Atul Gawande writes:

It was January, my final week in the outgoing Administration. In a few days, Donald Trump would be inaugurated as President. I had come to the United States Agency for International Development in early 2022, leaving my surgery practice and public-health research in Boston to lead the agency’s global-health efforts. Now I’d be returning to my previous life.

I spent my last days at U.S.A.I.D. in meetings with our civil- and foreign-service leaders, thanking them. Their work with partner countries had helped to contain twenty-one outbreaks of deadly disease, sustain Ukraine’s health system after Russia’s invasion, combat H.I.V., tuberculosis, and polio, and reduce maternal and child deaths worldwide. On a budget of just twenty-four dollars per American—out of the fifteen thousand dollars in taxes paid per person last year—they had saved lives at an almost unimaginable scale. An independent, peer-reviewed analysis in The Lancet estimated that U.S.A.I.D. assistance had saved ninety-two million lives over two decades.

Many of the leaders voiced trepidation about what the incoming Administration might bring, but I struck a sanguine note. U.S.A.I.D., I pointed out, had more than sixty years of solid bipartisan backing. Trump had advanced significant parts of the agency’s work in his first term. He had personally pledged to end H.I.V. as a public-health threat by 2030. The incoming Secretary of State, Marco Rubio, had been a vocal supporter of the bureau. There would be isolated partisan skirmishes—over diversity initiatives, abortion-related policies, and the like—but more than ninety-five per cent of our bureau’s work had never been under contention.

Clearly, I lacked imagination. Within hours of being sworn in, President Trump signed an executive order for a “pause” to all foreign assistance. Secretary Rubio sent a cable suspending every program outright. No program staff could be paid. No services could be delivered. Medicines and food already on the shelves could not be used. No warning had been given to the governments that relied on them. It was immediately obvious that hundreds of thousands of people would die in the first year alone. But the Administration did not reconsider; it escalated. Elon Musk exulted in swinging his chainsaw. Within weeks and in defiance of legal mandates, he and Rubio purged U.S.A.I.D.’s staff, terminated more than four-fifths of its contracts, impounded its funds, and dismantled the agency. Neither Congress nor the Supreme Court did anything to stop it. [Continue reading…]