USAID Closure Puts “Millions of Lives at Risk,” Humanitarian Groups Warn
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From KQED in San Francisco, I'm Alexis Madrigal. You've probably heard that the Trump administration is gutting USAID, a major source of humanitarian aid around the world.

This tiny piece of the American budget nonetheless has supported countless programs in children's health, disaster relief and HIV treatment. While it's not at all clear why Elon Musk and Donald Trump have so aggressively moved against USAID, it is clear that some very poor people will suddenly have less care, fewer treatments and attenuated programs.

We talk about the on-the-ground impacts of losing USAID and efforts underway to save the agency. It's all coming up next, right after this news. Welcome to Forum. I'm Alexis Madrigal. There have been critics of USAID since its creation during the Cold War. Some of them have come from the left, people suspicious of any vehicle of American power, no matter how soft. Others have been critical of onerous USAID reporting requirements or reliance on American suppliers.

But those critiques are a far cry from what is happening right now at USAID. The deep cuts were pretty much unthinkable before Elon Musk began tweeting that the Trump administration was feeding the agency quote into the wood chipper. They are part of a much broader set of cuts and freezes in the American government from health research to the National Weather Service.

Many Americans have a fairly distorted view of foreign aid, wildly overestimating how much the U.S. spends on it, and perhaps for that reason are lukewarm on American humanitarianism. Today we want to get both at the politics of the USAID situation and get a sense of the work it has supported on the ground and what might happen as American support is withdrawn.

We're joined this morning by the president of Refugees International, Jeremy Knyndyk. He served in the Biden administration as USAID's lead official for COVID-19. He also served in the Obama administration as the director of USAID's Office of U.S. Foreign Disaster Assistance. Welcome, Jeremy Knyndyk. Thank you so much. Great to be here.

So there's been a lot of confusion and chaos. Let's just start with sort of sorting through from your perspective what's happening right now to the agency.

Well, what we're seeing is a kind of two-pronged attack on USAID from within the administration, one prong being led from the State Department by a gentleman named Pete Morocco, who served at USAID and in several other roles during the first Trump administration. In his brief tenure at USAID, his behavior towards his team prompted a 13-page dissent channel memo. That's basically the

the mechanism that the USAID and the State Department staff have to register dissent to leadership. And after that, he went on leave for quite a long time for most of the rest of the administration. He had a kind of history of toxic behavior towards staff that had led him to bounce around to a number of different roles in that administration, and USAID was the last place he landed.

So he is at the State Department now running the Foreign Assistance Budget Office and appears to really have an ax to grind towards USAID and has been attacking it since almost the first days of the administration. The other prong is led by Elon Musk.

and his team of kind of Doge 20-something tech whizzes. And they have gone into the agency now, and while Elon tweets, I think we just have to call it what it is, he tweets just straight disinformation about the work of the agency. His team of Doge folks has been taking over agency computer systems, seemingly getting into the classified networks,

and taking over all of the personal information of USAID personnel and the business information of USAID vendors and contractors. So there was a great ProPublica piece a few days ago that pointed out the huge range of laws that that is likely breaking. And I think what unites both Morocco and Musk is a willingness to completely disregard the

The law or any sort of normal procedure or legal requirement as they now are both attempting to destroy the agency And I think that is the that is their shared objective musk tweeted last weekend that he had spent his weekend Putting USAID through the wood chipper. Yeah, so what does that mean for the people who worked for this agency? You know all across the world. I mean of course there's the the DC Kind of headquarters, but all across the world are people just having to fly home like are they having it what's happening? I

So people are in a very frightening state of limbo right now. There was an order last week that came from the State Department that all overseas USAID – virtually all USAID personnel overseas were going to be pulled back.

Um, that prompted a legal challenge by the employee unions and a Trump appointed judge on Friday issued a one week restraining order for blocking the government for moving forward with that. Um, in the meantime, uh, email was shut off. A lot of the USAID personnel overseas just found themselves now, uh, in a situation where they didn't know if they were still employed or not. Uh, there was a really powerful interview with one of them.

in Politico over the weekend where he said, look, I don't know if I still have a job. I don't know if I have a salary. I do know that if I or someone on my team were kidnapped, we'd have no way to get in touch with embassy security because our communications have been cut off. So it is really creating, I think, quite intentionally trauma and abuse towards the USAID workforce. Yeah.

It's also hugely disruptive to USAID activities and partner activities. And so one of the things that Morocco did from the State Department very early on was institute what's called a stop work order directing that all USAID partners around the world had to stop all ongoing activities. And that included humanitarian activities, that included distribution of critical HIV drugs that keep people's HIV infections suppressed.

