They Killed USAID — And the World Is Paying for It in Children's Lives

A Bronzecomm Community Blog | Published by Denise Corder Hall

There's a story that didn't get nearly enough attention on the South Side. Not because it doesn't matter — it matters more than almost anything happening right now — but because it happened far away, fast, and to people who have no lobbyists, no press secretaries, and no Twitter accounts powerful enough to fight back. It happened to mothers in Kenya watching their malnourished children fade. It happened to clinics in Zambia that ran out of HIV medication. It happened to kids in sub-Saharan Africa who were days away from polio vaccines that never arrived.

What happened? A group of tech workers with no foreign policy experience were handed a chainsaw and pointed it at one of the most effective humanitarian programs in American history.

What Was USAID, and Where Did It Come From?

The United States Agency for International Development — USAID — was born on November 3, 1961, when President John F. Kennedy signed the Foreign Assistance Act into law and created the agency by executive order. Kennedy had traveled through Asia, the Middle East, and other developing regions as a young congressman in 1951, and what he saw changed him. He understood that poverty, disease, and instability were a threat to democracy — and that America had both the obligation and the strategic interest to help.

Before USAID, U.S. foreign assistance was scattered across multiple agencies with no unified direction. Kennedy consolidated them all under one roof, building on the legacy of the Marshall Plan — the post-World War II program that helped rebuild Europe — and pointing it at the developing world. The idea was that a more stable, healthier, better-fed world was also a safer world for the United States.

Over the next six decades, USAID operated in more than 100 countries. Its mission evolved: food security, democratic governance, disaster relief, education, clean water infrastructure, economic development, and above all, public health. It became one of the largest foreign aid agencies on the planet, administering roughly 60 percent of all non-military U.S. foreign assistance.

And for all the politics that surrounded it, the results were undeniable.

What USAID Actually Did for the World

You can measure USAID's work in numbers, but the numbers don't capture what it actually looked like on the ground. It looked like a child drinking clean water for the first time from a well that didn't exist the year before. It looked like a woman in Uganda who found out her HIV status early enough to start treatment and live long enough to watch her grandchildren grow up. It looked like a community in Ethiopia that survived a drought because food aid arrived before starvation did.

A peer-reviewed study published in The Lancet in July 2025 analyzed USAID's impact across 133 countries over two decades. The findings were staggering: USAID funding was associated with a 65% reduction in mortality from HIV/AIDS, a 51% reduction from malaria, and a 50% reduction from neglected tropical diseases. All told, the study found that USAID-supported efforts helped prevent more than 91 million deaths — including 30 million children.

Let that land for a moment. Ninety-one million people.

The agency helped lead the global eradication of smallpox, played a central role in eliminating polio across Africa, and launched child survival campaigns that saved millions of lives through something as simple and inexpensive as oral rehydration therapy — a packet of salts and sugar that costs pennies but stops children from dying of diarrhea. As one researcher noted, the average American taxpayer contributed about 18 cents per day to USAID — and for that small amount, USAID was able to save up to 90 million deaths around the world.

The HIV/AIDS Fight: PEPFAR

Perhaps nothing illustrates USAID's reach more clearly than PEPFAR — the President's Emergency Plan for AIDS Relief. Launched in 2003 under President George W. Bush with bipartisan support, PEPFAR became the single largest commitment by any nation in history to address one disease. Since its inception in 2003, the U.S. government invested over $100 billion in the global HIV/AIDS response, saving over 25 million lives, preventing millions of HIV infections, and supporting several countries to achieve HIV epidemic control.

PEPFAR enabled 5.5 million babies to be born HIV-free to mothers living with HIV and provided critical care and support for 7 million orphans, vulnerable children, and their caregivers.

As of 2024, across 55 countries, PEPFAR was supporting life-saving antiretroviral therapy for 20.6 million people, including 566,000 children with HIV.

This is not an abstract policy achievement. This is 25 million human beings who are alive today because of a program run through USAID and funded by American taxpayers.

Then Came DOGE

On January 20, 2025 — his first day back in office — President Donald Trump signed an executive order implementing a 90-day freeze on all U.S. foreign aid. Within days, ELON Musk's Department of Government Efficiency — DOGE — sent its team into USAID's headquarters. What followed was not a reform. It was a demolition.

The Department of Government Efficiency (DOGE), led by billionaire Elon Musk and a team of his followers, entered the offices of USAID, shuttering much of the agency and its functions. They sent home a majority of Washington D.C.-based staff on administrative leave, ordered staff located abroad to travel back to the United States, and roughly 10,000 staffers from around the globe were placed on leave.

