How an Estimated Seven Hundred Thousand People Have Died from DOGE’s U.S.A.I.D. Cuts

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0:35You're listening to The Political Scene. I'm David Remnick. Early each week, we bring you a conversation from our episode of The New Yorker Radio Hour. The New Yorker Radio Hour is a co-production of WNYC and The New Yorker. Welcome to The New Yorker Radio Hour. I'm David Remnick. DOGE, the so-called Department of Government Efficiency, has officially been terminated. Its July 4th sunset date was part of the original Trump executive order that created the agency, and Elon Musk, the chainsaw-wielding leader of Doge, oversaw the dismantling of USAID, which used to provide life-saving medical and nutritional programs all around the world.

1:22Musk, who recently became the world's first trillionaire, claims there's no evidence that a single person died after the Trump administration canceled more than 80 % of USAID's programs, cutting basic health care access to some 95 million people. All right, it's Monday in America, and Elon Musk is having a stage five meltdown on Twitter over Congressman Ro Khanna. That's right. The world's richest person has spent all day tweeting going after me. Why? Why? Because I cited an academic study that his doge cuts may lead to the deaths of millions of children overseas. Musk says no one can name a single person who died, quote, not a single name.

2:05And he also tried to claim that USAID is responsible for COVID and the Russian invasion of Ukraine. Trump was fixated on USAID and its spending, which is a little surprising given it amounted to less than 1 % of the federal budget. Yet, Trump and Elon Musk quickly dismantled the agency, with Elon at one point proudly tweeting he'd spent the weekend feeding USAID into the wood chipper. Atul Gawande was the assistant administrator for global health at USAID until he stepped down the same week that Donald Trump stopped U.S. foreign assistance. Gawande says an estimated 700 ,000 people have already died as a result of these cuts.

2:46Back in 2025, I first spoke to Atul, who writes for The New Yorker, when USAID was being targeted. And over a year later, I wanted to check back in with him to see what's happened in the aftermath.

3:04Atul, Elon Musk claims there's no evidence at all that doge cuts to USAID led to even a single death. He tweeted that, and I'm quoting here, that no validated medical funding was stopped and that legitimate life-saving funding continued. And you've replied saying that the reduction in life-saving aid has already led to no less than 700 ,000 deaths. How do you come to that number and how do you imagine he came to his conclusion? The 700 plus thousand that have been estimated to have died at the end of a year since the USAID closure comes from a couple of different sources. One is a Boston University estimate.

3:46A separate one comes from an international study published in The Lancet looking at the impact USAID had over the last 20 years, saving 92 million lives, and projecting based on the cuts that have occurred, how many deaths have occurred. And they came up with a very similar number. This is what pissed off Elon Musk. Ro Khanna cited the estimates that 4.5 million children, just children, would die by the end of 2030. The precision of the numbers is a question, but it's clear it's at minimum tens of thousands in 2025 and very likely hundreds of thousands. This is an enormous number. So I think it would be worth specifying what people wear, people dying of what.

4:42Maybe if you could put some more specificity on this that it ceases to be just a gigantic number. Yeah, a big part of what USA did was humanitarian response, disaster relief for tens of millions of people who are fleeing war or in conflict zones or were driven out by floods and those kinds of things. WHO estimates that where 80 million people were reached by emergency health services in 2024, that number in 2025 dropped by more than 50 million people. That included, for example, 14 million people who were victims of severe acute malnutrition. 2.5 million of them were children, like a peanut bar that gives you your calories for the day.

5:38distributed by community health workers that the U.S. manufactured but was cut off. That cut the death rate to less than 1%. That's just one category. Another one is childbirth. You know, many of these people who are being forced out of their homes are pregnant. They deliver thousands of babies and die when they have no services. Another example is Ukraine was the biggest single beneficiary of aid, and that was energy infrastructure that kept heat going. It was services for three and a half million children and pregnant women displaced from their homes. I could go into the HIV story. I could go into the TB story.

6:22I could go into the ways that USAID was ensuring vaccines were going out in the world. We're not even beginning to see the vaccine-preventable deaths, the HIV deaths, the TB deaths rise. We know these are only going to grow with time. Atul, there's a great deal of discussion about the number 700 ,000 and the mortality data itself. Help me on that. One of the complaints is these are projections, and therefore the projections are fake. When will we actually know what the child mortality rates are, it's going to be a while. The U.S. was the provider of some of the best, highest quality data in the world out of USAID, which was dismantled.

