Trump’s assault on global health is cruel — and it’s making America look weak

The totalitarian playbook that Donald Trump seems to follow lacks a chapter. Power-crazed the president may be, but he fails to grasp soft power. Wise military and diplomatic minds understand it well. George C. Marshall, the nation’s top general through World War II and later secretary of state and secretary of defense, lent his name and his energies to the greatest exercise of soft power in American history, the Marshall Plan. Such was his stature that, with help from President Harry Truman and Sen. Arthur Vandenberg, he persuaded an isolationist post-World War II Congress to approve the costly program and so secured Western Europe from Soviet political control, while defining the preeminent battle line of the Cold War.

More than six decades later, Jim Mattis, a retired four-star Marine Corps general who served as secretary of defense in the first Trump administration (when experience and professionalism were sometimes entertained in the Oval Office), championed soft power as Marshall had done. In testimony to Congress in 2013, he said, “If you don’t fund the State Department fully, then I have to buy more ammunition.” He was endorsing the soft power of diplomacy — to which he might have added the soft power of non-military assistance and moral and cultural influence. Soft power is the ability to “obtain the outcomes one wants through attraction and persuasion rather than coercion and payment” — through means, that is, other than bullets, bullying and bribery.

The United States Agency for International Development, or USAID, was a lineal descendant of the Marshall Plan and an embodiment of soft power. Its abandonment and ultimate destruction by the second Trump administration marks a watershed moment in the projection of American influence globally. Next to its headstone in the graveyard of institutions, one might also place a marker for the era that publisher Henry Luce once labeled “the American Century.” Like a married couple, the agency and its century deserve to be buried together, their lives having been intertwined and their dates nearly the same.

A possibly ketamine-pumped Elon Musk, brandishing a chainsaw at the Conservative Political Action Conference in February, proved an apt image for the Trumpist demolition of government institutions this year. The hideously misnamed Department of Government Efficiency, then led by Musk, performed no meaningful analysis of which government functions were essential to preserve, let alone which civil servants had the expertise and experience to make such functions viable. Employees were simply fired en masse in the bureaucratic equivalent of a meat-cleaver amputation (no scalpels involved).

Initially, there was no plan to demolish USAID, just shrink it. However, what began as layoffs and the appointment of unqualified individuals to positions of authority led to resistance from employees loyal to their agency and their mission. That, in turn, prompted further cycles of layoffs and demolition. When the red mist of fighting finally lifted, there wasn’t much left of the agency. Its remains were swept into the State Department, accompanied by solemn assurances that vital humanitarian programs had not been and would not be compromised, assurances no more real than an invitation to buy the Brooklyn Bridge.

Yes, USAID had problems. What $30-billion-a-year organization doesn’t? Some of its long-term advocates decried its faults as loudly as any MAGA cheerleader. In the words of one veteran partner of the agency, “The bureaucracy… was legion, hugely frustrating. In order to donate/spend a dollar you had to spend three, just to make sure the treasury wasn’t getting ripped off.”

It’s vital to understand that the agency’s sclerotic procedures and glacially slow decision-making resulted not from the rampant waste, fraud and abuse alleged by Trumpists but in order to avoid those evils. As a top executive of one of USAID’s largest contractors told me, “Outside auditors were never not in our offices.” Every expenditure was examined, checked against the highly detailed contract and program of work, and verified.

In cases where speed was necessary or where arrangements in some back-of-beyond province were too fragile, USAID bypassed its labyrinthine contracting process and made direct grants to non-governmental organizations, or NGOs, that were locally based and staffed whenever possible. Admittedly, in those cases financial controls were looser, usually because scant infrastructure and operational uncertainties made bean-counting impossible. Sometimes, to build capacity or save lives, a relief organization simply has to wing it. It’s tough to have it both ways.

The Trump administration’s diligent researchers wasted no time in unearthing the most egregious examples of abuse. In her first White House briefing, press secretary Karoline Leavitt bragged that the administration had blocked a lunatic plan to buy $50 million worth of condoms for Palestinians in Gaza. A victory for common sense, right?

Wrong! The Gaza in question was a province of Mozambique, 29,000 square miles in size and supporting a population of about 1.4 million. The USAID grant would have funded family planning services in that poverty-stricken region. The confusion no doubt derived from a DOGE word search, similar to the one that caused photos of the B-29 that dropped the atomic bomb on Hiroshima to be marked for deletion from Defense Department websites because, well, the plane’s name was Enola Gay, which to Elon Musk’s whiz kiddies sounded DEI-ish. (Actually the plane was named for the pilot’s mother.)

