Fmr. USAID Lead on Cuts: “Millions Affected Abroad and Now Millions at Home”

BIANNA GOLODRYGA, ANCHOR: Of all the sweeping government cuts made by the Trump administration, perhaps none is being felt so quickly as USAID. America’s Humanitarian and Development Agency has been largely dismantled in the name of government efficiency and rooting out supposed corruption. But around the world, the consequences are real, even fatal. Dr. Atul Gawande is a physician and former head of Global Health at USAID, and recently visited Kenya to see those consequences firsthand. He joined Hari Sreenivasan to describe what he saw.

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HARI SREENIVASAN, CORRESPONDENT: Bianna, thanks. Dr. Atul Gawande, thanks so much for joining us. You were one of the administrators at USAID and President Trump and Elon Musk have pretty much dismantled the programs that USAID was responsible for. It’s primarily an organization that is administering aid to developing countries around the world. You just came back from a trip to Kenya where USAID funding is crucial for providing everything from HIV/AIDS care to malnutrition. What type of impacts did you see on the ground?

DR. ATUL GAWANDE, FORMER ASSISTANT ADMINISTRATOR FOR GLOBAL HEALTH, USAID: First of all, it’s not just cutting some programs, it’s the dismantling of the entire agency, the removal of every part of the workforce except 15 people left at USAID, and 86 percent of the awards being terminated. So, it’s a massive impact on the program. So, then the question is, you said is, what’s happening on the ground? I went to Kenya and I visited over the last couple of weeks the — everything from a national AIDS center, hospital for advanced cases, to primary health facilities to a refugee camp. And everywhere you look there is a devastating impact. It is public health being dismantled in significant ways everywhere. I can point to you some numbers, credible estimates indicate that this is all already costing close — more than 300,000 lives. Most of them children. Malnutrition deaths, for example, are over 60,000 child deaths so far. Another 120,000 deaths of children from treatable pneumonia and diarrheal disease. So, this is devastating.

SREENIVASAN: One of the pushbacks that they — we’ve received from kind of the farther right corners is how can those estimates be accurate? What is the data? What is the tracking ability for us?

DR. GAWANDE: Yes. A couple of things. Number one, we have data from what’s happened when countries have been cut off from aid for periods of time before. There are also longstanding tracking of programs. So, I led Global Health at USAID. We could see in 2023 that there were 93 million children and pregnant women who were reached. We could see the improvements in life expectancy that came from that. We have documented and — that there is an added six years of longer life because of the programs. And those programs have been cut more than 90 percent. So, this is not theoretical. And then the reason I went to Kenya was to see the reality. So, for example, at a refugee camp on the border of South Sudan, the World Food Programme has been cut to zero funding. They supply the food to the people in the camp with donations from other countries. They’ve been able to supply only 29 percent of the daily caloric needs of families. And I saw deaths on a daily basis there from complications of severe acute malnutrition. It’s real.

GOLODRYGA: Here you are — we’ve also had a conversation with Nick Kristof after a trip that he took to Africa as well, and you are describing very specific incidents that you have witnessed firsthand on how, you know, policy preferences and changes and dismantling in Washington, D.C. have the impacts of lives and on deaths in other countries. And you have Secretary of State Marco Rubio telling Congress directly, you know, no one has died because of USAID. No children are dying on my watch. How do you respond to that?

DR. GAWANDE: It’s simply untrue. We have ample documentation. It’s — and they claim to be spending money that isn’t spent. They claim to have the ability to distribute programs that don’t have people on the ground, and it’s simply not happening. It is easier when these people are living abroad and it’s out of sight. But we’re seeing this playbook applied not just to public health happening abroad, we’re seeing it applied at home. So, it’s millions affected abroad and now it’s millions at home. And we can see the consequences of that right here too.

SREENIVASAN: Doctor, one thing that seems to have been a bipartisan effort across different administrations is PEPFAR. the President’s Emergency Plan for AIDS Relief. It’s the largest commitment by any nation to eradicate any single disease, and it’s responsible for providing HIV care in so many parts of the world. Secretary Rubio said to Congress that 85 percent of the organization remains active even after the administration made these cuts. Is that true?

