In January 2025, near the beginning of his second presidency, Donald Trump ordered a near-total freeze on foreign aid,[2] followed by placing most employees on administrative leave.[3] This led to multiple lawsuits being filed against the Trump administration.
The demise of USAID has had a large impact on global health, with a study in June 2025 estimating that funding cuts and the abolition of the agency could result in at least 14 million preventable deaths by 2030, 4.5 million of which could be among children under 5 years old.[4]
On January 24, 2025, during the second Trump administration, President Donald Trump ordered a near-total freeze on all foreign aid.[2][5][6][7] In February, the administration placed most employees on administrative leave.[3] Multiple lawsuits were filed against the Trump administration alleging that these actions were not within its powers without congressional authorization.[8][9] Also in February, the administration made several allegations of wasteful spending and fraud. An analysis by Al Jazeera reported the claims regarding fraud to be unsubstantiated.[10] An analysis by The Washington Post found some of the claims made by the administration regarding USAID spending to be misleading.[11]
Several days later, Secretary of State Marco Rubio issued a waiver for humanitarian aid.[12][13] However, a key issue developed over whether the waivers for lifesaving aid were actually translating into aid flowing.[14][15] Despite the waiver, there was still much confusion about what agencies should do.[14][15] More than 1,000 USAID employees and contractors were fired or furloughed following the near-total freeze on U.S. global assistance that the second Trump administration implemented.[16][17][18][19]
On January 27, 2025, the agency's official government website was shut down.[20]
Role of Elon Musk
On January 30, 2025, Elon Musk demanded that Jason Gray, acting administrator of USAID at that time, shut off email and cellphone access for USAID workers around the world, including in conflict zones. Gray refused, saying that doing so would put their lives at risk. By the next day, Gray was removed from his post.[21]
On February 3, 2025, Elon Musk, who has been carrying out parts of Trump's cost-cutting agenda, announced that he and Trump were in the process of shutting down USAID, claiming it to be a "criminal organization" and that it was "beyond repair".[22][23] Because USAID's Inspector General had previously launched a probe into Starlink, Musk was criticized as having a conflict of interest.[24][25]
Andrew Natsios, the administrator for USAID during the George W. Bush administration, told PBS that, "With all due respect, none of these people know anything about AID. What does Musk know about international development? Absolutely nothing. He has a bunch of young kids in their 20s. They don't know. They're techies. They don't know anything about international development. They don't know anything about the Global South."[26]
Taping over a USAID sign at the Ronald Reagan Building in Washington, DC on February 7, 2025
It was announced that on February 6, 2025, at 11:59 pm (EST) all USAID direct hire personnel would be placed on administrative leave globally, with the exception of designated personnel responsible for mission-critical functions, core leadership and specially designated programs.[31]
Initial effects on health assistance
On February 6, 2025, reports indicated that the total number of employees to be retained was 294, out of a total of more than 10,000.[32][33] Trump declared that agency leaders were "radical left lunatics", while the State Department ordered them to halt virtually all their projects, even if that meant ceasing programs that helped to eradicate smallpox and prevented millions of HIV cases.[34] The freeze in HIV relief programs, including PEPFAR, is estimated to jeopardize treatment access for 20 million people, including 500,000 children.[35] This drastic action led to sudden pauses in over 30 clinical trials for ailments such as HIV, malaria, cholera, cervical cancer, and tuberculosis, leaving participants with medical devices in their bodies and cut off from researchers, likely going against the principles of the Declaration of Helsinki.[36]
Initial effects on wartime assistance
It also led to a pause in other efforts such as wartime help in Ukraine, hospital assistance in Syria, education programs in Mali, and conservation efforts in the Amazon rainforest.[37]
On February 6, CBS News reported that due to the civil war in Sudan, often called the "Forgotten War" because it receives comparatively little attention compared to the Ukraine and Gaza, an estimated 3 million children under age 5 are suffering from acute malnutrition. In September 2024, the Biden administration planned for $424 million in new humanitarian assistance for Sudanese persons, including $276 million being sent through USAID. However, the Trump administration's 90-day freeze interrupted this.[38]