And so there is obviously damage to the workforce here. But there is also, I think, even more importantly, huge human damage being done in real time by these worms. And we're definitely going to talk about that more in the show, just so everybody knows.

There are some crosswinds on what's happening, right? I mean, Secretary of State Rubio has tried to soften or walk back some of the things that have been said. It appears from the outside, at least. And there is some sense that there's a carve out for some humanitarian programs. What are you hearing about that?

Yeah, you know, the narrative that I think they maintain publicly, which is, look, this is just a 90-day review. We're entirely within our rights. Secretary Rubio has issued carve-outs on paper for humanitarian activities and for some of the HIV activities. But in practice, that is not being translated into action on the ground. So even as those carve-outs were issued, most of the partners, virtually all of the partners, at least as of the weekend,

We're still unable to get their money. So it's fine to say we've carved out your activities, but if you are still blocked from the payment system, you still can't work. And that has been the case. The review, I think, is...

guys or a maybe a smokescreen if you are really reviewing programs You don't at the same time announce that you're shutting down the agency and begin firing all the staff And so I think what is what is clear now and maybe wasn't so clear a week or two ago Is that some of those moves are really to kind of sanitize or hide what's really going on? Which is the targeted destruction of the agency?

Is there any relationship between the sort of criticism of USAID that had occurred in the past? You know, it's largely been supported on a bipartisan basis. But of course, people have had criticisms of USAID. Is there any relationship between that criticism and, you know, at least the stated rationale that we're getting from the Trump administration about why it is that they're, you know, feeding the agency into the wood chipper?

Not, not really. And look, I mean, you know, if we had a long time, I could give you lots of things that I should be, that I think should be reformed about USAID. And I think anyone on the left or right probably has lots of opinions on that. I think that's a very, that's a debate very worth having.

But the agency needs to exist in order to be reformed. What we've seen instead from Musk and what is now being echoed from Trump is this idea that the whole agency is somehow a rogue Marxist slush fund. And those are terms that the president has used and Stephen Miller used in some interviews over the weekend. That really bears no relation to reality and not much relation to the critiques of USAID in the past.

Are there some programs that were funded under the Biden administration that Trump doesn't like? Absolutely. And that was the case in reverse, too. I was a day one Biden appointee at USAID and we found things that we we stopped because we didn't agree with them.

That's a normal part of a presidential transition. This is very different. This is not just rooting out or ending some programs that they don't like. This is using those programs that they don't like to act as if the entire agency is an unsalvageable mess and shutting it down. And so, you know, Elon, in addition to the woodchipper comment, referred to AID not as an apple with a few worms in it, but

nothing but a ball of worms. I mean, they're really describing a reality that does not exist. You know, one of our listeners, Carl, writes and say, you know, I'm for helping people survive, especially from lack of food, but I understand that USAID is spending on things that are not humanitarian in a strict sense. Like, what do you think he means by that? Yeah. Well, look, AID has a range of different things that it supports. So

In most years, 50 to 60 percent of what USAID does is either humanitarian relief, so life-saving humanitarian relief, or global health. But beyond that, it also has smaller programs for economic development, poverty alleviation, water, education, women's rights. And there are things in there that

depending on the administration, may or may not be supported. What I think is striking though, is that a lot of the criticism, particularly from the White House,

is criticizing things that didn't actually exist or aren't real. They put out a sheet last week listing a bunch of programs that they accused USAID of doing and being wasteful. Many of those were not even USAID programs. Many of them were small State Department initiatives funded by individual ambassadors and embassies. The Washington Post did a fact check on that and found that 11 of the 12 things on their list were basically misleading or outright false. Jeez.

I mean, it must be incredibly frustrating for you as someone who has been a part of the on-the-ground work, like the real things that are happening, to watch this layer of kind of disinformation. I mean, Elon Musk called USAID a terrorist organization. I mean, it must be so frustrating. It's immensely frustrating, and it's hurtful. And, you know, I have—

In my first time at USAID during the Obama years, I oversaw the disaster response office and I had to personally direct team members to go into the Ebola hot zone in West Africa at the height of that outbreak at great risk to themselves.

And they did so willingly because they believed in the mission and they knew they were doing it both for their country and for the good of the people that they were helping. And that really is the ethos and the spirit of USAID. It's the furthest thing from terrorism that you could imagine. It is self-sacrifice to better others. And I can only conclude that Elon just on some level doesn't understand that kind of an ethos, can't register it. Yeah.

Real quick, you wrote on Friday that you don't think the fight is over. Do you still believe that? I do believe that. Trashing an agency on Twitter and calling it dead on Twitter does not mean it's dead in real life. USAID was established by Congress. Well, it was established originally by Kennedy through an executive order. It was later established as a standing permanent independent agency by Congress in 1998.

