U.S. foreign aid changed in 2025 – and it was felt around the world

0:00On the night of his inauguration, President Trump signed an executive order that froze almost all international assistance for 90 days. Shortly after that, the State Department has issued an expansion on President Trump's executive action Monday to freeze foreign assistance for 90 days. In a memo, Secretary of State Marco Rubio ordered a pause on foreign aid spending and a stop work order for any existing humanitarian and development projects. What followed was the termination of billions of dollars in aid, which funded everything from infrastructure building to vaccination programs to getting supplies into sensitive conflict zones.

0:38Experts like Abby Maxman, president of Oxfam America, warned at the time that this move could have a destabilizing effect in countries where that aid's critical. It's having seismic impacts for the entire global aid system. And really, frankly, it's a cruel decision that has life or death consequences for millions of people around the world. One small U.S. foreign aid program working to eliminate so-called neglected tropical diseases was shut down this year. Those diseases affect more than a billion people worldwide and can be debilitating. Mamadou Kouibali coordinates several disease elimination programs for the Mali Ministry of Health.

1:19It was like a thunderbolt. This lack of financing has stopped our activities. He says the country has used its own money to fill the financial void, but it just isn't enough.

1:32These are diseases that make someone completely invalid. They have a very heavy impact on the development of the country. There could be a return of these diseases if we're not careful. Over in southwest Uganda, locals note that refugees are spending less on food. That's because the U.S. has not renewed its contributions to the U.N.'s World Food Program that helped them buy groceries. Economist Dean Carlin works on anti-poverty programs in the region. Because of the cutbacks in aid, there was less economic activity going on, the markets were not as thriving, and they could actually see that difference.

2:06As the Trump administration ends its first year, some foreign aid money is flowing again, but much less than before. And the future of U.S. foreign assistance now looks very different. Consider this, the complete overhaul in foreign aid policy is affecting people on the ground who need assistance now. and it may come to affect the reputation of the United States worldwide.

2:33From NPR, I'm Juana Summers.

2:45It's Consider This from NPR. The cuts to foreign aid and the shutting down of USAID had widespread impact on countries and programs that relied on that assistance. NPR's Fahmatanis and Gabriela Emanuel have been following this all year and spoke with my co-host Mary Louise Kelly about it. Gabriela, just reaction. The Trump administration makes this move right out of the gate. Reaction globally was what? At the beginning, total shock. Some people we spoke to called this kind of a cataclysmic event. OK, so Fatma, the why question. Why did the Trump administration, A, feel they need to do it and B, do it so quickly?

3:26Well, it became clear quickly that the Trump administration viewed foreign aid as a big fat problem, that it was not aligned with the national interest. It cost too much money, even though, you know, foreign aid was about one percent of the overall federal budget. So they wanted to really take the whole thing apart and recreate it in a way that fits the America First foreign policy. USAID, as the agency that led foreign aid, was seen by Trump Republicans as a bastion of the left. And some of its programs that supported gender equity or LGBTQ rights or climate solutions or even reproductive health, they were seen as part of this woke agenda that taxpayers should not be funding.

4:05And the president even accused the agency of waste, fraud and abuse, even though the White House hasn't provided evidence of that so far. I spoke with Max Primorak. He's with the Heritage Foundation. It's the conservative think tank that was behind Project 2025. Primorak has held several senior roles at USAID in the past. Here's how he put it. We were spending money every year. It was never changing. We weren't solving problems. We were not putting Africans in the lead. And it just threw inertia, spending a lot of money without really seemingly to get the kinds of results that we wanted. Other global health experts disagree.

4:42You know, we talked to people who said USAID could have been certainly improved in many different ways. But they also said that, you know, burning it all down, as the administration did, was arbitrary and irresponsible. Well, and Gabriela, say more about the burning it all down and the consequences. You were starting to describe this as you were hearing from people, chaos, words like cataclysmic. What was the impact? Yeah, so we talk to people all over the world. One woman who her son had died because their U.S.-funded hospital had closed. Another whose baby had died because she could no longer get the treatment for severe malnutrition.

