“A Tide of Suffering and Death:” NYT’s Nicholas Kristof on Musk’s USAID Cuts

CHRISTIANE AMANPOUR, CHIEF INTERNATIONAL ANCHOR: In the United States, a federal judge has halted the shutdown of USAID following relentless efforts by Elon Musk-DOGE guillotine to slash the agency. Musk insists no lives have been lost from the pause in foreign aid, but the reporting of our next guest proves otherwise. New York Times opinion columnist Nicholas Kristof joins Hari Sreenivasan to speak about the harrowing picture he saw in Kenya and Sudan after the USAID Supply lines were cut.

(BEGIN VIDEOTAPE)

HARI SREENIVASAN, CORRESPONDENT: Christiane. Thanks, Nick Kristof, thanks so much for joining us again. Just about two months ago, the president wanted to pause all foreign aid assistance. What has happened since this government has taken those steps?

NICHOLAS KRISTOF, OPINION COLUMNIST, THE NEW YORK TIMES: Well, I went to South Sudan to try to find out what was happening at the grassroots level, and Elon Musk had said that no one has died because of what he described as this pause, the review aid. And you know, Hari, within an hour of beginning my reporting, I had found the names of two young children, a 10-year-old boy and an eight-year-old girl who had died because their medication — their ARV medication against HIV had run out and they couldn’t get new sources. These were orphans and vulnerable children. You know, what is a 10-year-old orphan going to do in Juba, Sudan when the caseworkers are no longer available and he can’t get his ARVs? It turns out that he doesn’t get medicine, his viral load increases, he gets an opportunistic pneumonia, and he dies. And over and over in South Sudan, I found that kids were beginning to die because of the aid shut down and that that is likely to become a tide of suffering and death in the coming months.

SREENIVASAN: Put this in some perspective for us. Our work on decreasing HIV transmission in different parts of the world goes back through multiple presidents.

KRISTOF: The PEPFAR program against AIDS may be the Most heroic thing that the United States has done in my adult lifetime. It was started by President George W. Bush in 2003. And PEPFAR has saved 26 million lives around the world. It’s hard to think of any government program that hassaved that many lives worldwide. You know, the Trump administration has talked about continuing elements of it. But in fact, what I found was that it — you know, things were being shut down, that even where humanitarian waivers were granted, that, in fact, there was no one there to actually manage it, to make payments. And so, these programs de facto were being dismantled and, you know, kids were not getting their medication.

SREENIVASAN: You know, I think there’s going to be someone watching here that says, why is it the U.S. government’s job to fight HIV and AIDS in Africa and other places?

KRISTOF: So, I’d offer two responses. I mean, first of all, I think if you look at these kids and you understand that it is costing America just 12 cents a day per person to keep these children alive, then you think, you know, boy, maybe that’s a pretty good investment. And that has certainly been a bipartisan view in the United States for a long time. But even if antifreeze runs in your veins and you don’t care about the moral argument for what we can do to save lives, then I think there’s also a pragmatic argument of self-interest that we have values, but we also have interests at stake. And, you know, we confront China with aircraft carriers, but we also confront China with aid programs. And that’s so that we can have base rights, so we can have listening posts or that China can. That we can get support for our sanctions or that China can get support at the U.N. for its international efforts. And then, you know, beyond that, we also protect our health in America, in part by global disease surveillance. It’s a lot cheaper to fight Ebola in Uganda than it is in America. And you know, polio eradication, if that is one element that was suspended, the result is going to be more polio worldwide, and that some American kids are going to end up paralyzed or dying. Avian flu — coming right out of a pandemic, we should understand the risks of a pandemic. And avian flu surveillance has been suspended, last I saw, in 49 countries because of the USAID shutdown. So, you know, I certainly believe that we have — that there is a compelling moral argument to save lives inexpensively where we can, but there’s also an argument about just protecting our own interests and our own lives and our own people.

SREENIVASAN: You worked with a think tank based out of Washington D.C. in London, the Center for Global Development, to try to come up with an estimate of how many lives are at risk if we continue down this path. What did you find?