7:07The inspectors general that would be doing audits and investigations to show what systems were broken, they fired the inspector general at USAID and have intimidated the IGs from doing those kinds of investigations. And so the result is, in the best of circumstances, we will have data over the next two to three years. This is not like deaths of war where there are mass graves. You have a jump in child mortality from 3 % to 4%. That's a one-third jump. And yet, when you're in a community that has a 97 % survival rate versus a 96 % survival rate, you don't feel it. And you don't see it just from people walking around.

7:48We've been compiling a tracker. I say we. I have put together a team of a group of reporters and journalists that have been compiling all of these reports. And already they have documented not only the systems have gone down, but 1 ,200 different individually identified people who have directly died from the shutdown of foreign aid. Musk defenders have responded saying that the United States shouldn't be responsible for taking care of people around the world. What do you say to that argument? When JFK argued for USAID, he was arguing that assistance abroad, first and foremost, was also assistance to the United States itself.

8:32This is a tremendous source of influence for a president of the United States in exerting the power of this country in a way which serves our security and the long-range security of the countries that are involved. If we did not have this program, our voice would not be as distinct. So that this is very essential. I don't... One is the direct benefit to the United States of eradicating polio in the world, eradicating outbreaks. We eradicate, we were part, we were the driver of eradicating smallpox, interestingly, with Russia as the instigator of the idea. This was rooted in the Marshall Plan. The idea that we would, instead of pillaging the world around us as they were defeated in war or weakened, And we would invest, invest in their liberty, invest in their economic capacity, invest in their survival.

9:25And the result was trade partners of the United States received assistance from the United States along the way, whether it was Germany or South Korea or then India or then places like Mexico and Latin America. And now we see Africa starting to become middle income along the way. total foreign aid from the United States was in the$60 billion range, got cut more than 60%. And then what was left has been sort of turned into, give me your critical minerals or I won't give you HIV drugs. This goes hand in hand with an approach that says, we don't cooperate in the world. We try to dominate. USAID couldn't be more opposite in its approach to the world.

10:09You mentioned JFK. Let me mention RFK Jr. I haven't heard that much about him in this context. What has he been doing with the CDC and other agencies that fall under Health and Human Services, his agency? What's he had to say about all this? First of all, he's reached beyond HHS by stepping in to block foreign assistance with the White House backing for vaccines around the world. But within the HHS, CDC is hollowed out as an organization capable of acting abroad or at home in public health. More than a quarter of their staffing has been removed. Their laboratories have been shuttered, significant parts of them.

10:57The vaccine advisory committees needed to approve vaccines are not functioning at this point. And it's going to take a while to recover that. CDC can recover it because they still have an institution. They still have budgets that can be restored. It will take a while to build the expertise and infrastructure. USAID is a shell and will be hard to bring back. It will take time for countries to trust that every election does not become a change in the goals in the first place. It takes years to eradicate polio, years to build their surveillance for pandemics, years to reduce malnutrition in the world.

11:48And if we're divided about that and that becomes political fodder, then the institutions can't function. We won't be able to make a way forward. So I'd say the number one thing to restoring capacity is getting back to a place that we believe that these kinds of institutions are what we all want. Atul, you can't read anybody's mind, but what was Elon Musk's motivation when it came to cutting USAID so severely? The approach of Doge was like the approach he's taken with companies like Twitter. Take over, slash and burn. If anything's broken, we'll fix it after. And that continues to this day to be his argument.

12:32So his vanity, the vanity of an efficiency expert. Only he's destroying in the name of efficiency and left no efficiency behind at all. And he came in believing you could cut$2 trillion out of government. And it hit the shoals of USAID, this obscure agency accounting for less than$10 per American taxpayer per month. And within weeks, suddenly it became apparent that there would be massive loss of life. And it made the enterprise incredibly unpopular. He thought this was going to be, you know, a weekend and we'll move on, and it didn't turn out to be the case at all. I wonder if you could give a specific example of a program that went down in flames in this effort and what the effect of its destruction has been in concrete terms.

