Dr. Atul Gawande: Hundreds of Thousands Have Already Died Since Trump Closed USAID

AMY GOODMAN: This is Democracy Now!, democracynow.org. I’m Amy Goodman with Nermeen Shaikh.

NERMEEN SHAIKH: We turn now to the dismantling of the U.S. Agency for International Development, or USAID, the federal agency that funded global health initiatives for over six decades. Soon after President Trump began his second term in office, the agency found itself in the crosshairs of the so-called Department of Government Efficiency, or DOGE, led by billionaire Elon Musk, a megadonor to Trump’s election campaign.

Musk and DOGE pursued deep cuts and layoffs at the agency. Earlier this year, an independent analysis published in the medical journal The Lancet estimated that USAID had saved 92 million lives globally over two decades, including the lives of 30 million children. It further estimated that cuts to USAID could result in 14 million more deaths by 2030.

The authors wrote that for many countries, quote, “The resulting shock would be similar in scale to a global pandemic or a major armed conflict.” Of the roughly $15,000 per year most Americans pay in taxes, the cost for USAID is just $24 per person.

In a moment, we’ll be joined by Dr. Atul Gawande, the surgeon and health policy expert who headed Global Health at USAID during the Biden administration. His latest piece in The New Yorker is headlined, “The Shutdown of USAID has Already Killed Hundreds of Thousands.”

AMY GOODMAN: Earlier this year, Dr. Gawande spent time in Kakuma, a refugee camp in Kenya near the South Sudan border, looking at the impact of USAID cuts on childhood malnutrition. His experience is documented in a short film called Rovina’s Choice, directed by Thomas Jennings and Annie Wong. The film follows a mother, Rovina Naboi, as she tries to save her daughter Jane from starvation. Dr. Gawande met her at Clinic 7, where the sickest children are seen. This is a clip from the film.

ROVINA NABOI: After the changes in food rations, I realized my daughter Jane was sick. She had high fever and chills. Days later, she developed diarrhea and a skin rash. Then, her whole body peeled into wounds and became swollen. People told me, “Baby Jane should be treated at Clinic 7.” The place is very far. I had to leave the kids home alone with little food. I had to make the sacrifice to be with Jane at the hospital.

AMY GOODMAN: For more, we’re joined by Dr. Atul Gawande, Professor of Surgery at Brigham and Women’s Hospital in Boston, Professor of the Practice at Harvard Medical School. Also, an award-winning author of several best-selling books, including, Being Mortal and Complications. He joins us now from Boston. Dr. Gawande, it’s great to have you back, but under such incredibly painful circumstances. You say hundreds of thousands of people have died since the Trump administration basically ended USAID. Explain how you know this and your recent trip to visit the survivors of South Sudan.

DR. ATUL GAWANDE: I’ll give an example. One of the things I was most worried about is the advances we’ve made in malnutrition. People don’t recognize it, but in the last 20 years, we’ve discovered the protocols that could take a 20% death rate for children with severe acute malnutrition coming to hospital facilities and have brought that down to less than 1%.

How does that happen? It does it by moving more of the care for the severely acutely malnourished closer to the home with community health workers, with a measuring tape and a scale, checking on the weights and heights of kids and catching early signs of severe acute malnutrition. Then, when they – and they can get a fortified food, therapeutic foods, formulated in the United States, much of it manufactured by American farmers, and deliver it at home and rescue 85% of those children.

And then, the remaining 15% go for complications, or they’re very young, to hospitals. That process has dramatically changed malnutrition. It’s saved millions of lives just by itself. And that was cut off instantly. When I went to visit – I visited multiple communities, and Kakuma refugee camp was one of them, where you saw the total dismantling of this. Food aid was cut in this camp, for example, refugees coming from the South Sudan border, from Somalia and other places were down to only 40% of the minimum needs for real their calories being able to be provided.

So, children were down to just one meal a day. The community health workers were pulled from the field. The ability of nurses in the hospitals, those were pulled out. And so, you see a situation like Rovina Naboi, whom I met among many families, trying to navigate a broken system. We had the cure for death from malnutrition, and we took it away.

NERMEEN SHAIKH: And Dr. Gawande, you pointed out, in fact, that in Trump’s first administration, he advanced some of the agency’s work. And Marco Rubio had also been a vocal supporter of USAID. So, if you could say, what do you think accounts for the change? And also, the fact that Rubio had initially said that critical, life-saving aid would be exempt from these cuts? What’s happened?

DR. ATUL GAWANDE: It was a combination of total indifference of the White House and Elon Musk wielding his chainsaw, the rhetoric of, “This is a criminal enterprise. It’s a money-laundering operation,” and Marco Rubio signing on with that. It was a set of claims that are ideological and ignore the lives saved. It was immediately evident that hundreds of thousands of lives were going to be lost in a matter of months.

And there’s a – we now know it’s not just malnutrition. We see loss of control of HIV, loss of control of TB. All of the technical assistance we gave to many governments and communities that enabled the increases in vaccination rates, enabled the delivery of better childbirth, those have gone away, and you see the attrition of those services.