KRISTOF: So, look, there’s a lot of uncertainty and a lot depends on how much aid is actually dismantled and how much is revived. And of course,there’s litigation and there’s — you know, it’s very fluid. But their best guess is that USAID currently saves about 3.3 million lives a year around the world, and that’s one way of thinking about how many lives will be lost if everything were shut down. You know, in fact, I suspect some elements will be preserved. And so, the toll will be less than that. But, you know, there is no doubt that there will be many, many, hundreds of thousands who will die because we decided to shut down aid and largely to finance tax cuts for the wealthy in the U.S. And also, Hari, I should just say that, you know, we measure this in terms of lives lost, but aside from people who die there’s also an awful lot of aid that simply improves wellbeing, that helps girls go to school, that deworms children, you know, we deworm dogs in the United States, you can deworm a child internationally for about 50 cents a year, and that child is then healthier, more able to work, more able to study, more likely to become literate, and you know, those programs aren’t exactly lifesaving, but boy, they’re sure life enhancing.

SREENIVASAN: We’ve talked a little bit about HIV. What are some of the other programs that you had a chance to visit and what did you witness?

KRISTOF: Hari, one of the things that I saw was a program for malnourished children, and I don’t know if you’ve, you know, seen children starving to death, but it’s just something that just is shattering. This — typically, it’s young kids in the first five years of life, often just after they’ve been weaned. And they are expressionless. They don’t cry because the body is saving every calorie, every bit of energy to keep the major organs functioning. And so, they’re almost like zombies. And it’s — even though they’re in immense pain. And I went to an area that traditionally had a mobile clinic going there to bring emergency food rations to keep children who were severely malnourished alive, and a week before that had been cut off because of the aid shutdown. And now, you know, immediately upon reaching the village, I found a bunch of children who were severely acutely malnourished. None had died yet. I’m sure that some of those will die. And, Hari, you know, maybe the thing that just wounded me the most. I went to an area in the northwest of South Sudan, where traditionally there had been almost no health care and women died in childbirth routinely and newborns died as well. And then in December, a U.S. funded maternity clinic had opened up there and was saving women’s lives. Not one woman had died since that open. Not one newborn had died. And I show up and people, you know, see me asking questions about the clinic, and they mistakenly assume that I’m somehow responsible for bringing health care to this place. And there’s a woman in labor, and she wants to name her baby after me. The village elders show up under a mahogany tree outside, and they just effusively thank me, thank America for its generosity. They say women are now safe here. And what they don’t know is that the U.S. had just cut off that program and that that clinic was about to close and that women again, we’re going to be bleeding to death in that dust, and that just broke my heart.

SREENIVASAN: So what do you make of this juxtaposition that the people you’re meeting on the ground are some of the poorest on the planet, and the person at this moment responsible for some of those cuts is literally the richest man on the planet. And I’m speaking of Elon Musk.

KRISTOF: I asked people in the South Sudan whether they had heard of Elon Musk and most had not, you know, which is a reflection of how remote the place is, how little access they have to world news. But what I saw was these folks who were struggling with their own health, with their own access to food, were looking after vulnerable children. And when they couldn’t get medications, they were volunteering on their own time to try to get them to the hospitals to try to get aid for them. And to see folks who have nothing trying to share their nothing with other kids, with other people, with vulnerable people, I found kind of inspiring. And I wish that that would inspire the world’s richest man at a time when he’s dismantling American assistance for some of the neediest people around the world.

SREENIVASAN: You know, one of the critiques that the administration has had is that so much of the aid is going to international middlemen. Where is this sort of excess cost in delivering this aid through this pipeline and even down to the last mile?

KRISTOF: I think that critique is absolutely right. You know, way too much aid ends up being digested by these beltway bandit companies in the Washington area. And I think we get a lot more bang for the buck if more aid we’re going directly to nonprofits in these various places in the world. And, you know, USAID has recognized that. There has been an improvement in providing direct assistance, but it’s still, I think, that is a very legitimate critique. And, you know, I also think it’s a legitimate critique that Trump and Musk have made that a lot of aid, you know, isn’t as effective as it could be, that the organization could use reform, but what we’re seeing right now is not reform, is not making it more efficient, it’s just taking a bulldozer to it and knocking it down.

SREENIVASAN: You know, just last week, Marco Rubio, secretary of state and now acting USAID had said after a six-week review, we are officially canceling 83 percent of the programs at USAID. The 5,200 contracts that are now canceled, spent tens of billions of dollars in ways that did not serve and, in some cases, even harm the core national interest of the United States. Again, this is in spite of a judge ruling against the administration that these actions were unconstitutional.