You abolish an agency when you change the law that establishes the agency. They haven't done that. They have not changed anything in the law. And so it continues to exist. They do it through legal channels and the fight goes on. Jeremy Knyndyk, president of Refugees International. We'll be back with more on the Trump administration's efforts to shut down USAID. Stay with us.

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Welcome back to Forum. I'm Alexis Madrigal. We're talking about the Trump administration's efforts to shut down USAID. For the break, we were joined by Jeremy Knyndyk, who's president of Refugees International and under the Biden and Obama administration's

had worked at USAID. I want to bring in a couple of other guests now. Alyssa Mialene is a reporter covering USAID and the U.S. government for DevEx, which is an independent news organization covering global development. Welcome, Alyssa. Hey, thanks for having us. Yeah.

We're also joined by Joya Mukherjee, who's chief medical officer at Partners in Health, which has received USAID funding to care for pregnant mothers and newborns, provide food for malnourished children and treat infectious diseases. She's joining us from Sierra Leone. Welcome. Hi there. Yeah, great to have you.

Alyssa, let's start with you. Just for people who are wondering to themselves, why are we hearing so much about USAID now? Why was it founded? What's the sort of capsule history of this agency? - Yeah, so I mean,

USAID was created in 1961. So it was really created to administer humanitarian aid programs on behalf of the U.S. government, but also, you know, kind of as a both moral obligation, but also as a bit of soft power, right, to counter at the time Soviet influence through foreign assistance. And ever since it's kind of grown into a larger organization that does humanitarian response, health care, health

emergency food aid, responding to conflict, disaster, et cetera, across the world. So again, decades long history of this agency. And before the last couple of weeks, it employed about 13,000 people. Two thirds of them worked overseas. Yeah. Joya, you're joining us from Sierra Leone. Let's get to like what you think the main impacts will be on the ground there and in the rest of Africa if this agency really is more or less gutted, shut down.

Yeah, well, we see it already because everybody who's working for USAID-funded programs has been told to stay home for three months. So that means drivers, that means doctors, that means nurses, that means supply chain specialists. So all kinds of professionals that help governments to provide support for their people, help churches to provide support for their people.

And so right now we see a stalling of medicines moving through countries. We see food left at the ports. We see because there's no system. The system people have been told stay home. Have you ever seen anything like this in your career?

Absolutely not. And, you know, and I've been doing this for 30 years. I've worked in a dozen countries across Africa and even more in Latin America and Asia. And I've never seen anything where people who are willing to do the work, where even the supplies are there, where budgets have been formed, just say, go stay home. I mean, it seems just patently cruel.

When you have people, living people, living, breathing people who are relying on this assistance and has just dramatically stopped overnight. What are the people that you're talking to on the streets, but also, you know, in the halls of power in these various countries? I mean, what are they making of what the U.S. is doing right now?

So certainly on the ground, people are really upset because, as Jeremy said in your earlier segment, most people who do this kind of work just care about other human beings and want to help. And then suddenly your hands are tied. And so I think there's just a general dispiriting factor and chaos.

And as an infectious disease doctor, I'm always worried about chaos because that's where we get resistant virus. That's when we get the transmission of epidemics. In the halls of power,

Certainly, global health has been, as long as I have been involved, a very much bipartisan issue. We've had Republicans and Democrats, independents, everybody supports the idea of the U.S. leading and supporting in this very material way the poorest people in the world as a way to do the right moral thing, but also

But also as a way to, as your other guest said, have this kind of soft power and show that the U.S. is a good country, that our system cares about people. So I think I've heard from both sides of the aisle people who are really frustrated.

But what I'm worried about is just the chilling effect that the Trump administration has had so far on speech because there are Democrats standing up, but not a lot of Republicans. We're talking about the Trump administration's efforts to shut down USAID, joined by Joya Mukherjee, who's chief medical officer of Partners in Health, as well as Alyssa Miollene, who's a reporter covering USAID and the U.S. government for DEVX.

Well, of course, I want to take your questions that you have about this shutdown. Maybe you or someone you know has been directly affected by the closure or an organization that you support or work with. Give us a call. The number is 866-733-6786. That's 866-733-6786. You can email forum at kqed.org. You can find us on social media, Blue Sky, Instagram, or KQED Forum. And there's the Discord, of course.

Alyssa, let's talk a little quickly about how much of this was laid out in advance of the Trump administration. Like, is there a section of Project 2025 people could go read and say like, oh, OK, they were going to they said they were going to take out USAID or not?

