USAID: Can the world live without it?
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This BBC podcast is supported by ads outside the UK. For every five nasal scents we have, dogs have 2,500. Unexpected Elements from the BBC World Service. Search for Unexpected Elements wherever you get your BBC podcasts. Medical supplies have been abandoned in warehouses in Sudan. Scientists working to fight malaria in Bangladesh have been laid off.

Women in Gaza have lost access to contraceptives. And people clearing unexploded landmines in Cambodia and Laos have had to stop their lifesaving work. Fiji, Vietnam, Uganda, Colombia — people in these countries and around the world are feeling the effects of President Donald Trump ordering the shutdown of USAID or U-S-A-I-D.

USAID is the American government's main overseas aid agency, and it's also the world's biggest donor. It spends billions of dollars a year funding programs around the world and has offices in 60 countries. But Donald Trump has some strong views on it.

USAID, run by radical lunatics. And he and billionaire Elon Musk, who's got the job trying to slash American government spending, they want to shut it down. News have confirmed to CBS News that all USAID overseas missions will be shut down and all staff members will be recalled by Friday. In this episode, we're going to explain what USAID is and the kinds of programs it's been funding up until now. And we're asking, can the world live without it?

I'm William Lee Adams, and this is What in the World from the BBC World Service. First off, let's get the basics from Natalia Jiménez, our U.S. reporter. U.S. aid, or the United States Agency for International Development, is basically the main way that the U.S. government provides foreign aid to other countries. And it was created a while back in 1961 under the then-president John F. Kennedy.

They cover everything from disaster relief, that means sending food and medicine to war-torn areas, for example, to longer-term projects. So improving access to clean water, helping farmers grow better crops around the world. But in reality, U.S. aid isn't just a charity. It's also a pretty important foreign policy tool for different administrations, especially

Basically, by supporting development in other countries, the US manages to build allies. It can also help them create future markets for American businesses. In 2023, USAID managed over $40 billion dollars

Foreign aid actually makes up less than 1% of the entire U.S. federal budget. A big chunk of U.S. aid's budget doesn't leave the U.S. It stays within the country. A lot of that money actually goes to U.S. universities. It goes to businesses. It goes to organizations that have the responsibility of carrying out these projects abroad on behalf of U.S. aid.

Donald Trump has never been a fan of foreign aid since the beginning. He sees U.S. aid as basically a giant ATM handing out billions of dollars to other countries that he says are offering little in return for the U.S. I mean, just back in his first term, he tried to slash U.S. aid's budget by about 23%. That was in 2020. But Congress went ahead and immediately blocked that.

His administration is set on shifting USAID's focus towards things like trade deals, security partnerships, and aid to countries that align with his policies. Now, Elon Musk has entered the chat. Musk has also long railed against government inefficiency. He sees USAID as a type of bureaucratic black hole of just wasted cash.

Meanwhile, critics are saying this could cripple global U.S. efforts, disrupt programs that help millions of people around the world, and even weaken U.S. influence abroad. Because if the U.S. pulls out, its global rivals are more than happy to step in instead.

Thanks, Natalia. So now we understand what USAID is and the arguments around it. Now let's hear how it's used around the world and the impact its closure could have. Let's look at Africa first. Here to tell us more is Makuwachi Okafor. He is BBC Africa's health correspondent based in Lagos. Makuwachi, hi. Hi. So as a starting point, how much aid does USAID provide to countries in Africa? Okay.

And

And a lot of this aid goes directly towards programs that work with people living with HIV and AIDS and indeed HIV-AIDS prevention. Could you tell us about that? Oh, yeah, you're accurate. One of the concerns many people have had is how this, you know, the halt of this aid could impact diseases like HIV and AIDS. So the USAID, through the Presidential Emergency Plan for HIV Relief, popularly known as HIV,

It helps with HIV prevention programs, treatment programs, and research programs in Africa. For example, I've spoken with lots of people who work in that field who have said they're concerned about things like people getting drugs like PrEP, which they get for free due to USAID funding. PrEP is a drug people take, especially people who are high-risk communities, take to protect themselves.

If they feel like they're going to be exposed to HIV and AIDS and see that they do not contract the virus. And now they can't afford it because over the counter here in Nigeria, it costs as high as 80,000 naira. And also people can no longer get things like condoms.

because ideally they receive it for free because of the USAID funding. And these are things that people can get. And it's not just in Nigeria. We've seen reports from Malawi, from Uganda, from Tanzania. So yes, it actually does impact on funding of activities that help with treatment and prevention of HIV and AIDS in Africa.