Even after the mistake was reported to the White House, Trump repeated it (with elaboration): “We identified and stopped $50 million being sent to Gaza to buy condoms for Hamas… They’ve used them as a method for making bombs.”

Possibly his staff lacked the guts to tell him the boast wasn’t true. Possibly he thought it was just too good a line not to use.

The humanitarian consequences of USAID’s destruction have not gone unnoticed. Issue-specific websites have sprung up to tally the cost in money and lives. The New York Times, Washington Post and other leading news outlets have published dispatches from impacted areas documenting the harm being done. Esteemed journals like the Lancet and Science have published reports from ongoing field studies predicting dire outcomes. When I’ve brought such sources to the attention of ostensibly intelligent members of the MAGA faithful, I’ve been told that the estimated losses can’t be modeled, or that ChatGPT says the models are flawed, or that domestic humanitarian needs should take priority over foreign ones. Sound familiar? It’s climate-change denial in a new suit of clothes.

Such debating tactics track well with Dietrich Bonhoeffer’s analysis of stupidity. In his telling, stupidity is “not an intellectual defect but a human one.” Bonhoeffer deemed stupidity “more dangerous” than evil because, unlike evil, it cannot be directly contested. Bonhoeffer, a German anti-fascist who died for his heroism in 1945, described the characteristics of stupidity this way: “reasons fall on deaf ears; facts that contradict one’s prejudgment simply need not be believed… and when facts are irrefutable they are just pushed aside as inconsequential.”

Zambia provides some consequential facts: USAID assistance to Zambia peaked in 2024 at $409 million. Assistance under the Trump regime for 2025 has plummeted to $61.6 million, a decrease of 85%. More than half of those funds ($34 million) are marked for combatting HIV/AIDS, which sounds reassuring. Essential stuff will still get done, right? Oops, sorry, the previous 10-year average for USAID’s Zambia HIV/AIDS program was $147.7 million (and those years included both the first Trump administration and the chaos of the COVID pandemic years).

When you slash a program by 85%, what happens to the mothers and children who depend on it for life-saving therapies? Even if you continue to buy some of the drugs, you still have to deliver them to widely dispersed patients in countries with limited transportation infrastructure. So, if the administrators, warehousemen, truck drivers and clinicians who make the system work have been fired, and if the warehouse and office leases have been terminated, and now fuel-less, unrepaired trucks remain mothballed, maybe the drugs will find their way to the dump or the black market, but they surely won’t be going where originally intended or most needed.

Something similar happened to 500 metric tons of high-energy food bars stockpiled in Dubai in the United Arab Emirates and intended for mothers and children facing malnutrition. Trump officials, with a customary lack of accountability, blamed the Biden administration for having bought too much, creating an unneeded surplus. Now that the use period for the bars has expired, they will be burned, dumped or converted to animal feed. Evidently, the Trump administration failed to find any people who needed nourishment. One wonders if they looked in South Sudan. Or in Gaza. No, not that Gaza! The other one.

USAID wasn’t the only U.S. agency fighting HIV/AIDS in Zambia, nor was the U.S. the only nation in the fight, but the U.S. provided about 44% of overall funding for the program. Here’s what we and our global partners, including Zambia itself, managed to accomplish: “Despite population increase, AIDS-related deaths in Zambia dropped from 120,000 in 2001 to 19,000 in 2022” — that’s a drop of 84%. Elizabeth Burleigh, an international health expert with nearly three decades of experience with USAID in Latin America and Africa, provided me with those numbers. As she put it, “This was due to global efforts in prevention, particularly the use of condoms and reduction in the practice of multiple concurrent partnerships, and to increased access to anti-retroviral therapy.” The near-conquest of HIV/AIDS in Zambia is a great story and it’s not the only one.

In Africa, malaria kills far more people than AIDS, but the fight against that grim disease has been hugely successful, too. Its incidence in Zambia has dropped by two-thirds since 1996, when the U.S. began funding malaria control. Children under five and pregnant mothers, both of whom are especially vulnerable, have seen their rates of infection drop by half in those years. Currently, the U.S. provides about a third of anti-malarial funding in that country. President Trump’s current budget proposal for FY 2026, however, would cut that contribution by half.

