Lawfare Daily: The End of USAID, with Nicholas Kristof

[Intro]

Nicholas Kristof: What I have seen since is a monumental increase in waste and abuse. You know, goods sitting in warehouses unused as children die. The cost of dismantling a program turns out to be really, really expensive.

Anna Hickey: It's the Lawfare Podcast. I'm Anna Hickey, associate editor of communications with Nicholas Kristof, New York Times opinion columnist.

Nicholas Kristof: The collapse of USAID is a gift to China. We are now competing with China in Africa, for example, for goodwill, for rare earth minerals, and one way we compete is by saving lives.

Anna Hickey: Today we're gonna discuss the impact of President Trump's decision to freeze foreign assistance and dismantle the U.S. Agency for International Development on the communities that had relied on that aid and on U.S. national security.

[Main Podcast]

The Trump administration has canceled 84% of USAID contracts and fired 93% of agency. And on July 1st, the remaining staff and grants were absorbed by various bureaus within the State Department. But before we dive into what's been going on this year, Nick, can you explain to listeners kind of who you are and how you first ended up reporting on USAID and humanitarian assistance and foreign aid?

Nicholas Kristof: Sure, and great to be with you. It's an important topic.

So I became interested in kind of global development issues when I was escaping torts and contracts as a student of law in Britain at Oxford University, and. Oxford has a great vacation system. I was I was on a scholarship that paid large stipends and I was interested in journalism.

So I escaped each vacation and spent a lot of time in Africa, in Asia, and, you know, it is kind of heartrending when you go to a place like Mali or Niger, and you see so many people who have been blind unnecessarily from diseases like river blindness or who have leprosy, things that are eminently treatable, who aren't getting an education. And so I became increasingly interested in these kind of global health and development issues.

And then later when I became a journalist at the New York Times, having fully fled law, I, you know, I started out covering international economics and exchange rates and oil prices and so on. But I was really drawn to these issues of humanitarian reporting because it felt like that is where one can really make an important difference.

Anna Hickey: Before this year, before your reporting trips this year, when you were going to different countries, what kind of work did you see USAID doing on the ground when you were going to Africa or Asia?

Nicholas Kristof: So in previous years, if you had asked me about USAID I might have complained about, oh, they're so bureaucratic, so much of the money goes to beltway bandits. And, you know, all that is true. There could have been some useful reforms, but it's also true, and I saw it in country after country that USAID was saving more lives than you know, any agency in federal government. It was estimates are maybe 3 million lives a year on a pretty modest budget.

And so whether it is the PEPFAR initiative that George W. Bush started to fight AIDS or the malaria initiative or work in neglected tropical diseases, I mean, you just manifestly see, lives being saved. And one of the things that I've been able to see in the arc of my reporting career is enormous improvements in global wellbeing that I think many Americans don't appreciate.

When I graduated from college, 41% of the world's population lived in extreme poverty, now we're down to less than 10%. You know, when I was a kid, a majority of human beings had always been illiterate, and now we're pushing 90% adult literacy.

And, you know, a lot of that, not all of it, but a lot of it is because of the work of USAID. We were saving lives you know, every few seconds around the globe. And that is, that became much, much less true after January when President Trump took office and dismantled USAID.

Anna Hickey: So kind of thinking about what happened in January, USAID ended up in the crosshairs of DOGE and Elon Musk. Members of the Trump administration criticized the agency as corrupt and wasteful, beyond repair, and run by radical left lunatics.

You've mentioned that US, USAID did, in your view requires some reforms. How did you view the criticisms coming out of the Trump administration in January and February? And did they match at all with how you thought of USAID and the criticisms you had? Did you see wasteful spending when traveling around the world and, you know, reporting on the United States foreign aid and humanitarian assistance?

Nicholas Kristof: The criticisms were essentially ridiculous. You know, this is an organization that has lost about a hundred people on the front lines around the world in conflicts while trying to help others. This is a group of people who have sacrificed income, wellbeing to try to help others around the world. It represents, they represent the best of, of the American bureaucracy.