Treatment can be very effective in preventing HIV from developing into AIDS. Why is it dangerous to stop or pause treatment? When you hold, for example, there are drugs that people living with HIV take, they're called antiretroviral drugs.

When you pulse or hold this treatment, it kind of allows the virus to multiply rapidly in the body. And this will increase viral loads and can lead to further weakening of your immune system, of the person's immune system. And then when this happens, there is, of course, heightened risk of life-threatening infections.

And then beyond that, interactions like this can actually lead to the virus developing resistance to drugs and complicating further treatments when you eventually continue the treatment. And how big of a problem is HIV across the continent?

So HIV is very prevalent, especially in sub-Saharan Africa, where we're talking about people in millions living with HIV and AIDS. For instance, South Africa has approximately about 7.8 million people living with HIV and AIDS. Earlier, you mentioned other programs like food and sanitation.

What impact is the withdrawal of USAID or the freeze on USAID going to have on programs in those areas? The aid freeze would threaten the delivery of millions of, you know, say, food programs. And that means that as sad as it is, more people might die from malnutrition or hunger. And then you see things like water and sanitation schemes have been halted. And then it could increase

increase spread of diseases like cholera, diarrhea, and even other waterborne diseases. And even there's also a broader impact beyond this in the fact that even people who do have jobs

in these agencies will no more have jobs and that would affect people's pockets and people's lives. There are current medical researches that are going on and cutting off funding for labs and scientists and drug trials could delay

ongoing and new treatments. And then we have fewer studies now that could have provided solutions to things like HIV or malaria. And these impacts are sort of multilayered from humanitarian to health to economic development. Macauachi, thank you so much for explaining that. Thank you so much, William.

Here's Hilda Damon from Search for Common Ground, an international NGO that uses USAID funding to help people affected by violent conflict. For example, in DR Congo, where violence is an all-time high in eastern Congo, we have been working with US-supported programs on preventing the further spread of violence at the very localized level. We have teams on the ground in Goma, Bukavu,

USAID also funds lots of programs in Latin America and the Caribbean.

Here's Anselm Gibbs, a BBC reporter based in Trinidad and Tobago. USAID has been helping out the Caribbean in different ways, from donating kits to test for dengue fever to recently commissioning a study to help police fight criminal gangs, which have been responsible for deadly violence in many Caribbean countries. In November, some Caribbean states signed up to transform youth justice. Thank you.

through the Oasis Project, which is funded by, you guessed it, USAID. It helps courts to use counseling, mediation, and alternative sentencing mechanisms to divert young people who broke the law away from prison cells and towards rehabilitation. USAID also helped launch a youth council with people between the ages of 18 and 29,

to share their experiences on the most pressing issues affecting young people. So if USAID is actually shut down, organizers will have to scramble to find funding from elsewhere, or sadly, some programs will have to be shut down sooner than planned.

And the hurricane season this year, that will be tougher than usual because USAID provides millions upon millions of dollars to help Caribbean countries respond to natural disasters. People lose everything. It's no joke.

Schools, airports completely destroyed. So Caribbean countries need money immediately to respond and help from agencies like USAID

goes a long way. So at the moment, President Trump has ordered a 90-day pause in the operations of USAID. But can he shut it down for good? Here's Natalia again. Trump and Musk can't technically shut down USAID overnight despite what they're saying. It legally can't be dismantled without congressional approval first.

But that doesn't mean that the administration can't do everything possible to shrink its relevance, to gut it, to essentially render it powerless, which is what's happening right now. So as we heard, USAID has for decades delivered disaster relief, health services and programs that fight poverty in almost every corner of the world. Its reach has been so widespread and so sustained, many people are struggling to face the reality it's been frozen and may soon shut down.

The former Kenyan president, Oruhu Kenyatta, told African leaders recently that they should take this as a wake-up call. He said, quote, As part of that, Mr. Kenyatta stressed that nations should use their resources to fund health projects rather than buying bullets and guns.

That's it for today. Thanks for listening to another episode of What in the World from the BBC World Service. I'm William Lee Adams. We'll be back with another episode soon. Joining me in the studio is a science someone who always makes me smile. Unexpected Elements brings you the most surprising science.

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