Yeah, so it's a good question. I mean, I think I'll start with the fact that, you know, a lot of this was laid out in Project 2025, but not all of it. So the different pieces that were laid out, for example, were, you know, really kind of the author of the chapter talking about how the Biden administration had, quote, deformed the agency.

And really using it to, quote, pursue overseas political and cultural agenda. So those are things like abortion, promotion, climate, quote, extremism and different topics about gender and that kind of thing. So kind of the typical counter counterpoints or talking points here.

Now, also in the chapter, the author recommended something similar to what we're seeing today. So deep cuts to USAID, having kind of a somewhat of a merger between state and USAID with the same person responsible for both the agencies, you know, USAID as an agency and also the State Department's F Bureau, which is the Office of Foreign Assistance. But there

differences. So I think regardless of the fact that a lot of this was laid out in terms of cuts, et cetera, you know, it's still the way that I read Project 2025 and reported on this, you know, kind of this time last year was the fact that USAID as its programs would still be there. It would just look differently and it would perhaps be smaller. I think there were other important differences in terms of, you

There's a lot about countering China's development challenge, which is what the author refers to it as. Also, importance of faith-based organizations, local groups, the American private sector. The majority of those organizations with this 90-day funding freeze are not going to make it, and they will not be there to pick up the pieces after this review is finished. They just won't survive.

I mean, in part, that wasn't one of the sort of like provisos in USAID contracting that the organizations that were receiving this money had to have like very limited reserves.

So, I mean, it's also a function of the way in which these organizations operate. I mean, we're talking about nonprofits, right? So often bigger organizations will do the work and invoice the U.S. government later. Smaller organizations will have a line of credit that they'll be able to draw on as they do the work. In both cases, that funding has stopped. So in the first case, I'm hearing from large organizations, you know, many of them based here in Washington, D.C., where I live, that they're

Don't even have the money for work that has been previously performed because the tap is now shut, that cash flow tap. Other smaller organizations, they don't have the money to do the work because again, they're nonprofits, they're small, they're built this way, right? To be able to kind of do the work, get more money and it's funded by grants.

Yeah, I think in a survey that you cited in your work, it was only about a quarter of organizations that were surveyed reported that they'd been paid for the work that they'd already done before January 24th. Right. So we're talking like people have already done the work for the U.S. government and are essentially being stiffed. You got it. And in terms of the impact, yeah.

I mean, just here in D.C., thousands and thousands of people are being laid off both within USAID and also all of the thousands of organizations that USAID partners with. So, you know, there's a real ripple effect here in terms of the American populace and, as Joya and Jeremy mentioned, the people on the ground who are receiving that work from those employees. Yeah.

What do we know about why Elon Musk is so focused on USAID? I think it was a bit of a surprise that this was the first agency that was targeted in this way.

Definitely. I mean, if you look at the way that USAID, you know, the money that USAID programs, I mean, last year it was something like, you know, the main figure people have been throwing out is 1%. It was less. It was more like 0.5 to 0.7% in terms of disbursement when it comes to the federal budget. So it's interesting that USAID became the first target because the money is really pennies when you kind of compare it out in terms of the, you know, the broader government spending.

But yeah, Elon Musk and Trump have both taken a particular like to USAID. Jeremy and I think you, Alexis, said at the beginning that Musk has been tweeting kind of ceaselessly about the agency being a criminal organization, that it needs to die. And

I think both leaders have looked at it as pursuing, again, a liberal agenda. This is going back to Project 2025 and kind of the descriptors of the agency in that document. It's not necessarily new. You know, Republican lawmakers, many of them have often pushed the State Department to control more of USAID spending policies and programs. But as Joya mentioned, it's also been bipartisan in many other ways. You know, things like

global health, humanitarian response. Again, using this as a soft power element of what's in our toolbox as a foreign policy.

And Alyssa, thank you for helping me correct myself. Elon Musk called it a criminal organization, not a terrorist organization. Misspoke earlier. Joy, let's talk about something that is kind of very far away from the idea of USAID, which is PEPFAR and the kind of work that the United States has done to increase the access to HIV treatments across the world. Can you tell us more about that and how that work has been supported? Yeah. So, I mean,

Yes, thank you for asking. And it's not, unfortunately, it's not very far from USAID. It is an American initiative that was started during the Bush administration in 2003, was announced, started in 2004.

And it was a bipartisan coalition of senators, congresspeople, and, you know, faith leaders, academics, people themselves living with HIV saying, you know, we could do better as a globe. We have this amazing technology, sometimes referred to as the cocktail or antiretroviral therapy. And it was getting to just a few

a few percent of people on the African continent that was home to 95% of the people living with AIDS. The death rate back then in those dark days was 8,000 people a day from untreated HIV almost 10 years into the fact that we had had this successful cocktail.

