The Economist: What happened next with USAID

On January 28, Secretary of State Marco Rubio issued an “emergency humanitarian exemption” to allow life-saving aid to be exempt from Donald Trump’s foreign aid freeze.

Two weeks later, in Malawi, a country of 20 million people in southern Africa that is the seventh poorest in the world by GDP per capita, most local organizations have been forced to stop working. About 5,000 people—many of them health workers—have lost their jobs, says Mazisayko Matemba of the Health and Rights Education Program, a local NGO. “We expect more people to get infected and start dying.”

From South Africa to Afghanistan, the situation is similar. Rubio issued two executive orders to save PEPFAR, a successful AIDS program, as well as other essential health, nutrition, and housing programs from the destruction that Elon Musk is wreaking on the Department of State Efficiency (DOGE).

Musk has swiftly dismantled USAID, but DOGE has destroyed foreign aid systems so quickly—closing offices, laying off thousands of contractors, freezing bank accounts—that Rubio’s orders are still having no effect, according to aid workers in several countries.

 “Even when an exemption is issued, there is no way to enforce it because the payment system is broken,” says Kate Almquist Knopf, former USAID Africa director based in Nairobi.

In Malawi, antiretroviral drugs funded by PEPFAR are one of the main reasons why life expectancy has increased from 45 years in 2000 to 63 years in 2022. In South Africa, the $440 million the US spends each year on fighting HIV and tuberculosis represents about 17% of the national budget for treating these diseases.

Jeremy Nel, who runs one of the largest HIV clinics in Johannesburg, says PEPFAR-funded staff were informed on January 27 that they could not report to work. They are still waiting for instructions from USAID, but “it is unclear whether USAID still exists,” he says.

"The biggest problem has been the sudden interruption."

Across Africa, aid workers are struggling to figure out how necessary a program must be to get the Trump administration's support.

Direct food aid may be allowed, but what about cash vouchers to buy food at the market? HIV medication may be allowed, but what about education programs to stop transmission?

Is distributing seeds to villagers who will go hungry if they don't plant before the next rainy season considered life-saving aid? In Washington, there is no one to answer the phone and resolve these questions, aid officials say.

“The moves were made with such ignorance, without understanding what was required on both sides of the implementation chain,” says Nathaniel Raymond, executive director of the Humanitarian Research Laboratory at Yale University’s School of Public Health.

Rubio, a supporter of PEPFAR and foreign aid during his Senate career, may still have an opportunity to repair some of the damage he has overseen.

But Trump has offered little diplomatic support for doing so and seems to believe Musk's claim that foreign aid is fundamentally a corrupt scheme./ The Economist