DR. GAWANDE: It’s not. Number one, let’s just take this into context. There are 20 million people plus who are on HIV treatment because of the compassion and contribution of the United States. And no plan for what happens if you’re going to cut 15 percent of the people off. But furthermore, it’s nowhere near 85 percent funding moving forward. They’ve been asked for documentation repeatedly and they’ve not provided. But I can give a very concrete example. One of the policies is that no prevention for HIV beyond the transmission of HIV disease from mother to child is now allowed to be done. That’s taken millions of people off of HIV prevention treatment. I briefed the Senate Foreign Relations Committee before I left office in the last administration about a breakthrough prevention, a single shot remedy called Lenacapavir, which can stop HIV for up to a year. We were ready to deploy that by the millions because this is all like a flu shot that can stop HIV. That has been dismantled. And we are trying to domestically also drive that kind of prevention program for HIV, but that too has been purged with the severe cuts for CDC. So, this is happening at home and abroad.

SREENIVASAN: Another line of thinking about this is that, look, that USAID needed to be dismantled because there was a major, as they like to say, fraud, waste and abuse in this system. Is there any validity to that claim? Is there any kind of stress testing that’s happened where even in your time there, you found, okay, here are places where we could be more efficient?

DR. GAWANDE: Absolutely saw places that, that we could be more efficient. But that is not a a case for then dismantle it entirely. This is a a program – I got to lead 2,500 people across 65 countries. We had the budget of half of what my hospital system at home in Boston has. It was about $24 per person per year, per American taxpayer per year for health. And it reached hundreds of millions of people and saved lives by the millions. It was an incredibly efficient program considering comparison with our own health system and what we do at home. We saw ways that clearly there were improvements to be made. We drove a number of improvements to document ways that we were getting more lives saved per dollar, and there were more opportunities like the HIV one that I gave but the notion that it was a criminal enterprise or a money laundering operation fraud that claimed 90% of dollars before they got to people in the front line, those were simply not true.

SREENIVASAN: Can you tell me a little bit of the difference between Trump 1.0 and Trump 2.0? Because there were some things that you sort of inherited when you came in during the Biden administration that the president at the time seemed to be in favor of, like eradicating HIV for example, by 2030.

DR. GAWANDE: There were really important goals that the Trump administration passed during 1.0 that I built on to carry forward. The HIV commitment to eradicate the pandemic of HIV by 2030 was one of them. And it was aimed in the United States as well as abroad. That was why that breakthrough shot for, single shot long-acting treatment was so is so important. Another area that, that Trump 1.0, 1.0 pushed very hard was to invest more in local organizations rather than large multinational organizations that were swooping in from the outside. So it put people and, and countries on a swifter path to self-reliance. I thought that was exactly right. And grew from only 10% of funds getting to getting to, to local organizations abroad to over 30%, getting to that point. All of that has ended up being dismantled and destroyed. We, we are far from building more of that capacity. We are undermining it.

SREENIVASAN: I want to also talk a little bit about kind of health in the context of research and universities. Right now, Harvard seems to be at one of the epicenters of targets in the bullseye, so to speak. The president has not only dismantled USAID, but he’s also frozen about 2 billion — $2.2 billion in grants and $60 million in contracts to Harvard University. Give me an idea of how health research works and how, if there are longer effects here that we should be looking out for?