And so these leaders on both sides of the aisle said, we can do better. And the U.S. created this fund, the President's Emergency Plan for AIDS Relief. It's been audited multiple times. All of us, Partners in Health and our sister project in Haiti, Zami La Santé, has had PEPFAR money since 2004.

Anyone with PEPFAR money has had to go through first world audits from PricewaterhouseCoopers and other major auditing firms. It has been very, very, very well implemented. And more than 20 million people around the world get their AIDS drugs from that fund.

Now, because there are sort of two different agencies that work on the ground for the United States, about 60% of that money was administered through USAID from PEPFAR into USAID and the other 40% through the Centers for Disease Control in Atlanta.

Just depending on, you know, where people were. So even as they're saying, well, there's some waiver for PEPFAR, it still will have to go through USAID or CDC. And who's going to process that paperwork? The offices are shuttered.

So we know that there's some, you know, waiver for some of the pieces in PEPFAR, maternal to child transmission, treatment, et cetera. But there are loads of people who are getting support for HIV prevention, HIV education, staff that's in place to make sure that, you know, things go fine, like the supply chain, et cetera. And those waivers don't cover all of that. And so it is fascinating.

Again, bringing us back to this idea of chaos, and frankly, just to answer an earlier question, I think the USAID is a trial balloon. I don't think it's the point. I think it's an example of the power, the unchecked power that the Musk administration has with their secret Doge people. Yeah.

And they're going to come for Medicaid, Medicare, Social Security, the Department of Education. This one is trying to fly under the radar because it's little. It's a small piece of the budget, but...

When you look at Project 2025, which Alyssa has much more than I have, it's about gutting the federal government, period. And so I think this is a test of the emergency broadcasting system, and we have to be on high alert that this is going to happen elsewhere.

You know, just to finish up on the idea of PEPFAR, I mean, does this literally mean that people who essentially have been on antiretrovirals for a long time will go to get their medicine and it just won't be available because the dollars and supply chain flow has been broken? Yeah.

It will mean that eventually right now it's a little bit different than that because much of the medication themselves, the medication itself is supplied by a different funding stream, the Global Fund to Fight AIDS, TB and Malaria. What PEP

far supplies is a lot of the wraparound things. So like the testing for resistance, the testing for tuberculosis in HIV patients, the store room. So right now, medicines are there, yes.

But the system itself that needs to be there to provide treatment for people living with HIV, to provide prevention, to provide the prevention of transmission to mother, mother to child. The systems are already cracking. There is, you know, we talk a lot about HIV AIDS, but there also is really important work that's been happening around tuberculosis. Right. And preventing the spread of TB. Can you tell us more about that work, too?

Yeah, so Partners in Health is an organization that has always led with TB because it fits so much with our ethos of trying to take care of the poorest people on earth. And tuberculosis is still a scourge. It is still a pandemic.

but it mostly affects the poor. And it is airborne, like COVID-19. So it brings the level of sort of infectious threat higher than many other things because it's in the air we breathe. Tuberculosis is curable. Unlike HIV, which is treatable if you have long-term treatment, you can cure tuberculosis, but it takes about six months of therapy. So if

you're going to cure tuberculosis, people have to take their medicines all the time, regularly, reliably for six months. What that means is a system has to work to make the diagnosis, to have the pharmaceuticals in the store, to make sure that people follow up with their treatment. And if you don't take that

medicine very regularly, one, people can die, and two, they can develop resistant tuberculosis that can then also be spread and change really even the ease of treatment and the seriousness of infection.

So it is something that has to continue. It has to continue uninterrupted. Yeah. Thank you so much for that. I don't think people quite realize how much of that work is going on around the world and the way that it could affect global health. Angela writes in to say, can administration of USAID be improved? Yes, absolutely. Does USAID shift its left or right-leaning program support depending on which party is in power? Yes, absolutely.

But a canceling of USAID is catastrophic to life-saving, health-promoting, hunger-abating programs over the whole world. This is the most callous example of throwing the baby out with the bathwater ever by the richest man in the world. Joseph writes, while it is lamentable what is happening with the withdrawal of funding for USAID, one need only look at the massive need here in the U.S. For example, in the Tenderloin, the money is well spent assisting our own citizenry. And Ruth writes, Trump has Congress. Why doesn't he tell Congress to eliminate this legally?

We're talking about the Trump administration's efforts to shut down USAID. I'm Alexis Madrigal. We'll be back with more right after the break.

