Trump’s Foreign Aid Freeze Is Already Putting Lives At Risk

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A Trump administration freeze on foreign aid is causing U.S.-supported organizations around the world to suspend or shut down some of their operations, including medically essential care for people fighting life-threatening diseases, according to several sources who spoke to HuffPost.

Among the affected services is HIV treatment that organizations provide using funds from the President’s Emergency Plan for AIDS Relief, known as PEPFAR. In the two decades since it was established by then-President George W. Bush, PEPFAR has enjoyed strong bipartisan support and is believed to have saved more than 25 million lives.

Other programs affected by the order supply nutrition or help with sanitation, or offer assistance with economic development.

“It doesn’t matter if you have funds in the pipeline, drugs in the warehouse, people on staff,” Atul Gawande, who oversaw assistance programs as former President Joe Biden’s director of the U.S. Agency for International Assistance, told HuffPost on Monday. “They can’t be paid. The drugs can’t be dispensed. The services cannot continue. … As we speak, there are people in the field being pulled out and sent home.”

A physician now working on one global health project, and who requested anonymity to protect the program from retaliation, confirmed this was happening in his initiative: “A lot of these activities just have stopped,” he said.

He added that he was especially worried about the consequences for children, given their sometimes urgent need for treatment. “If you have a child under 5, particularly under 2, who is infected with malaria and there are no drugs there, that kid’s gonna die,” the physician said.

“None of us can perfectly quantify what that means, and it’s going to be different for different health conditions and disease entities,” the physician went on to say. “But those of us who have worked in the field, who’ve worked on these programs for decades, we know that in this next week, there are children who will die who would not have otherwise died. In the next two weeks, there will be more. In the next month, there will be more.”

“You’re talking about women not getting their prenatal or postnatal care,” said the leader of another foreign aid organization, who also requested anonymity. “We’re talking about kids not getting their vaccines. … We’re talking about HIV/AIDS patients not getting their antiretrovirals. We’re talking about [tuberculosis] patients not getting their antibiotics.”

The Order ― And Its Aftermath

The order to suspend all foreign aid went out Friday night and was first reported in The New York Times. It came from newly confirmed Secretary of State Marco Rubio, who said he was carrying out an early Donald Trump executive order calling for a 90-day pause in assistance so the administration could review and realign existing policies to fit with the “America First” agenda.

New administrations frequently shift foreign aid priorities, and Trump’s allies had made clear their intent to undertake some sweeping changes. Project 2025, the governing blueprint from the right-wing Heritage Foundation, singled out existing foreign aid programs as inefficient and ineffective ― and, the authors claim, as being responsible for advancing “a divisive political and cultural agenda.”

But Rubio’s directive included a “stop work” order, meaning organizations had to cease any operations they finance with money from the U.S. government.

“Contractors have had to stop their work all across the world.”

– Jen Kates, KFF

That came as a shock to private and former public-sector leaders who assumed that any changes would take place more gradually, with plenty of time for local agencies and organizations to make adjustments or alternative plans. The leaders made this assumption because immediately stopping aid ― and demanding that organizations receiving that aid stop any operations funded with the U.S. dollars ― could have potentially drastic effects, like cutting off life-saving medication for people with HIV or tuberculosis.

And yet that appears to be exactly what the Trump administration has done.

“Contractors have had to stop their work all across the world, and people are being told they’re losing their jobs or they’re having to halt their work,” Jen Kates, senior vice president and director of the Global Health & HIV Policy Program at the nonpartisan research organization KFF, told HuffPost.

Confusion And Dismay

Matthew Soerens, vice president of advocacy and policy at World Relief, said his organization is “certainly concerned about programs that are affected ― or could be affected ― by these orders, because they have a profound impact on public health, and especially on people who rely on life-sustaining medications.”

World Relief is a Christian humanitarian association that partners with faith-based groups around the world. And Soerens emphasized that he believed the Trump administration was within its right to change the focus of foreign aid.

“We actually think the Trump administration, like other administrations, has a mandate to ensure that U.S. funds are used in responsible ways that meet U.S. interests,” Soerens said. “We have no reservations with that at all. I think what is unique about this dynamic is that it pauses funds for existing programs in ways that are likely to be very disruptive.”

