t just a year ago.
After COVID, we had invested hundreds of millions of dollars to build up early warning systems to detect and respond to outbreaks in communities before they could even spread to a hospital, much less spread internationally. And that was the first thing to go.
The few things that they have saved, I think — it’s hard to tell, but it sounds like — are continuing treatment for patients with HIV, and continuing to supply drugs for malaria and tuberculosis. But, all the surveillance, all the monitoring, all the prevention is gone. So I’m particularly concerned about what that means for our own vulnerability, as well as the billions of dollars that we’ve invested over the years. How far are we going to backslide before we get a handle on this❓
Along the same lines, they did release one-quarter of PEPFAR data. (President Bush's Emergency Plan for AIDS Relief)
It’s a weird single quarter in the middle of a time period, and who knows what monkey business was involved in deciding on that.
But, the reason they did it was that it showed no major decline in the number of people total that were on treatment from pre-cuts to post-cuts, about six months in. Of course, the reason that it showed that was because treatment is often distributed in six-month batches, so you wouldn’t actually see the decline until just after that. But what that data did show was that they basically have stopped providing testing services. We’ve seen a cut of 4 million HIV tests year over year. Diagnosis is equally down, not surprisingly. And they have basically stopped all the prevention activities and stopped providing support to vulnerable communities. They call that DEI, but really it’s just standard epidemiology.
How bad is this for the fight against HIV and AIDS overall?
What it looks like from the data is that the U.S. government has abandoned its commitment to ending the HIV pandemic and is only looking at trying to preserve treatment of already diagnosed patients. We were getting very close to ending it as a public-health threat, and now we’re basically giving up on that and putting ourselves in a position that we’re always just going to be providing drugs without ever trying to actually get past the epidemic itself, or to help build health systems that can deal with this on their own. There’s talk about not fostering dependency, but the administration’s actions show that the activities that they’re continuing are the most likely to involve us providing drugs forever.
One other crushing thing is the end of our global immunization campaign, where we provided immunizations against a host of the world’s worst and most likely killers of children under 5. That just stopped in its tracks. We haven’t seen the impacts of it yet, but over the next five years, kids are going to die in massive numbers, and none of them had to.
Lots of other governments are also pulling back on foreign aid, and I know nonprofits can’t replace the level of funding that was lost. But have you seen any positive signs of other people or organizations stepping in to do any of this work?
No. The nonprofits are just as devastated as the government. They’re all going bankrupt or getting rid of their staff because they were very much either tied in with or dependent upon U.S. government funding to run their programs. And like you said, other countries haven’t stepped up to replace the U.S. — weirdly, it’s been the opposite.
Over the long term, this administration talks a lot about countering threats from China, but what we’re actually getting is a situation where all the goodwill, all the trust that we’ve built over all these years … it’s kind of similar to what’s happening with NATO and other alliances. When we break our promises so profoundly and the resulting damage is so immediate and devastating, how can we expect countries to come back to the table in the future and want to be our partners? It makes me wonder where they’re going to turn instead for support when they need it.
USAID also did a lot of work that wasn’t lifesaving treatments. They also funded news outlets and political opposition around the world, and not all of it was savory. Let’s say there’s a revamp of the agency. Should it focus more narrowly on the issues we’ve discussed in this interview, like immunization and medicine?
There are definitely things that are outside of lifesaving treatment that should be continued in a new agency for international development. I think maybe the easiest example of that is education. The support for increasing literacy and for having girls and women stay in school longer is one of the most effective and long-term efficient ways that we build stability and build economic development in countries, which actually ends up benefiting the United States.
Specific to democracy and government stuff — this is a little bit outside my expertise, but I will say that when at the beginning of the Iran war when Trump stood up and said he wanted the grassroots pro-democracy protesters to take over the regime, it was frustrating to hear because those were some of the groups that USAID had supported. And a year before, he had abruptly cut off support to them and made them extremely vulnerable to retaliation by the regime. That investment may have been able to pay off, but we’ll never know.
What do you think of the prospect that USAID could come back under a Democratic president? Do you think anyone would spend the political will on actually doing it❓ And perhaps make it leaner or more efficient❓
I don’t know if the will is there, but I think it needs to be, and I hope Americans will demand that the agency be brought back. Again, it doesn’t have to be the same. There are ways USAID could be made much more efficient. And in that sense, there is an opportunity to redesign it in a way that breaks through some of the bottlenecks we faced and the very real inefficiencies of USAID. There are ways to do that when it’s been torn apart so completely.
But I think we do need to have an independent agency for international development. Having an independent agency that is the face of American generosity means something to the world. The way it’s being run out of the State Department, with these transactional and exploitative partnership agreements, where basically we’re dangling the prospect of providing treatment for lifesaving diseases to countries in exchange for them to give us access to their mineral rights or to send our deportees to their countries — it’s like forgetting all the lessons we’ve learned about what works in international development over the last 60 years, which is that if you build your foundation of partnership on goodwill and trying to do good, you will actually be able to build more long-lasting trust.
The other thing I’ll say about this is that people didn’t know about USAID — that’s true. But now, they’ve actually heard of it, and they’re really mad about the way it was torn down. Pew came out with some good polling about what people think of foreign aid and about what DOGE did to it. I think politicians will see that it actually is not going to cost them a lot of political will to restart USAID. I think that’s actually what people want and expect.
This interview was edited for length and clarity.
