A year after some of the world’s richest men cut aid for the world’s poorest children, they’re trying to roll out a new public relations narrative:
Aid continues! We’re saving lives from AIDS! Anyway, aid never really worked, so we’re focused on trade! Building opportunities for American companies while saving babies!
As Jeremy Lewin, the acting under secretary of state for foreign assistance, put it: “Contrary to false media narratives, the data shows that President Trump’s foreign assistance review maintained and improved frontline lifesaving programs, while reducing NGO bloat and costs.”
“False media narratives” may refer to my reporting from a series of African countries on children dying as a result of the Trump cuts.
Let’s first concede a few points. American humanitarian aid was never great at nurturing economic growth, but it did save one life every 10 seconds until last year. It’s also true that public pressure led the administration and Congress to retain some lifesaving programs, particularly for H.I.V./AIDS, and to its credit the administration has expanded use of a drug called lenacapavir to fight AIDS. Finally, the Trump administration is right that trade is crucial, which is why President Bill Clinton started a fine trade program with Africa; unfortunately, it expires this year, and its long-term future under Trump is in doubt.
None of this changes the fact that this glossy new Trump narrative is absurd. Trump’s most lethal policy will almost surely be his 71 percent cut in humanitarian aid from 2024 to 2025. A Boston University researcher estimated that the aid cuts cost more than 750,000 lives worldwide in their first year. A recently published study in The Lancet, the British medical journal, forecast that at present rates the defunding will cost 9.4 million lives by 2030, including 2.5 million children under the age of 5.
Are these figures correct? Exaggerated? I can’t be sure, and neither can Trump or anyone else, partly because the administration has cut data collection that might help us assess mortality accurately.
Meanwhile, Trump and his aides continue to take steps that will add to the toll.
The administration is now withholding aid for vaccines for poor countries in ways that may cost the lives of vast numbers of children. Trump slashed funding for an international vaccine alliance called Gavi, and now the administration is also refusing to release $600 million for Gavi that Congress has already appropriated and that must be spent by September.
Gavi is one of the most cost-effective aid programs in history. One study found that each dollar spent on vaccines in poor countries brings a return of $54 in reduced health costs and other benefits. I was once hospitalized with a serious case of malaria that I caught in the Democratic Republic of Congo, and I think it’s a miracle that a few doses of a $3 malaria vaccine can now save a Congolese child’s life — and a scandal that administration officials are willing to let such children die because of ideological hostility toward vaccines.
Gavi also pays for HPV vaccines that prevent cervical cancer, which kills more than 900 women every day worldwide. Cervical cancer is an excruciating, humiliating way to die — it is sometimes diagnosed partly by the odor of rotting flesh — yet a $4 vaccine can prevent it. Gavi’s vaccinations have already averted almost one million of these horrific deaths from cervical cancer.
Trump’s cuts have created a budget crisis for Gavi and other aid agencies. It has been magnified because European countries followed America’s lead with cuts to their own aid budgets. Gavi estimates that 600,000 lives will be unnecessarily lost by 2030 as a result. Think of your mother, wife, daughter; multiply by 600,000, and you glimpse the cost of Trump’s destruction of just the Gavi element of American aid.
The Trump administration is also, unintentionally, exacerbating global poverty with its catastrophic war with Iran, and not just because the war has displaced more than 2.2 million women and girls in Iran and Lebanon. Because of the war, diesel prices have risen 160 percent in Myanmar and 87 percent in Nigeria, while 40 percent of gas stations have closed in Laos, according to the United Nations. Rising fuel prices are increasing costs of transportation and thus food.
The upshot is that if the Gulf crisis doesn’t end by next month, an additional 45 million people worldwide are likely to suffer severe hunger in the latter part of this year, according to Cindy McCain of the U.N World Food Program.
An even bigger impact may come, after a delay, from shortages of fertilizer, often made with oil and gas byproducts from the Persian Gulf. Perhaps one-third of the world’s fertilizer production will be disrupted if the Strait of Hormuz remains closed, and shortages will most likely mean lower crop yields, higher food prices and more starvation. José Andrés of World Central Kitchen has warned that fertilizer shortages could lead to a multiyear famine beginning as early as the end of this year.
Think of it this way: Artificial fertilizers keep roughly half of humans alive. Without them, the earth would be able to produce enough food to support only about 4 billion people.
Even as the Trump administration has created this crisis, it has unraveled some of the global health systems that would normally save lives of starving children. And Trump administration proclamations of “trade over aid” sound empowering until you realize that what they mean in practice is that America is talking about withholding lifesaving medicines from villagers in Zambia unless the Zambian government sells more minerals to American companies.
A new book, “Into the Wood Chipper,” recounts the reckless way in which DOGE officials dismantled the United States Agency for International Development. Written by Nicholas Enrich, a former top health official at the agency, it chronicles the “callousness, dishonesty and ineptitude” of Trump aides who destroyed programs that they didn’t understand.
“I had no idea you did all this,” Enrich quotes one of the newly arrived officials saying. “As a Republican, when I think of what U.S.A.I.D. does in global health, I assumed it was just, you know, abortions.” (In fact, no American aid dollars went to abortions.)
Please excuse my intemperate tone. But in my travels over the last year, I’ve seen children dying because of our aid cuts. This doesn’t feel like policymaking so much as vandalism, accompanied by wasted food, ruined contraceptives and an estimated $6.4 billion spent closing down the United States Agency for International Development (that sum alone could have saved more than one million children’s lives).
Actually, for all my harsh words, Trump is talking about providing emergency financial support for one nation. That’s the United Arab Emirates, which is pinched by the Iran war and may get a lifeline from Washington to support its currency.