Now, many of those deaths will take a while. The loss of vaccines, loss of HIV control, TB. Many of the deaths take months or years. So, we’re seeing early deaths like the malnutrition cases, and then we see the wave that’s more to come.

NERMEEN SHAIKH: Dr. Gawande, if you could speak specifically, you mentioned HIV, the status of PEPFAR, the President’s Emergency Plan for AIDS Relief, which was one of the most successful aid programs launched by the U.S., credited with saving 26 million lives and enabling almost eight million babies to be born without an HIV infection, what is the status of that program?

DR. ATUL GAWANDE: Well, on the one hand, PEPFAR is under the best condition of many of the programs. About half of the funds are remaining and moving out. And yet, even there, the damage is severe. First of all, the removal of the infrastructure of teams – I had 2,500 people in 65 countries implementing assistance that reached hundreds of millions of people and saved lives by the millions.

Those people in the field are gone. The dismantling of oversight systems, inspectors general that made sure that waste was reduced to a minimum. Was there more that could’ve been done on waste? Yes. But the removal of any data monitoring of the inspectors general has only made waste worse of a problem. There’s medicines being lost in warehouses, food aid that’s not distributed. And the PEPFAR program, what keeps people alive are programs that ensure that high-risk groups are able to be identified, that they’re able to help stay on their medicines if they have HIV and get prevention if they don’t.

The preventive programs have been completely dismantled. They’re barely functioning at this point. We made a discovery, the United States, of a drug that could stop HIV for six months, and recent research shows it can be as long as a year. We would be deploying that right now to drive down the mortality from HIV. Some of that is supposed to be moving, but it isn’t anything like the ramp-up that should be happening and that PEPFAR would’ve been making happen right now.

AMY GOODMAN: You quote Richard Rhodes, the historian’s phrase, “Public man-made death.” And you talk about a Boston University epidemiologist keeping track of the USAID cuts. As of November 5, 600,000 people already died as a result of the cuts, two-thirds of them children. Talk about why it’s so hard to get information on this, and can this be reversed?

DR. ATUL GAWANDE: So, yes.

AMY GOODMAN: Of course, not for the people who’ve died, but for the future.

DR. ATUL GAWANDE: We’re in the midst of public man-made death now, and yet it can be so hard to see because it doesn’t happen like in a war, where the bomb drops, and then you see the bodies in the field. Here, it’s difficult to see because number one, data monitoring that would allow us to see it, and the inspectors general and other audits aren’t functioning, so you don’t get some of the visibility there.

Number two, the deaths are scattered. Seeing a mortality rate rise in communities for children from 3% to 4%, which is the kind of thing that you can begin to see now, that’s a one-third increase in deaths, but you can’t feel and see the difference just walking around. A lot of the most powerful interventions that were done were ones that would raise vaccination rates from 60% to 90% or raise HIV coverage, keeping people on their medicines jumping from 70% to 95%.

And then, when you have that attrition, it can be very difficult to see, which is why I joined with a film team that followed me as we came to Kenya and as we were visiting other places in the world. And that allowed us to follow the story of individuals who are trying to stay alive, who are trying to keep their children alive and what they have to go through that no longer is there.

Now, USAID works by doing two things. One is humanitarian assistance, helping the most vulnerable and the at-risk to stay alive and to survive. But the second thing is building support for the countries, for the systems that they can stand up on their own. And Kenya’s an example of a country moving towards middle income that has been in this process, and the struts have been pulled out.

NERMEEN SHAIKH: Dr. Gawande, before we conclude, if you could also talk about the systematic attacks on science and medicine here in the U.S., from the CDC, to NIH and of course, Harvard University.

DR. ATUL GAWANDE: Yeah, I returned from my time leading Global Health at USAID to my public health work at Harvard, where the research center I founded with 200 associated associate faculty has had a third of its budget shut down completely, programs that we were running. For example, surgery work that cut deaths by half that was now deploying new tools to figure out how to reduce the death rate for geriatric patients undergoing surgery, older adults.

That funding is gone, and blocked and terminated. Harvard’s only one example. The NIH funds for research, CDC programs for HIV and vaccination have been slashed. We’re seeing the dismantling of global public health abroad coming to domestic public health at home, and we’re going to see – we are seeing many of the same results, not in the dire numbers of hundreds of thousands already, but in conditions like measles, like HIV having outbreaks and starting to move in the wrong direction again.

AMY GOODMAN: Dr. Atul Gawande, I want to thank you so much for being with us, former Head of Global Health at USAID, U.S. Agency for International Development. We’ll link to your article for The New Yorker, “The Shutdown of USAID has Already Killed Hundreds of Thousands.” Professor of Surgery at Brigham and Women’s Hospital in Boston, Professor of the Practice at Harvard Medical School.

That does it for our show. Very happy birthday to Ishmael Daro. Tonight is the premiere of Steal This Story, Please! at the SVA Theatre here in New York City. Nermeen and I will be there at 6:15, tomorrow morning at IFC in New York City at 11:15.

I’ll be speaking in Amsterdam – yep, in the Netherlands – before the two premieres at 5:15 and at 8:30 in the evening at the Royal Theatre Carré. Hope to see many people there at the largest international doc fest in Europe. I’m Amy Goodman with Nermeen Shaikh.