13:33the tb program which dealt with a long-term effort to try to reverse what is still the biggest infectious killer in the world and there are drug resistant strains that are now evading our current arsenal of tb drugs that work involved a project that i was part of that brought chest x-rays that were read by an AI reader for countries that didn't have a radiologist. You would screen, get a molecular test the same day, and be able to be put on treatment and follow up so that you stay on your medicines, because you have to stay on your medicines for a year. Those trials, the innovation was stopped.

14:17The programs to roll out the innovations that have been created were stopped in South Africa, in Mozambique, in other places like that, where you had high rates of TB, and they have now seen the tuberculosis deaths starting to rise. The cases have grown by multiples, and they had the names of people who've died. A couple of things happened financially in the world in the last two weeks. The first is that we have now conclusively discovered that the president of the United States, who we have to say is the person most responsible for this, has enriched his family by, at the very least, a couple of billion dollars in cryptocurrency scams that have taken hold while he's president that enrich him and his family.

15:06And Elon Musk has become the world's first trillionaire in the history of humanity, the first trillionaire. When you think about this, what possibly motivates these two unbelievably wealthy human beings to exact such what seems to me and certainly seems to you ruthless destruction on programs that for with all their flaws and all programs have flaws, such ruthless destruction on the health of humanity? What could possibly motivate them? And here I'm enlisting someone who's a surgeon as a possible psychiatrist. Let me put it this way. In the memorandums of understanding that they now make with countries where they are putting some foreign assistance in, you don't see commitment to goals like we're going to reduce the overall mortality for children in the world.

16:10We're going to stop neglected tropical diseases that the U.S. has led the way in eliminating conditions that ranged from leprosy to river blindness. It's unimaginable that this is a group of people who would commit to such goals. They see them as woke. They see them as signs of weakness instead of taking a ruthless—their view of the world— Wait, wait, wait. How is it woke to save the lives of children? Is it because they're not white European children in the main? The worldview, the actions that you see, are that you believe the world is in a moral, ruthless, Mad Max world of the dominators and the dominated.

16:56And it is woke to believe that we can come together and solve problems. It is naivete, and worse, it's a distraction from the fact that we're in a battle, and the world is governed by those who are strong, dominating the weak.

17:23I'm speaking with Atul Gawande, former assistant administrator for global health at USAID. He's also a surgeon, a professor of health policy, and a longtime contributor to The New Yorker. This is The New Yorker Radio Hour.

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19:29This is the New Yorker Radio Hour. I'm David Remnick. USAID was originally established by President Kennedy in 1961. It helped eradicate smallpox in the 70s. And since 2003, it's provided HIV and AIDS treatments that have saved some 26 million lives. In recent years, it helped save more than 9 million children through vaccine access. and it also helped eradicate wild polio in Africa in 2020. I'm speaking with Atul Gawande, someone who's very familiar with the successes of USAID over the years. He was an assistant administrator for global health at the agency before stepping down in January of 2025.

20:13Let's return to our conversation.

20:17I had never had the impression that Trump voters wanted this, that Trump voters were voting for Trump the first time, the second time, or the third time because they wanted to see aid to really disadvantage populations all around the world dry up and disappear, leading to hundreds of thousands of deaths. I couldn't agree more. That has been extremely unpopular. As the word filtered out of abandoning HIV patients, people in clinical trials, you name it, the U.S., across both parties and independents, reacted with horror. What is your sense of how reversible this is? In other words, how much more damage is going to be done and how much is it possible to put this terrible genie back in its bottle, if that's the right metaphor?

21:21It's so unpopular that both Republicans and Democrats in Congress and the Senate voted for restoring the budget for foreign aid. They also refused to end and close down USAID completely. So it didn't exist on paper. And they want the president and his officials to spend the funds on the things they specified. The power of the purse includes instructing the executive branch. It's already become apparent to the administration that they need these functions after all. They are now attempting to rehire into the State Department disaster assistance teams that were dismantled. But they have none of the infrastructure we had with offices around the world and embassies, depots that had stockpiles ready to go.

