On inauguration day, President Trump ordered a sweeping 90-day spending freeze on virtually all U.S. foreign aid, including many forms of health and food assistance. An independent agency, the United States Agency for International Development, is the most prominent entity to be severely impacted. It appears that now, beyond a stoppage of USAID activities, senior officials at the agency have been placed on administrative leave while Trump and cabinet members consider the entity’s future.
USA Today says that the USAID’s website is offline and that employees have been told to stay home on Monday, with security guards blocking the entrance. While this was happening, Elon Musk announced on X that he and Trump plan to shut down the USAID entirely.
The USAID undertakes a wide range of activities, which include among other things food aid and distribution (often in conflict zones), clean water provision, maternal and infant health support, mass administration of rehydration salts for children suffering from diarrhea, malaria prevention and treatments and polio vaccinations in countries where the disease is still endemic.
Ostensibly, agencies whose mission is to provide foreign aid are undergoing a three-month review by the Trump administration. Secretary of State Marco Rubio says that he is now acting director of USAID and will assess how money is being allocated. He declared that the dollars being spent must be “justified” by evidence that such expenditures make the U.S. “safer, stronger and more prosperous.”
Though unclear exactly what role Musk plays in determining USAID’s future, he has been given an office in the White House to run what Trump is calling the Department of Government Efficiency. Presumably, Musk’s task is to cut $2 trillion from government spending, with foreign aid being an area in which substantial budget reductions would apply.
It remains to be seen, however, whether USAID will be completely dismantled. This may depend on which parts of USAID’s work meet the criteria laid out by Secretary Rubio. The BBC reports that the Trump administration may have plans to merge it with the U.S. Department of State, where in all likelihood there would be a significant curtailment in its funding and workforce.
The USAID was established under President John F. Kennedy in the early 1960s to administer humanitarian aid programs around the world on behalf of the U.S. federal government. Congress appropriates funds for USAID’s operations. The agency employs roughly 10,000 people, two-thirds of whom work overseas. In fiscal year 2024, the agency received more than $44 billion in federal funding. Most of that money is spent in Asia, sub-Saharan Africa and Europe (primarily on humanitarian efforts in Ukraine). While a considerable sum, it merely accounts for 0.4% of the entire federal budget.
The implications of a greatly diminished U.S. presence in health aid, international development and disaster assistance could be profound, specifically around the global humanitarian programs which rely on USAID. In terms of international assistance, the U.S. is by far the world’s largest donor. The U.S. spent $68 billion on international aid in 2023. The aggregated sum is spread across several departments and agencies, but USAID’s budget constitutes more than half of it at over $40 billion.
Beyond the impacts on USAID, other initiatives, such as the U.S. President’s Emergency Plan for AIDS Relief created by former President George W. Bush in the 2000s, are under threat. This program represents the largest commitment by any nation to address a single disease in history. PEPFAR is managed and overseen by the U.S. Department of State’s Office of the U.S. Global AIDS Coordinator and Health Diplomacy. During the first week of Trump’s second term in office, he issued an executive order temporarily halting all PEPFAR activities. Secretary which signed a waiver at the end of January that allows for the distribution of certain HIV medications. However, it’s unclear if the waiver extends to preventive medicines or other PEPFAR activities.
And Trump’s actions are also affecting what is termed the President’s Malaria Initiative, an organization also founded by former President Bush. Through the work of this entity, the U.S. has become the world’s largest donor to anti-malaria programs and research. According to the New York Times, one of Trump’s executive orders has led to two-thirds of the staff being let go from the Malaria Initiative.
And by pulling out of the World Health Organization, Trump further diminishes the critical role the U.S. plays in combating neglected tropical diseases, such as leishmaniasis, river blindness, Dengue fever and trachoma. These preventable and mostly treatable infectious diseases affect millions of people in tropical regions of the world, causing severe health problems, including anemia, blindness, chronic pain, infertility and bodily disfigurement. Historically, despite the large burden imposed by neglected tropical diseases on many people, they’ve received a relatively small portion of resources for drug development and treatment distribution. U.S. aid agencies have filled some of the void. Until now.