The American Farm Bureau Federation stated, "AID plays a critical role in reducing hunger around the world while sourcing markets for the surplus foods America's farmers and ranchers grow".[39]
Famine Early Warning
CNN reported on March 9 that the Famine Early Warning Systems Network (FEWS NET) had stopped operating and had its data pulled offline. FEWS NET had been considered the "gold standard" of famine warning, providing 8-month projections of food security issues.[40]
The Integrated Food Security Phase Classification (IPC) is another early-warning system supported by various governments, including the United States. IPC uses volunteers for specific country analysis, whereas FEW NETS had used paid staff.[40]
Reduction to 17% of programs
On March 10, 2025, U.S. secretary of state Marco Rubio announced that the Trump administration had concluded its review, and 83% of USAID's programs would be cancelled, involving approximately 5,200 contracts.[41][42]
Gavi Foundation and vaccines
On March 24, 2025, the Department of Government Efficiency (DOGE) announced the termination of a $2.63 billion grant from USAID to the Gavi Foundation because the Gavi Foundation "prioritizes 'zero-dose' children."[43][44] DOGE stated the United States federal government saved $1.75 billion by cancelling the grant, which was a little less than 7% of the total USAID budget.[44]
Partial add-backs for UN World Food Programme
On April 8, 2025, USAID announced it was making some exceptions to the recent announcement of cancelled participation in the UN's World Food Programme. Specifically, USAID was restoring food aid to Lebanon, Syria, Somalia, Jordan, Iraq and Ecuador, and other countries for a total of 14 nations (plus the International Organization for Migration in the Pacific region).[45] However, food aid was not restored to Yemen or Afghanistan with a State Department spokesperson saying this was "based on concern that the funding was benefiting terrorist groups, including the Houthis and the Taliban."[46]
Competition with China
Senator Roger Wicker (R-Mississippi) said, "I have felt for a long time that USAID is our way to combat the [$1 trillion] Belt and Road Initiative, which is China's effort to really gain influence around the world, including Africa and South America in the Western Hemisphere." In addition, China often completes such projects on the basis of loans, not grants.[47][48] Since 2000, African countries have been the recipient of over $182 billion in Chinese loans, with interest rates averaging about 3%.[49]
In February 2025, China pledged an additional $4.4 million to de-mining efforts in Cambodia.[50]
Regarding the March 28 Myanmar earthquake, a U.S. State Department spokesperson stated that the United States is working through local partners in Myanmar, and said, "The success in the work and our impact will still be there." However, a former USAID mission head in Myanmar said, "This is the new normal. This is what it looks like when the United States sits on the international sidelines, when the United States is a weaker international player, when it cedes the space to other global players like China."[51][52] Other potential issues are secondary crisis(es) from diseases such as cholera which can appear in the days and weeks following a disaster.[53]
Michael Sobolik, a China analyst at the conservative Hudson Institute think tank and a former aide to Senator Ted Cruz (R-Texas), has stated, "Sure, USAID was doing some highly questionable stuff that's worthy of review. But don't throw the baby out with the bathwater. Beijing is hoping we do exactly that."[48]
Lawsuits
Case
Court
Case no.(s)
First filing date
Outcome
Notes
American Foreign Service Association, et al. v. Trump, et al.[54]
However, on February 21, 2025, Judge Nichols reversed himself and cleared the way for the Trump administration to move forward with thousands of layoffs of USAID staffers, as well as providing those abroad with a 30-day deadline to move back to the United States at government expense.[61][62][63] Nichols had previously stated that these Trump administration policies threatened the safety of USAID workers abroad because many were deployed in unstable regions.[64][65]
5-4 Supreme Court decision that completed projects must be paid for
On February 10, 2025, the AIDS Vaccine Advocacy Coalition and the Journalism Development Network filed suit in District Court seeking a preliminary injunction that would prevent the enforcement of the 90-day freeze.[54][66]