The story of tuberculosis, Burleigh points out, is another chronicle of reduced infection rates and lives saved. But here’s the catch: If you’re serious about controlling infectious disease, as the U.S. used to be, you commit to the long haul. You don’t turn the funding on and off like a spigot. If you do turn it off, as the Trump administration has indeed done, you have to expect significantly more people to get sick and many of them to die, while hard-earned progress in reversing the spread of debilitating and often fatal diseases will itself be reversed. You can visualize the outcome of funding cuts for HIV/AIDS, malaria and tuberculosis in a two-line graph: long-term funding gradually rises over a period of decades until 2025, when it suddenly plunges, while the long-term trend of diminishing deaths, inversely proportionate to funding, ceases its decline and begins to leap upward.

One might sensibly strive to reform and improve USAID or, if termination were imperative, to at least devise a thoughtful and compassionate strategy for weaning countries, patients and other beneficiaries from its programs. What stands out amid the carnage wrought by the Trumpists, however, is its sheer meanness. In the mob world, “making your bones” is shorthand for establishing your bona fides. Part of the mythology of gangsterdom is that an entry-level thug makes his bones by murdering someone. Contemporary bro culture features an analog to this. A true bro cultivates a harsh, insouciant machismo. He’s no softie and he’s not afraid to be cruel. He’s Joe Rogan. He’s Stephen Miller. He’s Pete Hegseth. He’s Russell Vought, Trump’s director of the Office of Management and Budget and an architect of Project 2025. Vought has said publicly of federal employees: “We want to put them in trauma.” Within the bro culture now ascendant in the Oval Office, compassion has become a form of squeamishness — and the people USAID used to serve are paying the price.

Should we care about the deaths caused by abrogating our commitments? Should the abandonment of possibly hundreds of thousands of individual human beings in mid-treatment trouble our sleep? Well, for perspective, it may be worth knowing that Trump’s crew is doing the same thing to thousands of as-yet-uncounted American citizens, thanks to chainsaw cuts to the budget of the National Institutes of Health, the largest funder of biomedical research on the planet. NIH has been forced to terminate research-funding affecting at least 113 clinical trials around the country involving thousands of patients. Some of those participants were being kept alive by the therapies the trials provided. Some have devices planted in their bodies, including experimental brain implants, that will no longer be serviced or monitored. Good luck to them.

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And let’s not even talk about the impacts on non-human subjects in terminated medical research programs. No one wants to think about the millions of laboratory rodents and the thousands of macaques and other primates that will be euthanized because the government has reneged on their support. In some cases, the animals represent genetic strains that have been developed over many years and their loss will compromise prospects for future research for many years to come. Bones, indeed. The Trump administration is making a lot of bones.

Let’s talk, for a moment, about self-interest. What good did USAID do for this country? For starters, it created markets for our goods, especially agricultural surpluses, which USAID was still purchasing to the tune of several billion dollars annually before the recent chainsaws arrived. The shopping list grew longer with time and lately included billions of dollars-worth of drugs, test kits, contraceptives, medical equipment, personal protective equipment, computers (to help curb all that waste, fraud and abuse), construction equipment and goodness knows what else — the whole catalog of things that people, institutions, and developing nations need. Buy America!

Add to that the friends (or in some cases the non-enemies we made): the millions of refugees in camps around the world who saw “USDA” (United States Department of Agriculture) stamped on the bags of meal and beans that kept them alive; the patients and staff of the clinics and medical programs we funded; the in-country employees of not just USAID and its contractors but the NGOs that carried out so much of the agency’s programmatic work; the government officials whose agendas we advanced (and with our money also shaped); and our global partners, both other nations and multinational alliances, to whom we made what seemed to be solemn, multi-year commitments. Can you blame any of them for now feeling betrayed?

The list of benefits also included intelligence, the kind not gathered by spies but by something better: having eyes and ears in places where it’s hard to go, having a network of care and reciprocity that wrapped around the world, creating a “distant early warning” system for everything from epidemics to grassroots discontent. And yes, there were other, unquantifiable gains to be made for national security, because where misery and instability decline, peace can grow. That’s good for America and good for American businesses.

And then there’s the issue of influence, if not hegemony. In the capitals and far corners of the developing world, which superpower will people and their governments favor when a choice is to be made? Now that the many nations and populations that USAID once cultivated, provisioned and cared for feel double-crossed by the Trump regime, who will benefit most? (Xi Jinping, is that a smile on your face?)

Donald J. Trump and his minions think they’re right to put America first. What they don’t understand is that, defined in their narrow way, “America First” is America Alone. In an interconnected world, those who are alone, to use a favorite word of the president’s, are losers.