22:16And it's not clear they have the intent, but they know that it's unpopular. So they're trying to say we're doing some of this stuff. So let's assume the best thing happens and the money is restored, infrastructure is rebuilt. And in the end, what will be the damage report for this adventure in Doge? It's already public man-made death. We're at hundreds of thousands of dead. We're seeing the signs of reversal of gains in HIV. I just received information from the African Neonatal Network, and they have spikes already in women delivering babies who have HIV. So we know these conditions are getting worse.

23:10It's not just Democrats turning some of these things back on. And we have to have a bipartisan commitment about the idea of the role the United States plays in discovering solutions, cooperating and leading the world together to get them out into the world, and to set high standards for what the world can accomplish. That'll take time. But it's going to be millions of deaths. Millions of deaths. It's millions of deaths. Earlier I asked you to be a psychiatrist Now I'm asking you to be a political analyst And both things are asking a lot Who will be held accountable By either the law or more likely history in this episode And let's hope it's a limited episode How will the amount of destruction and death be accounted And what effect do you think it'll have on the lives of those responsible for executing this?

24:09I think that the reason why Elon Musk, the same month he's been made a trillionaire, is screaming online and aloud at congressmen and others and responding to things that I put online is because he believes he's going to be held accountable by history. Trump routinely asks publicly and reported privately about whether he's going to hell or not. And the anger that is so directed at those who suggest there has been public man-made death, the anger comes from the cognitive dissonance between what they want to think they are, world dominators, people who will be remembered in history as having done good.

25:01They can't countenance the image that is suggested by this, which is that they are monsters. Atul, you were just in South Sudan or not long ago. Tell me, why were you there in the first place? And what were you trying to find out? The United States has been instrumental in supporting its very establishment as a country. It's the youngest country in the world. It has still unresolved political issues and conflicts that have left people very vulnerable. And providing aid against suffering has been a key thing that the United States did. The sub-counties I visited where these primary health care centers were did not have intact government services otherwise.

25:45Who did you talk to? Well, I met with, first of all, a woman named Angelina David-Dewerr, who is the clinical manager in the county for the International Rescue Committee clinics. She was overseeing the clinics that were shut down and could tell me exactly what happened. Yes, I got a call that the manager, the health manager, James, can't send a boat to go and pick me because I was not aware that something is going to happen. I was just carrying out my normal duty. So I was called by phone, Angelina, you prepare your things. I said, what happened, why? I have not finished my work. He said, no.

26:29The information came from the head office that we have to stop what we are doing. And any spending on that project should stop. Then I said, okay. I went and packed my thing. I came to the board. I came to Gagne. here. When I reached at evening, I was called by the health manager, field manager, and this is what happened. So this is a stop order, not from IRC, not from South Sudan. It's from where we are getting the funding that we should stop. And that order come from the president of the United States. You know, it was a complete shutdown and a scramble because there were medicines and other things on the shelves they didn't want looted.

27:18So they had to get out to these places and they're very far away. You have to travel in some cases seven, eight hours in order to get to the extent of what's there. I then went and visited some of those facilities and I connected with her help to the sub-county chiefs. They're called the PYM administrators who keep their own records of deaths. So one of the things I found was that their own records showed that they are measuring an overall tenfold increase in child and adult deaths. Wait, wait, wait. A tenfold increase? Yes. A tenfold increase. And how much of that increase can be put at the feet of DOGE and the cutting of American aid?

28:03I can't exactly parse it out, but a huge amount of it, you know, went from 42 deaths in those seven sub counties for children, for example, over two years, 2023 to 2024. And those deaths rose to 214 that they recorded. I also met with villagers and learned of dozens of cases of direct effects. I'll give you an example. So one was a woman I met in a community called Machar, and her name was Nyajek Gai Gual. Her niece was staying with her, a two-year-old girl who developed the symptoms of a pneumonia. The clinic that would have been there to take the girl to was no longer there. In order to travel, she had to go three hours walking and by canoe.

28:59So when they start traveling from here, every minute they stop, then they give water. Till they reach almost to the nearest facility, then the lady stopped. The girl stopped taking the water at all. She was not able to swallow. The girl arrived alive. They, you know, attempted to do resuscitation. They tried, they tried, like, giving some air to support her in breathing. till now the child's twice start diarrhea-ing, start passing stool, coming out alone. And then from there, the breathing now reduces. The breathing reduces slowly, slowly. Then the nurse came again and showed the breathing, trying to check how the child is breathing until the last breath.