“Massive retrogression”: USAID cuts affect global morbidity and mortality

The US government has unleashed a whirlwind of public service cuts—those to international aid are already having life threatening consequences. Heather Rilkoff reports “What has happened has the potential to bring about massive retrogression. I’m very, very scared for the future,” Deborah Ikeh, executive director of the Debriche Health Development Centre, a non-governmental organisation (NGO) that supports community led monitoring of tuberculosis (TB) in Nigeria, says about US cuts to foreign aid. On 20 January President Donald Trump signed an executive order pausing foreign development assistance, including the United States Agency for International Development (USAID) and the President’s Emergency Plan for AIDS Relief (PEPFAR), for 90 days, pending a programme by programme review. A brief respite came a week later when the US State Department signed a waiver preserving funding for “life saving humanitarian assistance.” But then in late February the Trump administration added further confusion by terminating nearly 10 000 contracts, including some with organisations that had previously been covered under the waiver. The result is panic and uncertainty. Johns Hopkins University is reportedly being forced to make job cuts and cancel health projects—many global in scope—because of the loss of USAID funding, on top of cuts from the National Institutes of Health.1 And, says Chris Beyrer, director of the Global Health Institute at Duke University, “USAID was the implementing agency for a wide array of health and humanitarian programmes, including PEPFAR, the President’s Malaria Initiative, programmes for maternal and child health, and …