On February 13, 2025, a district court ruled that the government must pay $2 billion for projects already completed. On March 5, 2025, the United States Supreme Court ruled 5-4 that the federal government must pay for completed projects. Voting in the majority were the three Democratic appointees justices Sotomayor, Kagan, and Jackson, and Republican appointees Chief Justice Roberts and Justice Barrett. Voting in the minority were the four other Republican appointees justices Thomas, Alito, Gorsuch, and Kavanaugh. However, the district judge was ordered to proceed with "due regard for the feasibility of any compliance timelines."[67][68][69][70]
On March 11, Associated Press reported that "until recently" no payments had been made because DOGE had disabled the payment system.[68] On March 20, Reuters reported that the Trump administration was close to paying the $671 million owed for projects completed by the organizations which had sued.[71]
Lawsuit which claimed Musk needed Senate confirmation
On March 18, 2025, U.S. district judge Theodore Chuang ruled that Musk's and DOGE's actions in placing USAID employees on leave were likely unconstitutional. Judge Chuang issued a preliminary injunction against further employees being placed on leave, buildings being closed, or websites having their contents deleted.[72][73]
On March 28, 2025, the U.S. Fourth Circuit Court of Appeals overruled Judge Chuang on the preliminary injunction, without deciding the merits.[74][75] Judge Marvin Quattlebaum wrote, "And none of this is to say that plaintiffs will not be able to develop evidence of unconstitutional conduct as the case progresses. Time will tell."[74]
Absorption by State Department
On March 28, 2025, U.S. secretary of state Marco Rubio notified Congress that USAID would be dissolved and absorbed into the U.S. State Department, stating that USAID had been fiscally irresponsible and strayed from original mission.[76] He argued, "Unfortunately, USAID strayed from its original mission long ago. As a result, the gains were too few and the costs were too high."[77]
Since July 1, 2025, USAID's operations have ceased and U.S. foreign assistance has now been administered by the U.S. State Department.[78][79][80] In connection with this effort, 83% of USAID programs were canceled,[81] and 94% of staff were laid off.[82]
Representative Jim Himes (D-Conn.), the top Democrat on the House Intelligence Committee, stated as an example of what he viewed as abrupt and irresponsible cost-cutting: "Thanks to DOGE, the men we paid to guard the most vicious ISIS terrorists in the world in Syria walked off the job."[77]
USAID employees were not automatically transferred. Instead, the State Department is engaging in a "separate and independent hiring process."[83]
Impact of the demise of USAID on global health
The impact of the demise of USAID on global health is wide-reaching.[84] A study published in The Lancet on June 30, 2025, estimated that funding cuts and the abolition of the agency could result in at least 14 million preventable deaths by 2030, 4.5 million of which could be among children under 5 years old.[4]
PEPFAR and HIV medication
The Lancet study concluded that the discontinuation of PEPFAR alone could cause as many as 10.75 million new HIV infections and as many as 2.93 million deaths related to HIV. The study warned that for low and middle income countries, "the resulting shock would be similar in scale to a global pandemic or a major armed conflict."[4]
Another study published in March 2025 concluded that the suspension of PEPFAR could result in HIV-related deaths surging to as high as 630,000 per year.[85] Christine Stegling, deputy executive director at UNAIDS, estimated that there could be a 400% increase in AIDS-related deaths around the world if PEPFAR was not formally reauthorized for USAID funding, which represents around 6.3 million AIDS-related deaths within four years.[86][87] In 2024, PEPFAR funds accounted for 14% of the entire health budget of Zimbabwe.[49]
In March 2025, experts from the Center for Global Development estimated that before the freeze, USAID programs annually prevented approximately 1,650,000 deaths from HIV/AIDS, 500,000 deaths from lack of vaccines, 310,000 deaths from tuberculosis and 290,000 deaths from malaria.[88][89]
Breastfeeding and maternal health
USAID-funded breast feeding programs to reduce malnutrition in Nepal were brought to a halt following the aid freeze on January 20, 2025.[90]
According to Pio Smith, UNFPA's Asia-Pacific regional director, the USAID freeze could lead to 1,200 maternal deaths and 109,000 additional unwanted pregnancies in the next three years in Afghanistan.[91]
March USAID memo
