Fearless, funny, and expertly vetted updates on what is happening to public health in the US.
For quite awhile now these updates have been focused on domestic health issues, but the reality remains that the U.S.’s withdrawal from almost all foreign aid is also going to have devastating public health consequences. (It already is, and it’s going to get worse.) So this update is focused on What in the Health is happening globally. Read to the bottom for a time-sensitive and important action item!
As of July 1, 2025, all that’s left of USAID is 15 administrators who are legally required to have a job per Title 5 of the U.S. Code of Federal Regulations. Before Trump took office the second time, there were about 10,000 employees. Now there are 15. On the final day, the consolation prize for all those fired employees were three recorded messages, from former President G.W. Bush, former President Obama, and U2 singer Bono. “Is it in our interest that 25 million people who would have died now live? I think it is. On behalf of a grateful nation, thank you for your hard work, and God bless you,” said Bush in his message. (George W. Bush wasn’t exactly a favorite president of public health folks. The fact that he’s become an ally on some of these issues just shows how far we’ve fallen.)
Why are many people so devastated to see what’s happened to USAID? It’s not because we love corruption and waste, as some would ask you to believe. If you have criticisms of an organization’s efficiency or function, it’s important to work to improve those things. You don’t do that by eliminating the agency altogether. Why? Because it’s been doing work that has literally saved millions of lives. Lest you think I’m exaggerating, a recent study published in The Lancet (a highly reputable medical journal, according to pretty much everyone except RFK Jr.) found that between 2001 and 2021, USAID funding prevented almost 92 million deaths, including 30.4 million deaths in children younger than 3 years. Let that sink in. 92 million people is approximately the entire population of Iran. It’s the same as everyone who lives in Argentina PLUS Uganda combined.
USAID funding was also associated with a 65% reduction in deaths from HIV/AIDS (25.5 million people, alive today because of USAID), 51% reduction in deaths from malaria (8 million people), and 50% reduction in other “neglected tropical diseases” like dengue, chikungunya, and schistosomiasis (almost 9 million people).
Perhaps even more distressing, the same study found that because of the cuts enacted by Donald Trump and Elon Musk, we can expect 14 million additional people to die by 2030, including 4.5 million deaths among children under age 5. These are people who will die, but wouldn’t die if USAID had been left to continue its work. If you’re worried about government waste, are you worried about millions of children dying to prevent it?
In case you don’t believe this article in The Lancet, a USAID memo leaked in March projected that without the agency, we should expect another 12.5 million – 17.9 million cases of malaria (with 71,000 – 166,000 deaths every year) and 200,000 cases of paralytic polio every year. That’s 200,000 people paralyzed because USAID is gone, when this didn’t have to happen. What if that was your child paralyzed? The Stop TB Partnership estimates that there will be more than 10 million new cases of TB and 2.2 million deaths from TB by 2030 without USAID.
Maybe you don’t care that much, because you think it’s high time the U.S. stopped spending our taxpayer dollars to solve everyone else’s problems. “Other countries need to step up,” I’ve heard people say. “Their problems aren’t our problems.” But here’s the thing: these ARE our problems. Do you remember the Zika outbreak from 2015-2017? Cases were reported in Florida, Texas, Puerto Rico, and the US Virgin Islands. More than 42,000 cases were reported in US states and territories. Last year, more than 16,000 cases of Oropouche virus were identified in the Americas—like Zika, resulting in birth defects and fetal death. The U.S. used to work with neighboring countries to help them suppress outbreaks of diseases that don’t wait for passport control at international borders. That’s not just because we’re nice. It’s because if we don’t do that, then people in the United States will be coming down with Oropouche, too. (If you don’t know what Oropouche is—which is likely—you might want to study up.)
It’s not just USAID. The U.S. also recently withdrew from Gavi, which is a public-private partnership that helps make sure children in low-income countries around the world have access to life-saving vaccines. Gavi negotiates lower prices with vaccine manufacturers to make vaccines more affordable to poor countries, provides financial assistance to countries to support their immunization programs, offers technical expertise to help strengthen their systems for storing and distributing vaccines, and works to shape vaccine markets to ensure that vaccines are available and affordable. Why did we withdraw? Trump had already said we’d be dramatically reducing our contributions to Gavi as part of our general reduction in foreign aid. But RFK Jr. said he’s eliminating $1 billion in U.S. funds promised over the next 5 years because of concerns over “vaccine safety,” saying they’ve “ignored the science.” OH THE IRONY: To justify this, he cited a single, old, irrelevant, and poorly done study (in case we needed more evidence that he’s a lawyer and not a scientist). Gavi estimates that without that US support pledged over the next 5 years, there are approximately 75 million children who will no longer receive their routine vaccines, with 1.2 million children dying from vaccine-preventable diseases. Because RFK Jr. is concerned about vaccine safety, 1.2 million children are going to die unnecessarily. Are you feeling proud about how great America is becoming again?
***But there is something you can do!*** The Trump administration’s budget rescissions package (H.R. 4) has passed in the House and it must pass a vote in the Senate – with 50 votes – by July 18. That’s this Friday. If it isn’t passed by the Senate by Friday, then the package fails and Trump cannot request the same rescissions again. But if it passes, it will basically cancel funds previously approved by Congress, making Trump’s slash-and-burn approach to government spending officially Congressionally approved. This rescission package includes cutting approximately $8 billion in US foreign aid, $500 million of which is specifically allocated to global health programs—not just formalizing the destruction of USAID, but also eliminatingUS contributions to things like Gavi, UNICEF, U.N. peacekeeping missions, and international disaster assistance (plus $1.1 billion in funding for NPR and PBS). Yesterday, after pressure from their own constitutents, Senate Republicans agreed to strip out a $400 million planned cut to PEPFAR. This is huge! Our voices matter. But don’t let them sell this as a claw-back of the only piece that mattered. Jump on the phone today and call your Senators, especially if you live in a state where they’d consider voting yes…as you just read, millions of lives are still depending on it.
What in the Health?!
Fearless, funny, and expertly vetted updates on what is happening to public health in the US.