And, you know, were there problems? Absolutely. And is it true that there were often, you know, liberals who kind of went too far in their programs? Again, absolutely. During Democratic administrations, USAID tended to adopt, you know, various liberal programs that weren't always very evidence-based. And then in Republican administrations, Republicans adopted various conservative programs that weren't very evidence-based and didn't always work very effectively.

So, for example, the George W. Bush administration adopted a lot of abstinence only programs to try to fight AIDs. And that money, you know, did not work well. That was an example of waste, fraud and abuse, or not. It wasn't fraud but it, it was a certain amount of waste. But, you know, these were really at the margins.

And what I have seen since is a monumental increase in waste and abuse. You know, goods sitting in warehouses unused as children die. The cost of dismantling a program turns out to be really, really expensive. And so it just breaks my heart to see a program that was doing so much good around the world in moral terms, and also in advancing American interests as well as values. And have a bunch of folks in Washington who had no idea what they were doing and took it apart in ways that are causing kids to die every day.

Anna Hickey: On that note, it's, when asked about the transition of the remaining grants and remaining work formally that USAID had done to the State Department, a senior State Department official said we do not see a gap operationally. In May, Secretary of State Marco Rubio had said no one had died due to the pause and cuts in USAID.

And in March, Elon Musk said, quote, no one has died as a result of a brief pause to do a sanity check on foreign aid funding, end quote. You visited places impacted by USAID, like South Sudan and Kenya and Sierra Leone and Liberia this year. What have you seen? Does this match what you have seen in these countries in Africa?

Nicholas Kristof: I saw kids dying. I would love to take Elon Musk and Marco Rubio along on a trip to show them the consequences of their actions. And so, for example, when I arrived in South Sudan in March to test this proposition that no one had died, in my first hour of reporting on the ground, I found multiple cases of kids who had died because we had cut off their access to antiretrovirals for HIV/AIDS.

And you know, one was a 5-year-old boy called Evan Anzo, who was an AIDS orphan. You know, and then the social workers who provided him with those ARVs were, were fired. How is a five-year-old boy in Juba, South Sudan possibly expected to find ARVs on his own? And of course he couldn't. And so his immune system was compromised and he got an opportunistic infection of pneumonia, and he died.

And he was being kept alive for less than 12 cents a day with ARVs until Elon Musk showed up at and, and, and, and just dismantled the program. And, and then at that hearing that you mentioned with Marco Rubio, one of the members of Congress displayed a picture of Evan Anzo that I'd been given, and Marco Rubio, you know, dismissed that as a lie.

And, you know, and it just feels to me like such an insult to these kids who were dying that you not only take away their medications and cause their deaths, but then you try to erase them from history. And you, you know, you don't even deny it, it's not that you say, okay, there are difficult tradeoffs and we, we accept some deaths because we wanna spend the money at home or we want to spend the money on tax breaks for the wealthy here in America.

No, you just deny the reality. And nobody who travels in these countries can be unaware that kids are dying, that moms are dying in childbirth all the time.

Anna Hickey: Your first trip to South Sudan and Kenya was during that initial foreign aid pause, and then your latter trip, Sierra Leone and Liberia, was kind of after a large amount of gutting of the agency had been conducted.

Did you see any major changes in whether or not any programs that had been paused previously had been unpaused when you revisited Africa and Sierra Leone and Liberia later in the year, or did the programs seem to be continuing to be cut and not necessarily restarted?

Nicholas Kristof: So there's been movement in both directions, frankly. So there are some programs that had been, that had been paused or canceled, particularly around PEPFAR that were revived to some degree. And so in South Sudan for example, I think things are working a little bit better now in that HIV/AIDS community of AIDS orphans, for example. I, I mean, I think perhaps partly 'cause I wrote about it.

But overall in the development space, I'd say things are getting worse, and that's because stockpiles are running out of medicines, of nutritional support, and because families supplies are running out, their stockpiles of resources are running out and they're getting weaker.

So, you know, on this trip, for example, I was in a village in Liberia, and the U.S. had provided a ambulance to reduce maternal mortality, we paid $50,000. And then we had the idea that we wanted to stop providing fuel for that ambulance. And so, you know, the fuel supply in the tank ran out.