A USAID info memo written by Nicholas Enrich, Acting Assistant Administrator for Global Health, dated March 4, 2025, outlined the risks of the aid freeze. He stated that a permanent suspension of lifesaving humanitarian aid posed a direct threat to public health, economic stability, national security and biothreat vulnerability. He concluded: "Any decision to halt or significantly reduce global health funding for lifesaving humanitarian assistance (LHA)—despite approved waivers—and USAID global health programming, despite congressional mandates, would have severe domestic and global consequences."[92] Enrich was notified that he was put on administrative leave less than 30 minutes after the memo's publication, a decision that had reportedly been made a week prior.[93]
Cases refuting claim that no one has died
Pe Kha Lau, 71, died after she was discharged from a USAID-funded healthcare facility operated by the International Rescue Committee (IRC) while still relying on oxygen to survive. In the Umpiem Mai camp in Thailand, witnesses reported the deaths of multiple patients who too relied on oxygen. The IRC offered their condolences to the family and friends of Pe Kha Lau.[94]Nicholas Kristof also documented evidence contradicting Elon Musk's claim that "No one has died as a result of a brief pause to do a sanity check on foreign aid funding. No one."[88] Secretary of State Marco Rubio similarly claimed while testifying before Congress that no death resulted from the shutdown.[95]
Incineration of emergency food
In July 2025 The Atlantic reported that the order had been given to incinerate nearly 500 metric tons of emergency food. Citing former and current government employees, The Atlantic wrote that USAID had already bought the food, some $800,000 of high-energy biscuits (a stopgap measure for feeding children under 5) for the World Food Programme to distribute in Afghanistan and Pakistan. Instead, it remained in a warehouse in Dubai for months, was set to expire the day after the report, and would deteriorate quickly and be incinerated at a cost of $130,000. Employees could no longer ship the food without the permission of the new heads of American foreign assistance, which had been requested repeatedly. The Atlantic cited the sources as saying that improper storage or delivery complications such as floods or terrorism might previously have cost the agency a few dozen tons of fortified foods a year at most, and that they'd never before seen the U.S. government give up on food that could have been put to good use.[96]
Secretary of State Marco Rubio testified before the House Appropriations Committee in May that the food would be distributed before spoiling. The Atlantic's reporter stated she'd reviewed the incineration order, which had been given by the time of Rubio's testimony.[96] These high-energy biscuits are estimated to be able to feed 1.5 million children for a week. This food was previously under the authority of Pete Marocco, and then under the authority of Jeremy Lewin.[97]
Waste of mpox vaccines
According to Africa CDC nearly 800,000 doses of mpox vaccine the Biden administration had pledged to donate to African countries could not be shipped as they had not been sent by the time they had a remaining shelf life of under six months, which Africa CDC described as the minimum time required to ship vaccines in order to ensure arrival in good condition and allow implementation. Politico noted that the loss of the shots came after the Trump administration cut back on foreign aid programs and closed USAID, and that although the U.S. had not disclosed their price, UNICEF described a price of "up to $65" per dose as "the lowest price in the market."[98]
Reuters had reported in June that contraceptives meant largely for vulnerable women in Sub-Saharan Africa, including young girls who face higher risks from pregnancy as well as those fleeing conflict or who could not otherwise afford or access contraceptives, had been warehoused in Belgium and Dubai for months following Trump's cuts to foreign aid and USAID.[100] In its July article Reuters reported that the Belgian stockpile would be incinerated in France as medical waste, costing $160,000 and likely comprising "dozens of truckloads". The Belgium foreign ministry told Reuters it had "explored all possible options to prevent the destruction" and would keep trying. Reuters reported that the United Nations Population Fund (UNPFA) tried to buy the contraceptives. However, the fact that contraceptives were embossed with the USAID trademark was a problem, as was the way the U.S. could not ensure UNFPA would not share them with groups offering abortions, violating the Mexico City policy Trump had reinstated in January. Sarah Shaw, nonprofitMSI Reproductive Choices' Associate Director of Advocacy, told Reuters the organization had volunteered for pay for repackaging the supplies to remove USAID branding, shipping them, and for import duties, but the U.S. government declined, saying it would only sell the supplies at full market value. Shaw added that this was "clearly not about saving money." A source in this Reuters article concluded that "Washington did not want any USAID-branded supplies to be rerouted elsewhere."[99]