KRISTOF: Yes. I think that there is, you know, a widespread belief that the dismantling of USAID, an independent agency, was illegal and unconstitutional. I’m glad the judge intervened in that case. He restored e-mail to people on administrative leave, but he did not actually restore those programs, and I’m not sure how feasible that actually will be. And, you know, Marco Rubio was saying that these were not in America’s interest, but in the past, before serving in the Trump administration, he made a very compelling argument that the Biden administration should sustain or expand these programs because they were the best way to challenge China to an influence around the world, to advance American interests, not just our values. And I wish he would listen to what he himself had advised in the past.

SREENIVASAN: You know, I think there’s also sort of an us versus them framing sometimes. I mean, look, in the United States, we have somewhere about 36 million Americans who are living in poverty, 47 million who are food insecure, right? So, when the administration makes the case that we should be focusing on assisting our own citizens first, what’s wrong with that line of thinking?

KRISTOF: I think we can do a lot more for American citizens. I’m right now in a rural part of the country that has a real needs with addiction. But I would note that the apparent plan for dismantling USAID and saving billions of dollars is not to put that money into supporting veterans or fighting addiction. Rather, it seems to be two things. First, a preparatory effort to make a run at Medicaid and cut funding on Medicaid and perhaps Social Security. And then, that these savings together would go to extend the Trump tax cuts, 49 percent of which go to the top 5 percent of Americans. So, a lot of this is taking money that is keeping children alive for 12 cents a day and using that to fund tax cuts for some of the wealthiest Americans. But, you know, again, this is also keeping Americans safe from Ebola, from avian flu, from polio, from tuberculosis. Tuberculosis is likely to spread. The U.S. has been a major funder against tuberculosis. And every case of extensively drug resistant tuberculosis that comes to the U.S. costs an average of $500,000 to treat. It’s a lot cheaper to deal with those and limit their spread in other countries rather than to pay $500,000 a case to deal with it here.

SREENIVASAN: You have been writing about these topics of poverty and global health for literally decades now, and oftentimes you have made it a point to find people on different sort of ends of the political spectrum that can agree that these should be important priorities for the United States. What’s happening with those voices now, especially on the Republican side, when they see what’s happening? And yet, maybe just six months ago they, or a year or two ago, they might have been vociferous in the support of these programs continuing.

KRISTOF: So, I mean, as you suggest, there are a lot of bleeding heart conservatives as well as bleeding heart liberals, and the evangelical right has done heroic work in this issue along with the secular, secular liberals. And I think that these folks still care about these issues. I think there’s still a lot of members of Congress who deeply care about this, who are embarrassed about what’s happening. But I also think they’re worried about being primaried by, I think they’re intimidated by President Trump’s inclination, and Elon Musk’s tendency to bully people, to denounce them online. And so they say that they’re trying to work, you know, behind the scenes aid groups, including Christian aid groups, are also nervous that if they speak out, that then they’ll be revenge attacks on them and they’ll lose more funding and hurt more people. So I’ve gotta say that in reporting this story, you know, I talked to a lot of aid groups and it reminded me of my days reporting in China that people were so scared to speak, they were so scared to use email. And it’s kind of sad when groups that are truly doing the Lord’s work are afraid to talk about some of the great stuff that America does saving lives around the world.

SREENIVASAN: You had really some compelling stories that you shared in the column that you just wrote, but since you’ve been back, have you had any updates about what’s happened to any of those children?

KRISTOF: So, I’ve been in touch by WhatsApp with folks, mostly these are former social workers in these efforts to support vulnerable children, and they were laid off. They’ve lost their jobs, but they’re just still trying to do what they can on their own to keep programs going. And, you know, unfortunately, the upshot is kids getting more sick. It takes a while for somebody when they don’t — aren’t getting their HIV medication to get more sick when people aren’t getting food to get more malnourished for an infection to come along. But that is happening. And so, what I’m hearing is that there is going to be, you know, a real tide of disease and mortality in the coming months.

SREENIVASAN: Economist for The New York Times, Nick Kristof, thanks so much for joining us.

KRISTOF: Thank you.