By March 2025, the Trump administration announced plans to reduce USAID from more than 10,000 employees to just 15 people — a skeleton crew — and fold whatever remained under State Department control. The administration said at the end of February 2025 that it was freezing 90% of USAID's foreign aid contracts, leaving few projects intact. Secretary of State Marco Rubio ultimately announced that more than 80 percent of the agency's programs were gone.

USAID officially closed on July 1, 2025.

Did DOGE Have Any Idea What They Were Cutting?

This is where the story gets ugly — not just tragic, but infuriating.

The DOGE team assigned to USAID was made up primarily of young tech workers, most of whom had no background in global health, foreign policy, international development, or humanitarian aid. At the same time, USAID's most senior global health official — Nicholas Enrich — was watching the destruction happen in real time.

Enrich had spent his career at USAID, serving under four administrations. In early 2025, he was the acting assistant administrator for global health. What he witnessed when the Trump team arrived at USAID headquarters is documented in devastating detail in his new book, Into the Wood Chipper: A Whistleblower's Account of How the Trump Administration Shredded USAID, published April 14, 2026.

Enrich witnessed firsthand the Trump administration's lies, how it systematically prevented USAID from providing lifesaving foreign aid, and the death and suffering around the world that resulted from careless decisions. Finally determining he could no longer keep quiet, and risking the career that he loved deeply, Enrich released a set of whistleblowing memos exposing the administration's illegal and destructive actions.

In the days following their release, hundreds of canceled aid projects were revived, and the documents were cited in a Supreme Court case on the legality of USAID's dissolution.

An exclusive excerpt from the book, published by The Handbasket, revealed the staggering ignorance on display at USAID headquarters during those early days. One Trump official, when asked about the agency's global health mission, reportedly said: "I assumed it was just, you know, abortions." The same official demanded simplified, elementary-level briefings on programs that career staff had spent years designing.

According to internal memos reported by ProPublica, a DOGE engineer emailed staff and said they were not allowed to review the programs they were canceling. USAID's deputy chief of staff reportedly told agency personnel to take a "draconian" approach to approving any waivers for continuing programs. And when the agency's own experts tried to warn leadership about the human cost of what they were doing, political leadership "wholly prevented" staff from implementing Rubio's promise to continue lifesaving aid.

Enrich and his team sent urgent internal memos documenting what was at stake: up to 166,000 people would die from malaria; new cases of tuberculosis would go up by 30%; and 200,000 more children would be paralyzed by polio over the next decade.

The administration pressed ahead anyway.

A federal judge later ruled that Musk and DOGE likely lacked constitutional authority to help the Trump administration shut down USAID, fire staffers, and terminate humanitarian and development contracts — but by then, it was too late. The agency was gone.

The Budget They Gutted: Less Than One Penny on Every Dollar

Before we go further, let's address one of the biggest lies sold to the American public about USAID: that it was draining the federal budget.

According to a 2010 poll, the median American believed that 25% of the federal budget goes to foreign aid and that it should be 10%. In reality, between 0.8% and 1.4% of the U.S. federal budget has gone to foreign aid since 2001. USAID's specific slice? USAID accounted for 0.6% of the federal budget in 2023.

Let that settle in. Six-tenths of one percent of the federal budget. Not 25%. Not even 1%.

USAID's budget has always been small — recently, in 2023, making up roughly a $50 billion drop in the $6 trillion ocean of the federal budget. But USAID's projects had an outsized effect on the world.

This was not where government waste lived. This was where lives were being saved at scale.

Who's Paying the Price? Mostly Children.

The consequences of USAID's dismantling are not theoretical projections. They are deaths happening right now, in real time, in countries where there is no safety net to catch what America let fall.

One year after the Trump administration began its dismantling of USAID, a model tracking the impact of funding cuts on global disease prevention programs estimates that more than 762,000 people have died as a result of those cuts, including more than 500,000 children.

The Harvard-published account from former USAID Assistant Administrator Atul Gawande put it plainly: the dismantling of USAID "has already caused the deaths of six hundred thousand people, two-thirds of them children," and the toll will continue to grow and may go unseen because it can take months or years for people to die from lack of treatments or vaccine-preventable illnesses.

The Lancet study goes further, warning that if USAID cuts continue, more than 14 million additional deaths could occur by 2030, including over 4.5 million among children under 5 — about 700,000 extra child deaths per year.

The breakdown is stark: cuts to PEPFAR funding have resulted in more than 158,000 adult deaths and 16,000 child deaths, while terminated USAID funding has also resulted in more than 164,000 additional child deaths from pneumonia, 125,000 additional child deaths from diarrhea, and 70,000 additional deaths from malaria.