Citing unnamed sources and an internal document listing warehouse stocks, Reuters reported the contraceptives were due to expire between April 2027 and September 2031.[99]
Counter which estimates preventable deaths
Brooke Nichols, an infectious disease modeler working at Boston University,[101] created an impact counter to estimate the life toll of funding cuts on various USAID health programs.[102][103] As of January 1, 2026, the counter estimates that over 720,200 deaths have been caused by the funding discontinuation, over 480,300 of which are children.[104][105]
Malaria
The President's Malaria Initiative, started with help from George W. Bush, has contributed to a more than 60% reduction in malaria deaths, saved 7.6 million lives, and prevented 1.5 billion malaria cases globally between 2000 and 2019.[106] PMI has supported malaria prevention and control for over 500 million at-risk people in Africa.[107]
However, the USAID funding of PMI has been cut an estimated 47% as of June 2025. In countries such as the Democratic Republic of the Congo (DRC), these funds had supported the supply of antimalarial drugs to numerous health zones, including preventive treatments for pregnant women. Health officials in the DRC reported that the effects of these cuts were already being felt, with increased risk of severe illness and death from malaria among vulnerable populations.[108] Former aid workers and experts also expressed concern that reduced funding undermined disease surveillance systems that help detect malaria and other outbreaks early. Such surveillance not only protects affected countries but also contributes to U.S. health security by limiting the global spread of disease.[108] Aid organizations also highlighted how these cuts create a "vicious cycle", with malnutrition and malaria reinforcing one another. Reductions in U.S. support for nutrition programs increase children's vulnerability to malaria and other diseases, while higher malaria infections can worsen malnutrition.[108]
Humanitarian crisis in Haiti
In July 2025, the United Nations reported that the cut of USAID funding to Haiti represents a halt of approximately 80% of US-funded programmes. Food security, access to drinking water, primary healthcare, education and protection are all affected. Children are among the hardest hit. Modibo Traore, United Nations OCHA's country director in Haiti, said, "The withdrawal of US funding has led to a multidimensional regression in the rights of women and girls in Haiti."[109]
$8 billion "claw back" for USAID but not PEPFAR
In June 2025, the White House requested that Congress pass a package of rescissions, or "claw backs", of approximately $8 billion in foreign aid and $1 billion for the Corporation for Public Broadcasting.[110]
The House of Representatives passed the cuts as requested. The Senate excluded the PEPFAR cuts, which is the program started in 2003 during the presidency of George W Bush to help provide HIV medicines to lower-income countries. The Senate passed two preliminary votes in close 51-50 fashion with Vice-president JD Vance casting the tie-breaking votes. A rescission is one of the exceptions to the Senate's 60-vote filibuster rule.[110]
On July 10, President Trump focused on the public broadcasting aspect, criticizing CNN, and also "MSDNC" which is a portmanteau ("smash up") of MSNBC and DNC (Democratic National Committee). In a social media post, he wrote, "Any Republican that votes to allow this monstrosity to continue broadcasting will not have my support or Endorsement."[111]
On July 17, the Senate voted 51–48 in favor of the cuts. Later that same day, the House of Representatives voted 216–213 for the Senate version, meaning PEPFAR was protected in the amount of $400 million.[111] Regarding the cuts to public broadcasting, service to rural areas became one of the political issues.[112]
July 2025 reports that PEPFAR had been cut 50% back in February
In July 2025, four congressional aides reported that cuts by the Trump administration in February effectively put many contracts on hold. The aides stated that many of the promised waivers did not translate to action and an estimated 50% of budgeted money did not flow to providers.[113]
Range of avoidable deaths if all Trump-era cuts continue
An article updated July 2025 in The Lancet estimates 4.5 million avoidable deaths in children under five years by 2030 if all spending cuts continue (cuts in both PEPFAR and broader aid). These estimates ranged between 3.1 and 5.9 million.[4]