“What is unique about this dynamic is that it pauses funds for existing programs in ways that are likely to be very disruptive.”

– Matthew Soerens, vice president of advocacy and policy at World Relief

As with other orders the Trump administration has put out since taking office Jan, 20, neither the precise meaning nor the legality of the order on foreign assistance was clear. When HuffPost tried to get more information, a State Department media official responded via email that “We are fielding an incredibly high volume of inquiries and your patience is appreciated.”

The sources who spoke with HuffPost said they and their legal advisers were also uncertain exactly how to interpret the directive. But they said many organizations believe they must follow the order literally, even if that entails stopping active medical treatments — or, as one aid agency leader described, leaving food supplies rotting on a pier because the organization can’t pay to load, ship and distribute them.

The sources who spoke to HuffPost emphasized that, in many parts of the world, neither governments nor philanthropies have the operational capabilities or financial resources that the U.S. currently provides. Even if funding resumes after a few weeks, they said, that might be long enough to fray ties between organizations and their suppliers and workers, making it difficult to restart operations.

“When you have infrastructure in place, people and programs that are delivering services, and then you stop their ability to keep functioning, you can lose that capacity,” Kates said.

“The idea that foreign aid should be reviewed and examined isn’t a bad one … that’s a new administration’s purview,” she added. “It’s how you do it.”

Trump’s Intentions And The Consequences

The order to pause foreign aid is part of a broader Trump administration effort to pull back on America’s engagement abroad ― by, for example, withdrawing from the World Health Organization.

Trump has never hidden his disdain for international cooperation and the organizations that facilitate it, saying they put too great a burden on American taxpayers and subordinate American interests to foreign competitors like China.

More recently, conservative allies and advisers — including those who wrote for Project 2025 — have argued that recent management of foreign assistance turned it into a vehicle for promoting causes like “abortion, climate extremism, gender radicalism, and interventions against perceived systemic racism.”

Concerns that PEPFAR in particular might end up funding abortion came to the fore again earlier this month, following reports that four nurses from a PEPFAR-funded program in Mozambique had performed a total of 15 abortions since 2021.

“The implications are immediate and getting worse every week.”

– Atul Gawande, who led USAID in the Biden administration

But that news came to light because State Department officials reported the episode, saying they wanted to be transparent and show they had detected it ― and taken remedial action ― in the course of their normal oversight work.

And when it comes to protecting American interests, relative to that of the rest of the world, supporters of foreign aid said that it helps build alliances in unstable parts of the world, while pulling back will leave China and other U.S. rivals with even more influence.

“This isn’t just about saving lives and compassion, though it is that ― and that’s probably the primary motivation for a lot of Christians,” Soerens said. “It is also about U.S. interests at a time when we are competing around the world with other countries who want influence in places like Africa and Latin America and Asia.”

Gawande, whose led USAID all the way up through the final days of the Biden administration, said “we are the U.S. foreign policy ground game” and described operations abroad as “essential capacity” for building up trust in other parts of the world.

Now that capacity is at risk, Gawande said, because the “implications are immediate and getting worse every week.”

A Bipartisan History

Notwithstanding the recent controversies, PEPFAR has frequently won plaudits even from conservative Christian organizations, including ones like World Relief that promoted the cause to Bush before he signed the authorizing bill into law and became the program’s most visible champion.

“It hasn’t historically been a Democratic or Republican issue,” said Soerens, whose organization was among the earliest promoters of what became PEPFAR. “It’s been something that the U.S. does because we’re a great country and because we can, and we can literally save millions of lives with a very relatively small amount of U.S. investment.”

Strong support among conservative Republicans endured long past Bush’s presidency, through 2017 when a high-profile Republican senator gave a glowing statement about PEPFAR following his vote to reauthorize it even though Trump wanted to reduce its funding.

“I was proud that the Senate Appropriations Committee, on which I serve, fought to maintain funding for PEPFAR and other related programs despite the administration’s proposal to reduce it — a proposal that would have negative impacts across the globe,” the senator wrote in an op-ed that appeared on the Fox News website.

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The senator was Rubio, whose name is on the new order carrying out Trump’s command.

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