Staff at the U.S. Agency for International Development (USAID) marked their final day on the job on Monday with tributes from two former presidents and a rock legend as new research revealed the stark reality of life without their help.
George W Bush, Barack Obama and U2 frontman Bono expressed their thanks to departing employees from the international aid agency in heartfelt video messages as their offices were shuttered under President Donald Trump’s “America First” agenda.
Secretary of State Marco Rubio announced in March that 83 percent of USAID’s programs would be cut because they did not serve “the core national interests of the United States,” with the remainder of the agency being folded into his department.
But fresh doubt was cast on the wisdom behind that decision by findings published in The Lancet medical journal on the same day staff were saying goodbye, which indicated that 14 million more people will die over the next five years without the humanitarian support USAID once provided.
An international team of researchers found the agency’s global outreach efforts had prevented 92 million deaths between 2000 and 2021 across 133 countries, saving the lives of 25 million HIV/Aids sufferers, 11 million people with diarrheal diseases, 8 million with malaria and nearly 5 million with tuberculosis.
Of the 14 million extra deaths, 4.5 million will be accounted for by children under five, they concluded.
Davide Rasella of the Barcelona Institute for Global Health, one of the report’s co-authors, called the findings “striking” and said the likely impact on low and middle-income countries will be “comparable in scale to a global pandemic or a major armed conflict.”
He added that the cuts to USAID “risk abruptly halting – and even reversing – two decades of progress in health among vulnerable populations.”
The agency, founded in 1961, managed a budget of $35bn last year, according to the Congressional Research Service, and was involved in everything from running health clinics and building schools to more mundane but vital tasks like distributing nutrition pouches, mosquito nets and chlorine tablets.
“You’ve shown the great strength of America through your work, and that is our good heart,” Bush told the outgoing workers on Monday, according to The New York Times, also thanking them for enacting his signature Emergency Plan for Aids Relief.
“Is it in our interest that 25 million people who would have died now live? I think it is,” he said. “On behalf of a grateful nation, thank you for your hard work, and God bless you.”
Obama, in turn, attacked the decision to close USAID as “a colossal mistake” and lamented: “Ending your presence and your programs out in the world hurts the most vulnerable, and it hurts the United States.
“To many people around the world, USAID is the United States.”
Bono, well known for his advocacy for developing nations, chose to deliver his message in rhyme and said: “They called you crooks – when you were the best of us, there for the rest of us. And don’t think any less of us, when politics makes a mess of us.
“It’s not left-wing rhetoric to feed the hungry, heal the sick. If this isn’t murder, I don’t know what is.”
The Lancet’s forecast appeared to bear out his assessment and the research it published is by no means the only study to have anticipated such a bleak outcome from USAID’s closure.
A Boston University model, for instance, has put the human cost of its demise in even more shocking terms: 88 deaths per hour.
Amira Albert Roess, a professor of global health and epidemiology at George Mason University, told NBC News it was the speed of the Trump administration’s decision that is so dangerous.
“For better or for worse, some of the USAID-funded clinics in some areas, they were the main source of care,” she said.
“If you wanted to reduce USAID funding, it could have been done in a more gradual manner, instead of this sudden – and really, in a lot of places, overnight – shuttering of clinics.”
Roess said she was particularly concerned by the abrupt closure of HIV clinics and warned: “If you miss a dose or multiple doses, as was the case with lots of individuals, that’s creating a situation where the individual can start to deteriorate fairly rapidly.”
In May, Microsoft co-founder Bill Gates announced he would be bringing forward the charitable donation of $200bn from his personal fortune in order to help meet the shortfall and continue the fight against deadly diseases around the world.
In doing so, Gates derided his fellow tech boss Elon Musk for his part in the cuts as the then-leader of Trump’s Department of Government Efficiency (DOGE).
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