In an article published the same month, Kelsey Piper writing for Vox argues that it is difficult to predict the extent to which other nonprofits and governments will take the place of USAID cuts. She notes that even the most rigorous research must make large assumptions, and contends that if the numbers are over-estimated, opponents may be able to "dismiss the entire foreign aid project as one run by politically motivated liars." Additionally, Piper said, "The White House has repeatedly lost when seeking congressional approval to dismantle our best-performing life-saving programs. So the administration has resorted to doing it piecewise and, as much as possible, avoiding a public debate."[114]
Another attempted $5 billion in cuts, in form of "pocket rescission" in September
In late August, President Trump informed House speaker Mike Johnson, that he would not spend $4.9 billion in foreign aid which Congress already approved. This is a "pocket rescission", in which a president announces money will not be spent shortly before the 30 September end of the fiscal year, preventing Congress from acting on his request within 45 days. The Guardian states this is the first time in 50 years such a rescission has been made.[115]
In early September, a district judge ordered the Trump administration to spend those funds. On appeal, Chief Justice John Roberts, who handles emergency petitions for Washington DC, gave aid groups who had sued until September 12 to file a response.[115]
Some of the money was scheduled to go to United Nations organizations and peacekeeping purposes, as well as projects of economic development assistance and democracy promotion.[115]
Expanded anti-abortion and anti-DEI policies effective February 26, 2026
In mid-January 2026, the Trump administration adopted new stricter policies effective February 26, 2026, for both anti-abortion goals and anti-DEI goals (DEI stands for Diversity, Equity, and Inclusion). Since the Reagan administration in the 1980s, U.S. money could not be used for abortions. Each subsequent Democratic administration repealed that policy and each subsequent Republican administration put it back in place, as the Trump administration did early in his second term.[116]
The new policy bars organizations which receive U.S. money from either performing or recommending abortions, even with non-U.S. money. In addition, the organization cannot promote DEI goals. The policy states that the banned activities are to “provide or promote abortion as a method of family planning; Promote gender ideology; Promote discriminatory equity ideology; or Engage in unlawful diversity, equity, and inclusion-related discrimination.”[116]
Secretary of State Marco Rubio can issue limited waivers so that the new policy will not “unduly disrupt ongoing lifesaving programming, disaster response, and other critical priorities.”[116]
A critic stated that the new policy “will affect access to safe spaces for survivors of gender-based violence, efforts to increase women’s representation in peacebuilding initiatives, and a host of other work.” The cable announcing the new policy stated that it’s in line with the Trump policy to focus “resources on programs that are designed to effectively and efficiently save lives, support allies, and create commercial opportunities that benefit the American economy.”[116]
↑Enrich, Nicholas (3 March 2025). "Info memo for the USAID administrator and deputy administrator". The New York Times. p.20. Archived from the original on 3 March 2025. Retrieved 9 April 2025. The temporary pause on foreign aid and delays in approving lifesaving humanitarian assistance (LHA) for global health will lead to increased death and disability, accelerate global disease spread, contribute to destabilizing fragile regions, and heightened security risks - directly endangering American national security, economic stability, and public health
↑"Impact Metrics Dashboard". Impact Counter. Retrieved January 1, 2026. This dashboard visualizes the human impact of funding changes for aid and support organizations. Each metric represents real people affected by policy decisions.
123Lauren Kent; Nimi Princewill (June 11, 2025). "US foreign aid cuts threaten decades of progress on driving down malaria". CNN News. Aid organizations prepare for the annual peak of malnutrition – when fall harvests have yet to arrive and rainy seasons have increased malaria cases – by stockpiling ready-to-use therapeutic food sachets. But for this year's lean season, Mouly said there is 'uncertainty' about their availability.
12"Senate to vote to formalize DOGE cuts to public broadcasting, USAID", ABC News, July 14, 2025. In a post on July 10, President Trump said, "It is very important that all Republicans adhere to my Recissions Bill and, in particular, DEFUND THE CORPORATION FOR PUBLIC BROADCASTING (PBS and NPR), which is worse than CNN & MSDNC put together. Any Republican that votes to allow this monstrosity to continue broadcasting will not have my support or Endorsement. Thank you for your attention to this matter!"
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