The US says 'little to show‘ for six-decade aid agency. Supporters point to millions of lives saved

Supporters say USAID has fundamentally improved health systems and humanitarian networks around the world, promoted democracy and boosted countries and people out of poverty in a way that has saved lives, stemmed refugee crises and wars, and built markets and trading partners for the United States. In a Lancet medical study published Monday, USAID's last day as an independent agency, researchers credited USAID programs with preventing 91 million deaths in the first two decades of this century alone.

Staffers sign off with tributes, solidarity — and some anger

Globally, some staffers planned online meetups for their last hours, where they would simultaneously cut up their government IDs as they said the Trump administration had demanded.

In a show of support and gratitude, rock star Bono, Republican former President George W. Bush and Democratic former President Barack Obama filmed video tributes to staffers.

“They called you crooks. When you were the best of us,” Bono said.

In the days before staffers lost their log-in access, State Department official Kenneth Jackson sent an email, obtained by The Associated Press, thanking them for their “professionalism” in a “successful transition" amid “challenges.” Staffers shared emails some colleagues sent back, calling their firings illegal and the elimination of U.S. foreign assistance a threat to national security. They wrote that the lives they had saved would be their legacy.

The change was hitting a hospital in central Liberia where USAID over decades had built up maternal and child care and funded out-of-reach HIV medication, until the Trump administration slashed funding without warning earlier this year.

The hospital had no advanced notice that “after five months or a year or so, you say we'll no longer be able to be funding the health care services in Liberia," said Dr. Minnie Sankawulo Ricks, a pediatrician, of the cuts to USAID programs. "We just woke up one day and boom."

“No one ever saw it coming."

Rubio says USAID created a bureaucracy with ‘little to show’

Secretary of State Marco Rubio had ordered USAID and its remaining programs absorbed into the State Department by Tuesday. “Beyond creating a globe-spanning NGO industrial complex at taxpayer expense, USAID has little to show since the end of the Cold War,” Rubio said in a Substack post Tuesday.

The Trump administration's new slimmed-down aid system would cut bureaucracy to respond more quickly to crises, empower diplomats out in the field at a reduced number of regional bureaus, and emphasize U.S. trade, not aid, Rubio wrote.

The Trump administration has asked Congress for $17 billion for foreign assistance for next year, less than half the previous amount.

Asked for comment about the last days of USAID as an independent agency, the State Department said it would be introducing this week its foreign assistance successor, America First. “The new process will ensure there is proper oversight and that every tax dollar spent will help advance our national interests,” the department said.

Objections by USAID and State Department staffers to the slashing of foreign assistance and other changes resulted in an unprecedented 700 dissent cables, a traditional internal way of registering concerns to secretaries of state, said Andrew Natsios, a former USAID administrator who still has ties to both agencies.

The State Department did not immediately respond when asked if the figure was correct or to provide details on its new foreign aid plans.

In South Africa, dread is building as the world’s largest HIV program begins resorting to cutting doses, dragging out waiting time for appointments and missing testing targets. The USAID cuts have stripped more than $400 million a year from South Africa’s program through the President’s Emergency Relief Plan for AIDS Relief, an initiative started by the George W. Bush administration credited with saving more than 25 million lives in Africa and beyond.

A complex system — that works

President John F. Kennedy and Congress started USAID in the early 1960s. It was part of an emphasis on foreign aid as a tool of diplomacy and a belief that helping other countries become more stable and prosperous benefited the United States in kind. Kennedy had complained that State Department diplomats weren’t nimble enough at that. He wanted operations experts.

A study published in the Lancet medical journal on Monday gave an idea of its impact more recently: USAID helped prevent 91 million deaths worldwide between 2001 and 2021, researchers based in Spain, the U.S. and elsewhere estimated. That was led by more than halving of the number of deaths from HIV/AIDS, malaria and tropical diseases.

The study projected that USAID’s dismantling and deep funding cuts would lead to more than 14 million additional deaths by 2030, including 4.5 million children.

Natsios, the USAID administrator under Bush, ticks off a list of fundamental, systematic, and measurable improvements made by USAID around the world: USAID support played a vital role for agriculture’s Green Revolution, credited with saving 1 billion lives around the world, including by developing and providing improved crops. USAID’s building of a famine early warning system and other developments have sharply reduced the number and severity of famines.

USAID rapid response teams have scrambled to shut down epidemics before they spread, including in a 2014 Ebola outbreak that killed thousands in Africa. USAID work with other global partners has strengthened health systems around the world, contributing to reducing deaths among children under 5 by 69% since 1990.

Funding for many of those programs has been cut off or reduced under Trump. USAID and U.S. foreign assistance had been “a massive and very complex system, that works. That works,” Natsios said. “And now that system has been destroyed."

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Pronczuk reported from Dakar. Evelyne Musambi in Nairobi and Mogomotsi Magome in Johannesburg contributed.