By Lisa Jarvis / Bloomberg Opinion

Over the course of a few days, the rug was pulled out from the federal agency critical to advancing global health. The U.S. Agency for International Development (USAID) was, as Elon Musk so callously said, put through the woodchipper.

As the country’s primary international humanitarian and development arm, USAID provides invaluable assistance to more than 100 countries. Yet President Trump has accused it of being run by “lunatic radicals.” Musk has criticized the agency’s $40 billion budget as wasteful, axing funding for programs that amount to less than 1 percent of the federal budget. A staff of more than 10,000 is reportedly being slashed to under 300.

The impact of dismantling USAID can be hard to grasp for anyone not intimately involved in this wonky corner of government. But Americans must pay attention to the incredible harm shutting down the agency will do to vulnerable people worldwide, compromising short- and long-term health abroad; and in the U.S.

Even before Musk took an axe to the agency, its global health partners were reeling from Trump’s 90-day freeze on foreign aid. USAID provides food for starving people who would likely die without it. It keeps the lights on at hospitals in war-torn countries. If local governments, nongovernmental organizations (NGOs) and philanthropies are unable to step in quickly, expect horrific images to emerge in the coming weeks out of places like Gaza and Sudan.

The less visible consequences are equally terrible. As my colleague Andreas Kluth explained, the dismantling of USAID could swiftly undo the goodwill America earned through long-term investments in poor countries; goodwill that helps keep Americans safe.

It could also undo the progress made over decades in improving child and maternal health by providing medical care, clean water, nutrition assistance, and prevention and treatment for a lengthy list of childhood and infectious diseases.

Yet today, many programs that provide drugs for chronic medical conditions and preventive care have been shut down. Global health partners that rely on USAID funding are facing staffing cuts. Trust, an essential ingredient in convincing vulnerable populations to participate in care, has eroded.

Global health is already in a fragile state from covid. Pandemic-related disruptions to health care delivery in 2020 reversed more than a decade of steady progress against diseases like malaria and tuberculosis, which combined accounted for more than 1.8 million deaths in 2023. Recovering from those setbacks has been painstaking; some countries bounced back, while others continue to struggle.

Secretary of State Marco Rubio, who appointed himself acting director of USAID, has tried to quell fears of a health disaster. Last week, he granted a waiver to “lifesaving” humanitarian aid. Programs that provide direct food assistance and distribute medicine can continue, and other programs can apply for additional waivers.

However, people working at USAID’s global health partners tell me that Rubio’s waiver policy has left huge gaps in critical areas of health care and is wreaking havoc on the organizations responsible for administering that care.

For example, only programs supporting tuberculosis and HIV prevention and treatment are mentioned as eligible for waivers, leaving malaria efforts in the lurch. Through the President’s Malaria Initiative, USAID invested $778 million across sub-Saharan Africa and parts of Asia in fiscal year 2023. The money largely went to supply essentials such as 37 million mosquito nets, insecticide for 4.2 million homes, over 100 million rapid diagnostic tests, and treatments for 63 million people.Teams on the ground can distribute supplies they have on hand, but nobody knows when — or if — more aid is coming. This is happening while malaria season is in full swing in places like Mozambique and Botswana.

The impact of the aid freeze will be swift. “One difference between TB, HIV and malaria is that TB and HIV kill you slowly. Malaria kills you quickly,” said Larry Barat, an independent consultant who worked for USAID and USAID-funded malaria programs for more than 20 years. When the drugs run out, millions of children in sub-Saharan Africa won’t have treatment. “That means children will get sick. And many will die,” he said.

Even if NGOs wanted to request a waiver, several told me they had no idea whom to ask. Their points of contact within the government have disappeared.

Meanwhile, organizations that, in theory, should be allowed to continue their work remain paralyzed. The New York Times reported on Wednesday that HIV groups abroad have not received funding used to provide antivirals to millions of patients, despite a waiver given to the President’s Emergency Plan for AIDS Relief. USAID is the primary implementer of PEPFAR, which has saved some 25 million lives since its inception in 2003. And many say that the waivers granted are unnecessarily limiting. One NGO executive told me that out of the dozens of programs her organization receives funding for, a “minuscule” number have been granted a waiver. And the waivers they are given come with restrictions that will hinder progress. For example, I’m told initiatives to address HIV in vulnerable populations, like sex workers and LGBTQ+ communities, are excluded from funding.

Even if funding is restored, the delay will have long-term consequences. Health care workers invest much time in building community trust and connecting people to care. It takes time, for instance, to help patients understand that antivirals they take for HIV must be taken consistently and daily, says Linda-Gail Bekker, director of the Desmond Tutu HIV Centre at the University of Cape Town. Any lapse in medication can allow the virus to replicate, quickly compromising a patient’s health. It might also give people who are already uncertain about treatment an excuse to stop. Health care workers saw that happen during covid.

“People get lost, and they don’t come back,” Bekker says.

USAID’s essential contribution to surveilling the world for existing and emerging pathogens should matter to us all. With malaria, for example, it means knowing when an invasive mosquito species has arrived in a country, allowing workers on the ground to adapt their response. It means knowing when and where a drug-resistant strain of TB is emerging. And it provides the U.S. with eyes and ears on the ground so that when a new pathogen crops up, we know about it in real time; and hopefully can contain it before it becomes a more significant problem.

“We should be terrified as a country of what it means to have our disease surveillance system down,” an executive at a major global health partner to USAID told me. “We are hugely vulnerable even in the best-case scenario.”

It’s fair for a new administration to want to investigate how resources are being deployed. It’s also fair to want to accelerate a movement already underway at USAID to shift funding to local partners. This movement is driven by a desire to make countries more self-reliant and improve the sustainability of global health efforts. Getting that right requires careful planning and will require years of assistance.

But turning off the funding faucet overnight? Aside from being illegal, the dismantling of USAID’s global health efforts is plain cruel. It will cost lives, some in the near term from starvation, some in the coming months from preventable diseases. And many more long term if the money and infrastructure aren’t fully restored.

Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.