Donald Trump and Elon Musk want to dismantle USAID. Which countries will be hit hardest?
The Trump administration is overhauling the US’s key foreign aid programmes – and global health initiatives are directly in the crosshairs.
Since taking office on January 20, US President Donald Trump has temporarily frozen all foreign assistance and fired hundreds of people at the United States Agency for International Development (USAID), which works to improve health, alleviate poverty, and promote human rights and democracy in lower-income countries.
But now it appears USAID may be trimmed down and absorbed into the US State Department, according to multiple US media reports.
Its website vanished over the weekend, and Elon Musk, who is leading a review of the federal government on Trump’s behalf, labelled the agency, without evidence, as a “criminal organisation” that should “die”.
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“We’re shutting it down,” Musk said during a live session on Monday on his social platform X.
The stop-work order has already sent US-funded health programmes in lower-income countries into freefall, and USAID’s apparent dismantling could go even further.
The disruptions have “left the delivery of this critical aid in limbo and millions of lives hanging in the balance,” Elisha Dunn-Georgiou, president and CEO of the Global Health Council, which represents more than 100 organisations worldwide, said in a statement last week.
Where US health aid goes
In all, the US gave $71.9 billion (€69.1 billion) in foreign aid to 209 countries and regions in 2023, with much of it funnelled through USAID, according to US government data.
That year, 22 per cent of all US aid – $16.1 billion (€15.5 billion) – went to programmes that cover HIV/AIDS, nutrition, tuberculosis, pandemics and emerging threats, maternal and child health, family planning and reproductive health, water sanitation, and other health initiatives.
Some parts of the world are staring down a larger gap than others. Seventeen countries, mostly in Sub-Saharan Africa, received more than $100 million (€96.1 million) each in US health aid in 2023.
Based on their 2023 funding levels, the countries most affected by the US pivot will be Tanzania – which is currently grappling with an outbreak of the Ebola-like Marburg virus – as well as Nigeria and South Africa.
Impact of the health funding freeze
One of the USAID freeze’s biggest hits will be to the President's Emergency Plan for AIDS Relief (PEPFAR), which is credited with saving more than 26 million lives over the past two decades.
Last year, it provided antiviral HIV treatments for 20.6 million people in 55 countries.
Last week, US Secretary of State Marco Rubio issued a humanitarian waiver for certain life-saving medical assistance, including PEPFAR, but nonprofits running these programmes have said the terms of the waiver are unclear, leaving them unsure whether to continue work or not.
As a result, many health initiatives have already ground to a halt, according to the Global Health Council.
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It has tallied casualties including malaria prevention campaigns targeting nearly six million people in Kenya, Uganda, and Ghana; child nutrition programmes serving millions of people in the Democratic Republic of the Congo and elsewhere; bird flu monitoring in 49 countries; and global surveillance for drug-resistant tuberculosis, which is the top infectious disease killer worldwide.
Meanwhile, Avril Benoît, chief executive officer of Doctors Without Borders’ (Médecins Sans Frontières) US branch, said USAID-supported clinics and medical services have been “shut down without warning” over the past two weeks, leading to widespread confusion on the ground.
“We are talking about countless refugees and other displaced persons, children threatened by malaria, and people who need HIV and tuberculosis treatment, whose care risks being stopped,” Benoît said in a statement.