And in April I was in a village where a woman named Yama Freeman, a mother of two, she went into labor. She, was an obstructed labor, she hemorrhaged and the family called up that ambulance crew. And the ambulance crew said, well, our, the fuel in the tank has run out and if you want the ambulance, somebody's gotta come here and bring fuel.

And of course, you know they couldn’t do that. So 10 of the strongest men in the village wrapped her, wrapped Yama up in a hammock, and they put her on their shoulders and they, they ran down the, the path toward the hospital, which was more than 10 miles away, and she was bleeding and she didn't make it, she died en route.

And so, you know, you want to talk about waste. That was, that's a waste of a $50,000 vehicle that the U.S, had provided, but it's also a waste of a mother of two who died for one of a tiny amount of fuel without any kind of a, you know, discussion with the local authorities about trying to provide some alternate source of fuel, working with NGOs or anything else. It was just utterly reckless and reflected a complete disregard for human life.

Anna Hickey: You know, Americans tend to have a more negative view on providing foreign assistance to other countries. I'm sure some people would say, I mean this is all very sad, but in America we also face a maternal mortality crisis. And why can't the Liberian government, you know, provide fuel for that ambulance once the ambulance is over there?

Why couldn't the Liberian government provide fuel? What did you see on the ground there that might, you know, provide some resistance to that government providing for its citizens?

Nicholas Kristof: So I guess I'd say a couple of things. One is that a lot of these governments are really impoverished, and so if you're the Liberian government, then you had to figure out, are your scarce resources better spent providing bed nets to protect kids from malaria or anti-malaria medicine or free maternal care, for example, free C-section so that women actually deliver in health sections or you know, do you take money from that from those needs to provide fuel for the ambulance?

And those are really hard choices and if there is discussion, then they can try to help make those choices. But in this case, the U.S. just pulled out immediately after Liberia had already created its health budget.

Now Americans also tend to talk a lot about corruption in poor countries and bad governance. And that is also true. I mean, what maybe the world's worst humanitarian crisis right now is in Sudan, and that's because you have a couple of warlords who are fighting to the last child. But it's not obvious to me that we should be punishing the children in Sudan because they had, they made the bad choice of being born in Sudan rather than in New Jersey.

And you know, so much depends on the lottery of life. If we hold that all human lives have equal value then I think we should try to do what we can when it's inexpensive to save some lives. We can't save every life, but that doesn't mean we should save none.

Aand I guess I'd also make the point that it's not just about values, but it's also about our interests. When President Kennedy started USAID in 1961, he did it to reflect our national security interests. And you know, the collapse of USAID is a gift to China. We are now competing with China in Africa, for example, for goodwill, for rare earth minerals. And one way we compete is by saving lives.

And people really do appreciate it, they understand it. They, USAID logo is one of the best known around the world. In March, I was in a village in South Sudan, and it had never had any kind of healthcare facility. And then to reduce maternal mortality, the U.S. provided funds through the UN population fund to build the first maternal clinic in November.

And so I show up and people see this white guy asking about, you know, this clinic. And everybody comes out and they thank me and they say, the elders were telling me, you know, women here aren't dying anymore. There hadn't been one maternal death or one neonatal death since that clinic went up, that U.S. funded clinic went up in November.

And there was a woman who was presently in labor and she asked my name and she wanted to name her baby after me, outta gratitude toward the U.S. And what they didn't know was that because of the USAID funding cuts and cut, and the complete withdrawal of all funding for the UN Population Fund was that that clinic was now about to be closed. And women again, were gonna be bleeding to death in the dust there.

And you know, that is a moral insult to the idea that all lives have equal value, but it's also a loss of our soft power and China is winning that game. China has been quite deliberately moving into some of these places as we pull out.

Anna Hickey: And when you've talked to people who have been impacted by these cuts or this aid freeze, what has been the reaction? Do they blame USAID? Do they blame the American people? Does anybody mention President Trump or the changing administration? How aware are they of like the politics of America impacting, you know, their health and safety?

Nicholas Kristof: So at the, at the village level, in really remote villages, people have no idea who the president of the U.S. is. They, in some cases haven't even heard of Trump. They tend to know that the U.S. provides a lot of assistance and they tend to know about USAID, but in a, a very vague way. And so they understand that USAID is being cut back and that that may be the reason why condoms are now unavailable or why anti-malarial medications are no longer available, but it's only in a pretty vague way.

