ON JANUARY 28th the secretary of state, Marco Rubio, issued an “emergency humanitarian waiver” to exempt life-saving aid from Donald Trump’s freeze on all foreign assistance. Two weeks later, in Malawi, a country of 20m in southern Africa that is the world’s seventh-poorest by GDP per person, most local charities have stopped working and about 5,000 people—many of them health workers—have lost their jobs, says Mazisayko Matemba of the Health and Rights Education Programme, an NGO. “We expect more people to get infections and start dying.”
From South Africa to Afghanistan, the picture is similar. Mr Rubio issued two edicts that sought to rescue PEPFAR, a successful anti-AIDS initiative, as well as other “core life-saving” medical, food and shelter programmes from Elon Musk’s demolition crew at the Department of Government Efficiency (DOGE). Mr Musk has rapidly dismantled USAID, but DOGE tore apart foreign aid systems so quickly—closing offices, firing thousands of contractors, freezing bank accounts—that Mr Rubio’s waivers have so far proved meaningless, say aid workers in multiple countries. “Even when a waiver has been issued, there’s no way to execute it because the payment system has been broken,” says Kate Almquist Knopf, a former USAID Africa director based in Nairobi.
In Malawi, the antiretroviral drugs PEPFAR pays for are one of the major reasons why life expectancy has risen from 45 in 2000 to 63 in 2022. In South Africa, the $440m America spends every year fighting HIV and TB in the country accounts for about 17% of the government’s budget for tackling the diseases. Jeremy Nel, who runs one of the biggest HIV clinics in South Africa, in Johannesburg, says the staff in the hospital who were funded by PEPFAR were told on January 27th they could not come to work. They are still waiting for instruction from USAID, “but it is unclear whether USAID even exists anymore,” he says. “The number one problem has been the abruptness of the transition.”
Francois Venter, who runs a health NGO in the same city, points out that HIV programmes cannot be stopped and started “at the drop of a hat”. Charities don’t have financial reserves or access to loans; they need to know that the invoices they send will be reimbursed. The disruption in recent weeks “won’t cause death overnight but what it will do is set our progress back years,” says a doctor who until recently was funded via PEPFAR.
Mr Rubio has sounded defensive about the rapid and performatively cruel way that USAID has been dismantled. Initially, he blamed USAID staff for not co-operating. On February 10th, Mr Rubio conceded that there had been “some hiccups about how to restart the payment programmes, but all that’s going to get taken care of here very quickly.” PEPFAR and other lifesaving programmes “will continue”, he added, but he warned that PEPFAR is likely to shrink.
In the meantime, local and international charities face insolvency. A few large commercial and non-profit groups with diversified revenue may survive, executives in the sector say, but the business model for many charities reliant on USAID contracts is largely cash-in, cash-out, with little scope to build up reserves or borrowing power. When DOGE stopped payments, it cut off $750m to $1bn in money owed to contractors for work already completed, one executive estimates.
Across Africa, aid workers are parsing just how life-saving a programme must be to qualify for the Trump administration’s backing. Direct food aid may be allowed, but how about cash vouchers to buy food in the market? Medicine to fight HIV may be allowed, but how about education programmes to stop transmissions? Does the provision of seeds to villagers who will starve if they don’t plant before the next wet season count as life-saving? In Washington, there is no one to answer the phone and sort out such questions, aid officials say. “This was done so ignorantly, without an understanding of what’s required at both ends of the implementing chain,” says Nathaniel Raymond, executive director of the Humanitarian Research Lab at Yale University’s School of Public Health.
Mr Rubio, a supporter of PEPFAR and other foreign aid during his Senate career, may yet have a chance to repair some of the damage he has overseen. But Mr Trump has offered his top diplomat little cover to do so and appears more impressed by Mr Musk’s claim that foreign aid is essentially a corrupt racket. ■
Stay on top of American politics with The US in brief, our daily newsletter with fast analysis of the most important political news, and Checks and Balance, a weekly note from our Lexington columnist that examines the state of American democracy and the issues that matter to voters.