5:19When I went to Zambia about eight weeks after the foreign aid freeze went into effect, I met people who were on HIV medications and found that overnight their neighborhood clinics had shut down. These were clinics funded by the U.S. that had been part of this kind of massive decade-long effort that was started under George W. Bush to control HIV AIDS. The U.S. put over$100 billion into this. It's credited with saving 26 million lives. And then suddenly the doors are locked, electricity turned off, and people could no longer get their daily meds. Okay. So just make this specific. Like is there one human story you would tell that brings this home?

6:01Yes. So one mom I met, Teresa Mwanza, she had a 10-year-old daughter. They were both HIV positive. They got their daily medication from one of these local U.S.-funded clinics in their neighborhood. And then one day, her daughter went to get their medications. Here's Teresa Mwanza. So she'll run to the clinic, and then she'll come back home and say, oh, the clinic is closed. They're not there anymore. And what are we going to do? I was with them at their house. The little girl was confused about what was happening. And at that point, when I met the two of them, they had completely run out of their medications.

6:38And the 10-year-old girl, the daughter, was already showing visible signs of the virus, of HIV returning because she wasn't on her meds. And this is not an isolated event. I met many others who this was happening to as well. People losing weight, developing these open sores, flu-like symptoms, all signs that HIV was progressing to AIDS. And I'll just add here that the scale is hard to overstate. One study out of the Institute of Health Metrics and Evaluation found that this is the first year, this century, that child deaths under age five went up instead of down. And that is directly due to aid cuts.

7:18You know, Fatma, it's so interesting because it wasn't that long ago that you would have found a largely bipartisan consensus that, in fact, foreign aid was in America's interest. It was a tool of power that America could project abroad, a soft power, but making friends, building goodwill, spreading ideals about America and American democracy. I know this is hard to answer, but are you able to track how this year's developments have changed the way people see the United States? It is hard to track, like you said, but in speaking to people when we were out there on the ground overseas, you could see that it had had some impact on the way people viewed the United States.

8:00I saw that when I was in Uganda in August, and there was confusion about why the U.S., a global superpower, as people put it, would suddenly stop giving money. Some people thought it was a sign that the U.S. was struggling financially or that it wasn't as strong as it used to be. But it was also clear that years of aid had bought the U.S. some goodwill among people. Like Okat Bosco, he's a refugee from South Sudan who lost his job with an aid group because of the U.S. cuts. And he told me America's foreign aid money was not just a one-way street. It wasn't just the recipients like himself who benefited.

8:33America benefits, but they don't know that they're benefiting. They benefit their trust. People trust them so much. Bosco grew up in a camp for displaced people, and he told me he never forgot the food and medicine that he and his family got that carried the USAID logo, the American flag, with the words from the American people on it. Okay, so we're at this moment now, Fatma, where the U.S. is spending less money on foreign aid, and they're also spending it differently. There's a new approach they've rolled out. What is it? That's right. They rolled it out in September, and instead of working with nonprofits or aid groups like the old model, the U.S.

9:07is now prioritizing working directly with governments, creating opportunities for American businesses and also faith-based organizations. So the State Department recently announced one of its first major grants, $150 million to the American drone company Zipline to expand their operations in Africa delivering medicine, blood supplies, other health supplies. They also made agreements with Kenya, Uganda, and Rwanda, where the U.S. will be investing hundreds of millions of dollars to those countries, and those governments will be also putting in money as well. Here's how Primarac with the Heritage Foundation sees this new strategy.

9:41This administration is being a far better steward of American taxpayer monies than previous administrations were. So it's recognizing we have a debt problem. recognizing that we have to be effective around the world with less and taking the steps to do so. Okay, so the argument there for this new approach. Gabriella, one more question to you just before I let you all go. What happened to the little girl who couldn't get her HIV meds? So we have good news here, actually. The Zambian government heard our reporting. They went to the villages where we had profiled the community, and they re-interviewed them, saw the situation, and made sure that they could access their HIV meds.

10:22It's a small number of people, relatively speaking, but it was a good sign. And here's Gabriela Emanuel. And Fatma Tanis, thank you so much for your reporting. Thank you. Thank you. This episode was produced by Mallory Yu, with additional reporting by Jonathan Lambert. It was edited by Patrick Jaron Watananan and Rebecca Davis. Our executive producer is Sammy Yenigan. And thanks to our Consider This Plus supporters, who make the journalism you hear on the show possible. Supporters also hear every episode without messages from sponsors. Learn more at plus.npr.org.

11:03It's Consider This from NPR. I'm Juana Summers.