South Africa — home to the world's largest number of people receiving PEPFAR treatment — laid off approximately 8,000 health care workers due to the USAID freeze. Nigeria's lawmakers scrambled to pass a $200 million supplemental health budget just to deal with the sudden collapse of U.S.-funded immunization programs.

Meanwhile, Elon Musk, in response to reporting on the death toll, wrote on X that "zero people have died" — a claim that researchers, doctors, and public health officials around the world flatly rejected.

Is Anyone Stepping In?

The short answer is: not really. Not at scale.

The initial hope was that Europe, China, or other major donors might absorb some of what America abandoned. It hasn't worked out that way. Of 10 experts interviewed by Devex, no one could identify a project in Asia where China had directly replaced USAID funding. China's total foreign aid budget in 2024 was around $3.5 billion — only a fraction of USAID's former $65 billion portfolio.

China made a few high-profile gestures — stepping in with a $4.4 million demining program in Cambodia, offering aid to Nepal — but as analysts at the Center for Global Development noted, these efforts were largely cosmetic. The gap left by USAID was too large, too specialized, and too deeply embedded in local health systems for any single country or bloc to replace overnight.

Europe, meanwhile, is also cutting its own foreign aid budgets. Germany, the Netherlands, and Belgium have all reduced international assistance spending significantly. Analysts agree that Europe cannot replace USAID funding at a time when governments grapple with economic slowdown and soaring energy prices linked to Russia's war in Ukraine.

The organizations that were doing the work on the ground — the NGOs, the local health clinics, the community-based AIDS organizations — have been largely left on their own. Many have closed. Some are surviving on emergency bridge funding from private foundations like the Gates Foundation and the Wellcome Trust, but at nowhere near the scale needed. As Boston University professor Brooke Nichols put it, "It's hard to turn the tap back on once you've turned it off, especially if there is no staff to turn it on."

Now, Congress is beginning to scramble. In early 2026, the House Foreign Affairs Committee advanced legislation authorizing the State Department to "recruit, train and retain" specialized disaster assistance professionals after the Trump administration unceremoniously fired hundreds of aid experts. The same Congress also passed a $50 billion State Department budget that includes $5.5 billion for a new Bureau of Disaster and Humanitarian Response. Whether the expertise lost — the people who knew how to do this work — can be rebuilt is another question entirely.

The Book You Should Read: Into the Wood Chipper

If you want to understand what this looked like from inside the building, Nicholas Enrich's Into the Wood Chipper is the account to read. Enrich served as USAID's Bureau of Global Health's director of policy, programs, and planning until January 2025, when he was designated as USAID's acting assistant administrator for global health. On March 2, 2025, he was placed on administrative leave for exposing the Trump administration's illegitimate and dangerous dismantling of USAID.

His book, published today — April 14, 2026 — by Simon & Schuster, offers a ground-level account of what it looked like when ideologically-driven amateurs were handed authority over one of the most complex humanitarian operations on earth. Pulitzer Prize-winning author Samantha Power called it "a gripping page-turner" that reveals "the chilling indifference of the architects of USAID's destruction" and promises that "generations from now, people will read this book to understand one of the greatest blunders in American history."

The book is available now in print, digital, and audio formats.

Why This Matters to Us, Right Here on the South Side

We talk a lot about community care on the South Side of Chicago. We talk about showing up for our neighbors, about not letting people fall through the cracks. USAID was that, scaled to the entire world — and in particular, to the parts of the world that look like us. Sub-Saharan Africa. Haiti. South Asia. Communities that have historically been last in line for resources and first in line for disaster.

The Black community in America has a particular stake in what happens to Black and Brown communities globally. We know what it feels like when your health doesn't matter to the people making the budget decisions. We know what it looks like when systems built to help people are dismantled by people who never used them and never had to.

The dismantling of USAID was sold to the American public as a cost-cutting measure. It was nothing of the sort. It was a $50 billion line item — less than 1% of the federal budget — that was keeping 25 million people on HIV treatment, keeping polio out of communities that barely recovered from its last outbreak, keeping children alive long enough to go to school.

And it was ended, not by policy experts who weighed the tradeoffs carefully, but by a tech billionaire's team of young operatives who didn't know what USAID did and, based on the accounts from people who were there, didn't want to know.

We see you, and we're saying it plainly: this is not who we want to be.

Sources: The Lancet, ProPublica, Harvard T.H. Chan School of Public Health, Boston University School of Public Health, NPR, UNAIDS, HIV.gov, Center for Global Development, Devex, Britannica, Simon & Schuster.