PNHP

US global health assistance destroyed by DOGE

A new book by a US government whistleblower reveals the truth of early Trump administration elimination of the lead US agency for global health assistance: slashed funding, destroyed programs, millions of added deaths

Into the Wood Chipper, A Whistleblower’s Account of How the Trump Administration Shredded USAID, Simon & Schuster, 2026, by Nicholas Enrich

It had started on Inauguration Day, when President Donald Trump signed an executive order pausing all foreign assistance. Elon Musk, the tech billionaire and social media tycoon, had set out to destroy the agency as a test case to demonstrate the power of The Department of Government Efficiency, or DOGE, his new quasi-governmental creation. He didn’t know what USAID [U.S. Agency for International Development] did, or why it existed in the first place, and he didn’t seem to care. All he knew was that he intended to feed USAID, in his words, “into the wood chipper.”

Even as the administration publicly claimed that lifesaving programs were continuing, behind closed doors they forged ahead on their single-minded mission to destroy USAID. Funding was frozen. The workforce was slashed. Systems crumbled. Contracts were terminated. They even removed USAID’s name from the entrance to its headquarters.

I watched Musk flagrantly lie. Standing next to Trump in the Oval Office, he assured the gathered journalists and their live TV audiences that USAID’s programs to prevent the spread of deadly diseases were still operating. They weren’t. Trump then piled on, pushing absurd lies about our work.

On February 26, the malaria director told us that the primary contractor responsible for USAID’s malaria drugs and supplies was reporting that its contract had just been terminated. This was our flagship malaria contract, essential to continue life-saving drugs and services that protected millions of people from deadly disease, one of the world’s top killers of children under five.

The same day, the head of the tuberculosis team received an email from our partner who implemented our flagship TB contract. It, too, had been terminated. Tuberculosis is the world’s leading infectious disease killer.

Within the hour, I heard the same story from our maternal and child health team.

Those three critical contracts were not the only ones terminated that day. Nearly every Global Health contract received a termination letter, including the ones needed to provide lifesaving services for HIV, polio, neglected tropical diseases, family planning, emerging infectious diseases, and nutrition.

Whatever else we faced over the past weeks, we knew how to write a memo.

The first memo was titled, “Documentation of Challenges and Impediments to Implementing the Lifesaving Humanitarian Assistance Waiver for the Pause on Foreign Assistance.”

The second memo was titled, “Documentation of Bureau Global Health Workforce Reductions.”

The third memo, “Risks to U.S. National Security and Public Health: Consequences of Pausing Global Health Funding for Lifesaving Humanitarian Assistance,” was our official warning to the administration of the impact of halting critical global health programs. This memo presented modeling compiled across each of USAID’s global health programs and documented how the cuts to our programs “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.”

Overall, the modeling and analysis concluded that a staggering 2.6 million additional people would die per year due to the cuts to USAID’s global health programs.

We had the unfortunate distinction of being the first agency on DOGE’s hit list, but the callousness, dishonesty, and ineptitude we experienced offered a preview of how the rest of the Trump presidency was likely to unspool.

  • Step 1: Fabricate and spread false stories of waste and abuse to win public opinion against the work the agency is doing.
  • Step 2: Infiltrate and immobilize IT and financial systems to prevent the provision of services.
  • Step 3: Terminate contracts to ensure that the damage cannot be reversed.
  • Step 4: Vilify, demoralize and ultimately eliminate the staff.

Comment:

By Don McCanne, M.D.

The first day of Trump’s second term in office, I was shocked by his executive order to shut down USAID. My life has been devoted to health care, not only as a practicing physician, but also as an advocate for comprehensive, affordable health care for everyone. Although my advocacy activities have been limited to the health care system in the United States, I have always been thankful for the role of USAID in providing care for those most needy in other parts of the world.

I originally thought that it would not be problem convincing the people of the United States that we could easily design and implement a system that would work for everyone in our nation. I had hopes that I could then go on and provide help in some of the more needy nations in the world.

On reading this book, my dreams were clobbered. I was often brought to tears realizing that some of the most powerful people in our nation believed that the public’s health was of so little value that we could dump it “into the wood chipper.”

We need a reset. I believe this book will help do that.

Addendum:

By Jim Kahn, M.D., M.P.H.

I’ve spent much of my 37-year academic career analyzing the health benefits and costs of programs that reduce death and illness in low and middle income countries (LMIC). These are exactly the activities which USAID enabled, and were sabotaged by recent abrupt funding slashes. Colleagues and I repeatedly found that spending to prevent and treat AIDS, malaria, TB, and other killer diseases in poor countries is astoundingly cost-effective (less than $50 per added year of life), or even cost-saving by reducing future medical care needs or increasing the ability to work. These programs also generated massive goodwill from supported nations toward the US. Expanding global health assistance was the signal achievement of George W. Bush, and subsequent presidents of both parties built on that. Dismantling this activity is cruel and short-sighted, the epitome of deadly cynicism.

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