On the other hand, you know, in the cities and among health workers, people are very aware. I talked to some folks in a PEPFAR program in Bo, Sierra Leone where a bunch of people had died from when ARVs were cut off. And they completely made the connection to President Trump and they were aware of his cutbacks in USAID and PEPFAR and they drew that link immediately

Anna Hickey: To drill down on the point of how the dismantling of U.S. foreign assistance impacts national security. When people talk about, like President Trump or the U.S. withdrawing aid, does that impact their view of, like America as a whole? Does it make them, when you've talked to people, do they seem to have a more negative view of America, a more positive view of China? What has been like the impact when you've talked to people?

Nicholas Kristof: So, look, I think that people's attitudes towards different countries are complicated and you know, they like America partly because they saw a Tom Cruise movie or they listened to Taylor Swift. But they also do understand that USAID has provided food, has provided assistance in natural disasters.

And, you know, meanwhile they see China, for example, building new highways. Or they often build you know, arenas for soccer, stadiums for soccer and other sports and, and, you know, that creates support as well. And so there's no one metric for this competition, but USAID is certainly a very substantial element of that, of what is shaping their views toward the U.S.

And you know, I guess I'd also just make the point that national security isn't just about soft power, although that's one element of it, but another is health security. And we protect America with aircraft carriers in the Western Pacific or in the Gulf. But we also protect America with surveillance systems to detect new diseases, to respond to Ebola or tuberculosis elsewhere before they can spread to the U.S.

And that health surveillance system has been devastated by the collapse of USAID and by the withdrawal now in the works from the World Health Organization. I think that is a incredibly narrow minded and myopic view of national security if you disregard the health element of it.

Anna Hickey: Can you explain what these health surveillance systems are? What were they actually doing? What were people doing to surveil health and how would that impact Americans?

Because I think there may be a sense of maybe there's an Ebola outbreak in the Democratic Republic of Congo, but that is an ocean and a worlds away. Why would that then come an impact me living in Washington, D.C.?

Nicholas Kristof: Sure. So, you know, you look at the Ebola outbreak, for example, in West Africa. And that was contained in West Africa. I mean, there was a real risk that it was going to get to Nigeria, explode there and start traveling around the world in ways that would've killed many Americans, would've been something like the, the pandemic that we did get later with, with COVID.

And there are other diseases as well. I mean tuberculosis, if you get a multi-drug resistant tuberculosis or even worse extremely drug resistant tuberculosis, XDRTV, then that in the U.S. costs hundreds of thousands of dollars to treat.

And it is so much more cost effective to try to stop that outbreak of Ebola in the D.R.C,, in, you know, in, in West Africa or elsewhere. There was a an outbreak of Ebola in, I think it was maybe February, and normally the U.S. helps ship the samples that are taken to labs. And all of a sudden, USAID wasn't there to do that and the World Health Organization stepped in for that step. But you know, the WHO was also getting its funds cut. And at some point, you know there are gonna be shortcuts taken, more diseases will spread in rather unpredictable ways.

And I dunno if it's gonna be Ebola, I dunno if it's gonna be TB, I dunno if it's gonna be some new avian flu, but in the same way, we don't quite know, is China gonna make a move on Taiwan? Is it gonna make a move on the Philippines? There's a lot of uncertainty in all aspects of national security. And we respond by creating surveillance systems, intelligence systems, surveillance systems at sea and the air. And we also do that with health security, and these are really cheap considering the potential costs, as we saw with COVID.

Anna Hickey: Also on the point that if the U.S. or as the U.S. kind of retracts from foreign aid and humanitarian assistance, China might step up. I mean, some people might say, great, then America doesn't have to worry about that anymore. We can save that money and put it towards Americans. China can step up and help all these people in Africa or Asia or wherever USAID had their programs.

What would your argument be for why Americans should be concerned on China expanding influence in countries that America had previously had influence in?

Nicholas Kristof: So for example, if I think over the next 10 years, you know what the biggest potential catastrophe would be, I think it's probably a U.S. China war that would be started by some incident in the Taiwan Strait or possibly in the South China Sea. And how do we reduce the risk of that happening? I think it's partly by making China realize that it would pay an enormous economic and military price if it were to engage in such behavior.