Turing with Tia is the quirky YouTube talk show where Tia Creighton is the host and all her guests are talking AI chatbots. Whether it's health and beauty, science and technology, pop culture, or current events, Turing with Tia delivers answers about everything. That's T-U-R-I-N-G, Turing with Tia, a funny and fascinating way to experience artificial intelligence. Only on YouTube at Turing with Tia.

Welcome back to Forum. I'm Alexis Madrigal. We're talking about what's happening at USAID, joined by Joya Mukherjee, who's Chief Medical Officer at Partners in Health, as well as Alyssa Mielene, who's a reporter covering USAID and the U.S. government for DevEx. Let's bring in Monica in San Francisco. Welcome.

Hi, this is Monica Gandia. I'm a kind of longstanding HIV doctor. And what I wanted to talk about was the impact on communicable diseases, specifically of closing USAID, because PEPFAR, as Dr.

Dr. Mukherjee just said, actually has a collaborating partner of USAID. So that means that even if PEPFAR could resume full activities, which it's not been allowed to do, 50% of the staff come from USAID. So there's not enough people on the ground to give out the care and treatment. And then the other thing that the State Department did on PEPFAR, they said prevention can only be given to pregnant women.

HIV prevention, but no HIV prevention for other groups. So that destabilizing of the epidemic in communicable diseases makes Americans less safe, right? Like I think there's non-communicable diseases and communicable diseases, and we learned through COVID that not controlling communicable diseases has effects here in the U.S. So hopefully we can maybe just talk about that.

Yeah. Yeah. I mean, are you already hearing from people that you know in the field that they're unable to complete the work that they need to do? Absolutely. So really close collaborations with multiple PEPFAR sites around the country. This weekend, South Africa was cut off from all foreign assistance because of Elon Musk's

kind of a capricious decision there. So that will have a real impact because actually in South Africa, that is South Africa has the highest HIV burden of any other country. So there are two impacts. One is that USAID not having staff on the ground means that we can't do the care and treatment through PEPFAR because they collaborate. And the second is that prevention only being applied to pregnant women, but

But not to any other group, like gay men, adolescent girls who are non-pregnant, will mean that there will be destabilizing of prevention. And then what that means is very quickly, viral loads will rise. That means if you're not on treatment, the virus will start coming back. And that drives forward the epidemic. There is a massive impact on treating people on prevention outcomes. Hmm.

Last thing before we let you go, Monica, I mean, how much success has has occurred actually up to this point in the, you know, 20 plus years of this program?

Oh, PEPFAR. I don't think it can be overstated what PEPFAR has done. It was formed in 2003 by G.W. Bush. It has saved at least 25 million lives. The impact on saving children's lives, on reducing the number of AIDS orphans, on increasing treatment access for people worldwide. Basically, there are 40 million people living with HIV worldwide worldwide.

More than half of those individuals are on antiretroviral therapy because of PEPFAR. It has been one of the most diplomatic global health successes I can ever imagine. And it was bipartisan. It's always been bipartisan. And we have to continue this and we can't destabilize this program. Monica, thanks so much for calling in. Joya Mukherjee, do you want to add anything to that?

No, I mean, I think Monica said it all. Thank you, Monica. We rely on this program. I would say that I started doing this work more than 30 years ago in East Africa, which was the epicenter of HIV at the time. And there were no treatments anywhere in the world. And we went to hundreds and hundreds of funerals. Every weekend was for funerals in Malawi, where I work now.

The entire area around the hospital were just shops that made coffins. This is what it was like. It was a cataclysm. And today, if you go to that hospital area in Malawi, people are making furniture. So the way that society changed with the treatment of HIV is just remarkable. And I want to answer just quickly the question that one of your callers

wrote about there's plenty of problems in the U.S. Yes, yes, there are. And I think what is a beautiful thing about this work is it's never been us versus them. Many of the most important AIDS activists were people from the Tenderloin, from New York City. They had gotten their treatment through activism and a fight. They're the same people that are also fighting for housing.

not necessarily only for people living with HIV. It's an ethos of care. And again, if we look back to the Project 2025, there is this idea that, well, society doesn't need to care. That's the nanny state. Families need to care. Well, I want to live in a society both in the United States and globally where people care for one another. That is not a subversive idea. And we could do better for people in our own country and

continue the important work of caring for people around the world. Let's bring in another caller, John in Washington, D.C. Welcome, John.

