GEOFF BENNETT: The uncertainty around the Trump administration's sweeping funding freeze is also alarming many in the world of global health, since it could affect key programs overseen by the U.S. Agency for International Development, or USAID.

Late today, the State Department issued a waiver on its pause of foreign assistance in some circumstances, including for -- quote - - "lifesaving medicine and medical services."

But the waiver explicitly excludes activities that involve abortions, gender or DEI programs.

And there's still some concern about how the freeze will affect other programs.

For more, return now to Dr. Atul Gawande, who oversaw these programs as assistant administrator for global health at USAID during the Biden administration.

Thanks for being with us.

DR. ATUL GAWANDE, Former USAID Global Health Assistant Administrator: Glad to be here.

GEOFF BENNETT: So, as we said, you managed these global health initiatives for USAID until just a few weeks ago.

You had a $10 billion yearly budget, as I understand it, more than 2,000 staff in over 65 countries.

There was this stop-work order that was just met this evening with a waiver, which suggests the Trump administration is now rethinking their approach.

As best as you can gauge it, what's the impact at this point?

DR. ATUL GAWANDE: Well, I hope they are rethinking.

The stop-work order came in with the president's signing of an executive order on January 20, a week ago.

And already we have seen the shutdown of major programs.

I'm talking about the systems for the global HIV program aiming to end HIV.

It's called PEPFAR.

Their central information systems were turned off yesterday.

The distribution of drugs were ordered to stop.

And that affects 20 million people who require access to those drugs for staying alive.

But the waiver hopefully opens the door for that work to resume.

But we don't know.

And it's been disruptive on several other fronts.

The waiver does not seem to include programs, for example, that would eradicate polio, that are stopping neglected tropical diseases that are nearly eliminated, like river blindness.

And then there are -- there is unclarity in a lot of spaces, including around outbreaks.

You had an episode about the Congolese, where there is also going on a report of an Ebola outbreak going on there simultaneously.

And that ability to have surveillance and partnership with WHO, that is not waived.

Organizations like USAID and CDC are not even permitted to have communications with WHO.

So that means critical processes that keep America safe from outbreaks, but also get us the flu vaccine that WHO coordinates through its influenza network, those capacities are still blocked and frozen.

GEOFF BENNETT: Well, a Trump administration State Department spokesperson initially said this about the funding freeze.

"President Trump stated clearly that the United States is no longer going to blindly dole out money with no return for the American people.

Reviewing and realigning foreign assistance on behalf of hardworking taxpayers is not just the right thing to do.

It is a moral imperative."

React to that characterization of the work of USAID, that, at first glance, there's no direct return for the American people.

DR. ATUL GAWANDE: Well, here's a couple of things.

Number one is, every administration is going to do a top-to-bottom review of the spending that there is.

But you don't need a pause to do that.

And, in fact, it's enormously disruptive.

The -- and you're seeing the dismantling of major functions in the U.S. Agency for International Development.

So this isn't just about policy and whether these programs are tuned one way or the other way.

It is a -- USAID is the corner -- a cornerstone of national security.

These are networks of hundreds of thousands of people supported by awards and grants who are working on behalf of the United States in cooperation with other countries about areas of mutual interest.

It is our soft power.

They are doing work like advancing agriculture, advancing markets and development, as well as economic and health development.

So programs that are eliminating HIV, stopping T.B.

in the world, stopping malaria, so that it doesn't affect us and improves the world overall, that is The -- a core set of work, and not some kind of woke ideology.

The U.S. has been -- had an American century of health innovation and public health that has led the world, has advanced, doubled human life expectancy.

And this work, putting it aside, shutting it down, seeing now that there are -- there have been layoffs and dismissals, more than 1,000 staff have been sent home, many of them fired in the last 48 hours, that process is still under way and is a major concern.

GEOFF BENNETT: In the minute we have left, what would you say to those who hold the world view that the U.S. shouldn't be in this position to always have to step in and solve public health crises all around the world, problems the U.S. did not create, and that there could be private organizations, philanthropies or other countries that should step in to fill the void?

DR. ATUL GAWANDE: Well, the outbreaks that happen around the world are ones that affect us no matter what.

For example, avian influenza, bird flu, killed an American citizen on home soil.

We have monitoring for where it's moving around the world in 49 countries.

And that has been shut down this week.

Their staff have been sent home without pay.

And you start degrading and losing those people as you create that -- as you do that work.

That -- you have to work around the world to advance health.

You can't just advance health in the borders alone.

GEOFF BENNETT: Dr. Atul Gawande, formally of USAID, thanks again for your insights.

We appreciate it.

DR. ATUL GAWANDE: Delighted.