DR. GAWANDE: My homebase where I came from after 32 years of being a professor was as a surgeon and public health researcher at Harvard, Harvard School of Public Health, Harvard Medical School, and the Brigham and Women’s Hospital. I returned there. And what you are seeing now is the massive dismantling of — that had occurred to a place like USAID now being brought home to our systems for science, for health discoveries, and for universities at home. So, Harvard, now it’s up to almost $3 billion has been cut off. That includes my own research center’s work on reducing the mortality of surgery. We’ve had more than 20 years where we’ve cut the death rate for surgery across the United States and now the world by more than a third. And that same work that was creating the next set of advances was defunded last week, along with all the other public funding at Harvard. Now, what impact does that have? It ranges from dismantling programs that were showing the way to manage pediatric heart conditions to Alzheimer’s disease, HIV. Almost every American benefits from work that has been federally funded at Harvard and other institutions associated with it. And the impact is going to be felt for years to come. You know, the playbook from USAID has been applied broadly, and it’s important not to just separate them into individual fights. You’re talking about in the new tax and spending bill that the administration is moving through Congress, it’s more than 40 percent cut in the National Institutes of Health. A similar, massive cut in the CDC and its public health and public health research capabilities. Also, in NASA and in the National Science Foundation, the U.S. has been the leader for the world in advancing life expectancy and health through innovations as well as in engineering and a variety of other areas, and that is now being sacrificed. We are sacrificing our ability to win in the future. And you see that in what is happening at universities and in our institutions of science and public health.

SREENIVASAN: Give me an example. I mean, when it comes to research labs, I know, I talked about Harvard, but there’s about $16 billion worth of funding across the country in different research places that has been canceled so far. I mean, does that mean that the PhDs that are there are defunded and are looking around and trying to figure out where they should continue their work, or ones that would’ve come to this university or these colleges or these institutions aren’t coming? How does it actually kind of translate down into this idea of kind of research lost, lead lost?

DR. GAWANDE: This is so important. This is now a terrible time for a young person who’s interested in science. And the reason why is because one of the biggest area of cuts for the National Institutes of Health are the training grants that support PhD students across the country. So, the result of that is you have universities freezing, you know, not accepting any more PhD students at the moment. They’re even rescinding offers in instances, including for some at Harvard. Rescinding acceptances that PhD students had. And then, you have the professors and researchers themselves who are in — who are doing work cut off, having labs shut down. It is a devastating impact that will be felt for years to come.

SREENIVASAN: You mentioned the NIH. There was recently a letter published known as the Bethesda Declaration. This was sent out to the director of the NIH, Dr. Jay Bhattacharya. It accuses the leadership of, quote, “prioritizing political momentum over human safety and faithful stewardship of public resources.” What do you make of that letter?

DR. GAWANDE: What’s remarkable about it is that comes from the scientists within the National Institutes of Health who are reporting that they’re simply unable to do their work and unable to also support other programs across the country that were creating real breakthroughs, real advancements, and now are under often ideological attack, often not grounded in real science or facts and making it incredibly difficult for them to do their — the job that they are legally supposed to do.

SREENIVASAN: When you look at this entire picture, I’m wondering like, is this something that can be restored if say there’s a different party, a different administration that comes in a couple of years? Does that get turned back on? Does it take years to undo this?

DR. GAWANDE: Yes. This is such an important question. The — there are several layers of destruction and they’re on different timelines. One layer of destruction is our capacity abroad has been shut down. We’re talking about tens of thousands of people that are deployed around the world to do everything from — at USAID, you know, support the Ukraine health system to keep going and also its energy system to keep going to some of the poorest places in the world and conflict zones for humanitarian assistance and so on. That soft power capacity that the U.S. has had to do good and work on areas of mutual benefit, such as controlling HIV, that is dismantled, that is gone, and it took decades to build up, including the relationships and the capacities, and that’s not coming back anytime soon. The universities, even as much money as places that Harvard — like Harvard have, can’t keep, you know, linear accelerators for major physics programs running. They can’t keep genome programs running that are — you know, that have massive infrastructure capacity. And over the next few months, especially if this next budget cuts the NIH by 40 percent, you’re going to see that dismantled and disappear. We are — we have stopped welcoming people, the best and the brightest to come from abroad. We don’t have enough engineers. We don’t have enough biotechnology researchers. We don’t have the — and we want to be the place that attracts the greatest talent in the world, that’s already shut down and the trust that that is going to come back is harmed for years to come. All of it is happening at once though, and that is the really damaging thing.

SREENIVASAN: Dr. Atul Gawande, former assistant administrator for Global Health at USAID, thanks so much for your time.

DR. GAWANDE: Thank you.