Hi, thanks for taking the call. I would suggest the reason that Trump is first going after USAID. I mean, it's clear the reason, there are a number of reasons why he's, you know, stopping funding, right? Going to power the purse and trying to center the government on the executive. But why USAID, I think, is...

is since 2022, the vast majority of spending has gone to Ukraine.

for numerous, numerous projects. And, you know, he came out and said recently that he's had a discussion with Putin and, you know, there's everything going on with Zelensky. It's clear that there's things going on behind the scenes there. And I think that's what this is about as to why USAID is,

And the rest of it, I mean, it's horrible. I work with groups that have funding, PEPFAR and others. It's terrible what's going on. But I think from the administration's perspective, none of that is really meaningful or important. And it's really all about Ukraine. John, appreciate you calling in. Alyssa, how much USAID funding has gone to Ukraine for various types of projects?

I don't know off the top of my head, but John is right. I mean, there's a lot of money that's gone toward Ukraine in recent years. Again, this is all sorts of different types of activities. So I think, yeah, I don't know what I can say in terms of that response without doing my own reporting. Oh, yeah. Have you heard similar sentiments from anybody that you're talking to at USAID or other sources you have around Ukraine?

You know, what I've heard is that staff in Ukraine right now don't know what's going on. I think that's what I can really speak to. You know, I was recently on the phone with a staffer who was just saying, you know, they were locked out of their accounts. They don't have the ability to respond to partners. They don't have the ability to respond to organizations that they're working with. So, yeah.

I think there's a lot of questions, both within the staff, outside of the staff. Those organizations are all being cut off. So, yeah, I mean, it's been suspended now and that work is not going on at the moment. You know, let's go to another global hotspot. I mean, you recently wrote about a refugee camp in Syria and that there was some USAID funding going there that was sort of basically meant to prevent the spread of like chaos and maybe eventually terrorism. I mean, what do you what's happening in that area?

Yeah, so a pretty wild story. Again, yeah, you mentioned on Friday, so I reported on an organization called Blumen, which was managing the camp operations for Al-Hol, which is a camp in Syria. So this is in the northeast part of the country. It's a desert area. A lot of these individuals, they're about, I think it's 39,000 to 40,000 people are the wives and children and family members of ISIS fighters. So it's a tough camp and it's a tough spot because a lot of the

Conditions are really harsh, difficult, and there's a lot of potential radicalization going on there. So for almost a decade now, Bluemont, this organization, has been managing these operations to kind of keep things stable, to keep things under control. They do water systems, they do food systems, et cetera, and kind of manage the operations of the other organizations providing aid.

Now, they were one of the few organizations that I heard from early on that got a waiver. And we mentioned this in the first segment. These waivers that Secretary of State Rubio has said would be for life-saving assistance. Now, as Jeremy said, in reality, that really hasn't happened. Most organizations have not received these waivers. And those that have do not have the funding as of yet to back up those programs. So

That happened with Bluemont. So they received a waiver. Today, it was supposed to expire and the money also did not come through. So they were really at a precipice. Now, an update to that reporting right before I got on this call, I spoke with that organization who said that they actually did get the waiver extended. So now they have that waiver for the next 90 days, along with some funding. It's unclear how long that money will last.

So, all of that to be said, I think this is not just a problem in Syria and it's not just a problem with BluMod, this organization, but it's across these organizations that are working in these world hotspots, kind of providing that stabilization. And right now that stabilization is being shaken up. I mean, what does it mean if an organization like that essentially runs out of money and can't administer the camp? Yeah.

It means they shut down and it means that the stabilization that they were providing goes away. I mean, I did talk to a member of Lumont staff who said that after they were out of the camp between when they got their first waiver and or rather between their stop work order and their first waiver, they were out of the camp for three days.

And in that time, the rumors spiraled. So you had people or they had people telling them that they thought the camp was going to be handed over to Turkey, or they thought that they were all going to be killed because of the freeze or because of the suspension of aid. So almost immediately, this camp, which has long been seen as a tinderbox, kind of exploded, right? And luckily that a couple of days later, okay, things were able to continue, et cetera, et cetera. But we're talking again about super sensitive areas, super sensitive context.

that humanitarian assistance provides kind of, you know, they're letting things all go to flow. Without that, who knows what will happen? Joya Mukherjee, you know, a user on Blue Sky wrote in to say, you know, a lot of USAID is just PR, you know, parenthesis, soft power to cover up the abuses we've inflicted already. I had heard this kind of criticism before. I mean, what do you make of that?

Yeah, I mean, U.S. power is always suspect, whether it's soft power or hard power. Politics is complicated. There's always ulterior motives from different people. And so many of us have been critics of USAID from time to time.