How would we determine that economic sanctions, for example, would be broadly applied around the world? In part by having a lot of friends and allies around the world by having American soft power respected. And I should also say in part, by being able to access rare earth minerals for examples from Congo or Rwanda or other countries.

And so, you know, one of the things that I think we've learned is that allies and international friends really do matter. One of the weaknesses of Russia and Iran and China for that matter in international politics, is they don't have a lot of those kinds of friends, which is precisely why Xi Jinping of China has mounted a real international effort his Belt and Road Initiative to try to spend hundreds of billions of dollars winning friends around the world. Because he sees that there is a, an economic and political and military return for doing so.

And you know, Marco Rubio was one of the advocates who emphasized the importance of these kinds of investments in soft power because there were real benefits to the U.S. and he thought that until the moment he was appointed secretary of state.

Anna Hickey: You've also written that, you know, USAID was the agency that united humanitarian values and the U.S. national interest. Some would say that, you know, the State Department can pick up this baton. They are also a, you know, executive agency that has done a lot of diplomatic work.

How have you seen the State Department in your reporting on humanitarian assistance kind of working with USAID or USAID, and are you watching anything over the next few months to see how well that they can continue the work that they choose to continue from USAID?

Nicholas Kristof: It wasn't a completely crazy idea to move USAID into the State Department. And there have been others who have advocated that over the years. But the way to do it I mean, I, I should say that I'm still skeptical of, of the idea, but it wasn't a completely crazy notion. But the way to do it would be to absorb the staff and the programs of USAID, not to fire everybody from USAID. There is a huge loss of institutional memory, of knowledge.

And the way a lot of these programs tend to be done is with a lot of interlocking parts. So, the British Aid Agency will pay for one element, the U.S. will pay for another and so on and so on. And so when you lose these programs and these staff, then it becomes very difficult to put Humpty Dumpty together again. And even if you have some elements that are intact, now all of a sudden there's no warehouse to store medicines in, or there's no one providing the transport from medicines, you know, here to there. Or there's nobody to do the testing to see who needs it.

For, I mean, for example, in Liberia, they were running out of HIV test kits, so they were no longer able to test pregnant women coming in for prenatal care to see if they were HIV positive, which means that then you don't know who to give the drugs to, to prevent mother to child transmission, to save that baby from being infected in childbirth.

And so there has been such chaos in the system. Nobody really knows what is going on. And that too has led to, to, to waste. I, you know, one, one of the things that always gets me is seeing children who were starving because they you know, they don't cry, they don't scream, they don't complain, they just look at you with this blank expression moving very slowly. And that's because the, the human body is preserving every calorie of energy to keep the major organs going and not to not to protest, even though they are in such pain. And so you see that and it just, it wounds you.

And then as I was seeing that I found that the U.S. had paid for and was and owned 678,000 boxes of this miracle peanut paste, RUTF that bring these children back from the brink, and yet it was sitting in warehouses in Rhode Island and in Georgia, and in fact, the U.S. had agreed to pay storage costs for this RUTF in Rhode Island even though it was unwilling to ship the RUTF to alleviate the starvation of these children.

You know, what kind of a world is that where we buy this life-saving substance, we pay storage costs on it, we allow it to approach its expiration date to gather dust, but we're not capable and competent enough to actually move it to so it can actually save lives?

Anna Hickey: On that, thinking about, you know, other things that you've seen during your reporting, there was one woman who I remember in, I can't remember which country you were in, but you wrote that even though she was no longer being paid by USAID, she was continuing to wear her vest.

And I wanted to ask about any of the foreign service nationals or people who were from the countries who were employed by USAID and you know, people you met there who, who was, who were still trying to do the work even though they were not getting paid and what their view of the situation was, and kind of if you have any thoughts on that.

Nicholas Kristof: I think there were a lot of folks, both American nationals and foreign nationals who were really proud of their mission with USAID and you know, did they acknowledge that there were problems and that it was bureaucratic? Absolutely. But you know, at the grassroots level, you just can't help seeing lives that are being helped and transformed and saved all the time.