What we cannot do, though, is cut off a lifeline overnight. If people want to start thinking about how does the U.S. play more constructively in helping governments to get on their own feet, I know many of my colleagues in ministries of health and government positions would welcome that, right? But

But I think it's the method and the speed and the kind of name-calling that makes this so dangerous. So, look, any time the U.S. uses power, you know, one has to follow the money. One has to try to understand where is that coming from? What does it mean? But not this way, right? Not this way where people are going to get hurt.

and the most vulnerable are going to get hurt. That's my concern.

You know, one of the other criticisms that I had heard of USAID in the past was its sort of reliance on American suppliers, say, for food aid. And one of the things that we then saw just over the last few days were these sort of Kansas senators saying like, hey, wait, actually, we are farmers like sell to this program. Alyssa, have you been following the story about sort of American farmers and suppliers? Yeah, I can jump in there.

I think certainly. I mean, we reported just last week that definitely, to your point, Alexis, this being a leverage point, U.S. food aid makes up so much of what U.S. aid distributes across the world. We reported last week that there was about

$500 million in American grown food meant to feed 36 million people now stranded in ports and warehouses across the world at risk of rotting. So that just gives you kind of, again, as we're saying, the long-term effects or the on the ground impacts of this type of thing. But this is also, imagine $500 million of American grown food that's coming from our own American farmers.

So, yes, this is a potential point that things could change and could shift. And we are seeing different kind of groups, not just farmers, but unions coming out and trying to halt some of this rapid dismembering and dismantling of U.S. aid, you know, across just the last week alone. So we're waiting in the in the wings to kind of see what will happen in terms of various lawsuits that are being filed against the agency and against President Donald Trump and to see where that goes in the day ahead.

We've also talked a lot about workers in other parts of the world and the organizations that have depended on USAID. What about organizations here in the U.S. that have done development work? Do we know how many of those people are affected just here locally?

Thousands. I think the exact numbers we're still trying to pin down, but we have estimated definitely in the thousands. Some groups are estimating as high as 50,000. I mean, and just to kind of paint the picture of the vast network of

organizations and groups that get funding from USAID. I mean, I went to the other day, there was an event here in DC for folks to get together and just talk about what they were going through because of the stop work order. And I went to this bar and it was just kind of a number of different tables of people just kind of sitting there. Many just with glasses of water in their hand, just kind of like,

Tiers were all over the place, and it was just groups of company after nonprofit, after organization, after you name it, furloughed. And this is not just USAID staff, right? This is the whole network and ecosystem of international development, many of whom are headquartered here, but many also are across the world.

You know, we're kind of trying to do our own survey and impact across our audiences and across our readership to see what that really looks like. But again, this is a whole sector that I think is on the precipice of complete reshaping because USAID is and I guess was such a major part of this entire system. Yeah.

Yeah, and just, can I just jump in for one second? I'm sorry, I had the mute issue. Oh, no problem. But, you know, in the 1961 Foreign Assistance Act, because as Alyssa said, it is a Cold War era idea. There was the idea within it that we should buy American, we should hire American contractors, American organizations with American products, right? So it's the stuff that we buy,

is American made? The people that do the work are American, right? So it has, and then of course things like the Farm Bill, which is what really has the food aid as a surplus for farmers across the United States who used to go bankrupt. If they had a bumper crop year because the price would be so low, this is a way that we can protect farmers against financial ruin. So a lot of this is structured to help Americans

You know, and even forget the infectious disease threat for a moment. These are American jobs. These are American people. These are American products. I mean, in fact, that was one of the main complaints about USAID in years past from the left was that it relied too much on American suppliers.

We've been talking about the Trump administration's efforts to shut down USAID. We've been joined by Joya Mukherjee, who's chief medical officer at Partners in Health. She's joining us from Sierra Leone. Partners in Health has received USAID funding to care for pregnant mothers and newborns, provide food for malnourished children, and treat infectious disease. Thank you so much for joining us, Joya.

Thank you so much for having this show. And it's really a pleasure to talk to you. Yeah, thanks so much. We've also been joined by Alyssa Mielene, who is a reporter covering USAID and the U.S. government for DevEx. That's an independent news org covering global development. You can follow along on her reporting there. Thank you so much for joining us. Thank you so much.

Earlier, we spoke with Jeremy Knyndyke, who is the president of Refugees International, served in the Biden administration as USAID's lead official for COVID-19 and the Obama administration as the director of USAID's Office of U.S. Foreign Disaster Assistance. Thank you so much to everyone who called in and for your comments and questions. I'm Alexis Madrigal. Stay tuned for another hour of Forum Ahead with guest host Grace Wan. ♪

Funds for the production of Forum are provided by the John S. and James L. Knight Foundation, the Generosity Foundation, and the Corporation for Public Broadcasting.