And so, they felt really proud of that and they felt proud of wearing the USAID vests. And so in several countries I saw these health workers, even though they hadn't been paid, even though they officially weren't working, even though they weren't getting new medicines, they were going out in the villages person to person offering whatever counsel they could. You know, trying to figure out if a child has malaria and if so, you know, making sure that the mom went to the hospital to try to, with that baby to try to get some anti malaria medication to save its life, or that if a child had diarrhea, then try to make sure he was getting enough liquids. Things like this, really simple things that are utterly lifesaving.

You know, I think they're, they're proud of the role that they played. They're regarded with great respect. In the villages, there is, there's a group called Last Mile Health that does a lot of this in Liberia and other countries, and they could see the good work they were doing. But now they were handicapped because they weren't getting the anti-malarial medications, they weren't getting condoms or other forms of contraception to distribute. And so they were seeing people around them die unnecessarily. And when you see that up close, it wounds you. It's pretty heartbreaking.

Anna Hickey: If in 18 months or you know, I think it's three and a half years during a next Congress or a next presidential administration, there is a, you know, interest to either rebuild humanitarian assistance from the State Department or rebuild USAID, do you believe that there is, given what you've seen over the last six months in interest of people to rely on the United States again, or maybe it's too early to tell on how people may trust the U.S. going forward?

Nicholas Kristof: I think that in the development space there is more of a willingness to trust the U.S. again. I think that is less true in the case of NATO and you know, in like, I mean, I don't know to what extent Japan and South Korea and the Philippines and Australia are gonna feel confidence in the U.S., in the Western Pacific.

But I do think that in South Sudan, Sudan, Liberia, Sierra Leone, these places, moms are desperate to keep their kids alive and if aid can be revived and they can again get medicines that will be really welcomed. There's obviously been so much institutional knowledge that is lost, it'll, it'll take time to rebuild and there are people dying in the meantime. And you know, so I mentioned that mom in Liberia in that village who died, so now she's got two orphans and they're at greater risk as well.

But is there some capacity down the road to rebuild a lot of it? Yeah. And I hope that will happen.

Anna Hickey: And to kind of wrap up our discussion, is there anything else you saw in South Sudan, Liberia, Sierra Leone, or Kenya that you wanna, you know, mention or you wish I had asked about or, you know, the broader humanitarian assistance field and its connection to the U.S. national interest and national security.

Nicholas Kristof: Look, we can't save every life out there and inevitably it is gonna be higher risk to be born and grow up in South Sudan or somewhere like that. But we can save lives and improve wellbeing very inexpensively. And if any of us saw a child, you know, drowning in a creek nearby, we would immediately step over and try to help that child. We wouldn't say, oh, I might get a little mud on my shoes. And for a lot less than the cost of new shoes, we can save lives of young children in, I mean, in countries all around the world.

One of the things that struck me in particular was I was in Sierra Leone and I visited a warehouse where there were millions of doses of medicine that had been donated by American and European companies to help these kids. In particular, there's a disease called river blindness that causes excruciating blindness. And it has been, partly because of Jimmy Carter, bless his soul, there has been enormous reductions in river blindness.

And because the medicine is donated, in that case by Merck. So these are incredibly cost effective and every dollar spent on distribution leverages $26 in donated medicines. It's transformative. And yet this medicine, because the Trump administration canceled that distribution program, it's sitting in this warehouse, 7.6 million doses of that, that medicine for river blindness plus several million more doses of deworming medicine and schistosomiasis medicine.

And the upshot is it's approaching expiration, it's gathering dust. At some point if it's not distributed, then it will have to be incinerated at costs, at enormous cost and, and perhaps some risk. And you know, the idea that we would just let these donated drugs sit there and rot and expire rather than help millions of people avoid blindness. It's just a complete failure of empathy, a complete failure of, of practicality, and it's an embarrassment as an American that we'd let this happen.

Anna Hickey: And I think on that note, we'll end the conversation there. I'll say, I look forward to your future columns and any reporting you do. It's been invaluable in understanding what the end of foreign aid and humanitarian assistance means for U.S. security and people around the globe.

Nicholas Kristof: Thank you so much.

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