U.S. AID CUTS ARE STARVING AFRICAN CHILDREN. Apoorva Mandavilli reports for The NY Times.

Original article edited for brevity.

A $45 treatment can keep a child alive.

Starvation in Gaza has brought intense international attention to the horrors of famine, but less attention has been paid to a wider issue: the dismantling of U.S.A.I.D. has worsened the problem of severe hunger and malnutrition throughout the world.

Saving children with severe acute malnutrition is simple and inexpensive. Each packet costs less than 30 cents, but contains a high-calorie mix of peanuts, sugar, milk powder and oil — flavors appealing to children — and a blend of vitamins and minerals. A complete six-week treatment for a severely malnourished child runs to less than $45.

U.S.A.I.D. funded roughly half the world’s supply of ready-to-use therapeutic food, or R.U.T.F., purchasing some directly from American manufacturers and funding the United Nations Children Fund, or UNICEF, to manage its distribution.

All those grants were abruptly halted when the Trump administration froze foreign aid earlier this year. U.S.A.I.D. eventually reimbursed grantees for costs already incurred. The State Department authorized a $93 million new grant to UNICEF last week, but it is less than half what the government had typically spent. In 2024, the agency spent about $200 million on this work, not including aid for countries and direct grants to organizations that implement programs.

Funds for 2025 have yet to be released to manufacturers, the World Food Programme — which distributes a similar product for moderate acute malnutrition — those who transport the products or the many organizations, like the International Rescue Committee, or Helen Keller International, that run the malnutrition programs.

In response to questions from the Times, the State Department emailed a statement asserting that lifesaving malnutrition programs “remain a priority.”

“Malnutrition treatment is among the first new obligations of foreign assistance funding,” the statement said.

But it also said that “other actors — including national governments and international humanitarian organizations — must step up.”

President Trump has made the same argument for many aid programs, saying the United States should not have to carry the bulk of the burden of caring for the world. Though other countries do already contribute, and some organizations are scrambling to fill the gap, it is unlikely that they can do so quickly enough to help the children who are now in need.

Before the sudden withdrawal of aid, “things were absolutely moving in the right direction,” said James Sussman, a spokesman for the International Rescue Committee.

Now, boxes containing millions of dollars worth of the lifesaving packets are stuck at every link in the supply chain: in manufacturers’ warehouses, at shipping companies, in cities that received the shipments and in treatment centers that have shut down all over the world.

In nearly a dozen countries, the supply chain for the packets has become so unstable that thousands of children are at high risk of dying, according to organizations that help distribute the treatments. Tens of thousands more could be in danger in the coming weeks and months if funds for this year do not move quickly.

“We have seen the mortality rates in the hospitals increasing by the day,” said Aliyu Mohammed Jabo, Helen Keller International’s director for Nigeria. “This is the ugly situation that we are facing because of this funding cut.”

In Nigeria, 150 clinics operated by the World Food Programme in Borno and Yobe states, which provided treatment for more than 300,000 children below the age of 2, shut down at the end of July. In Bauchi state, Helen Keller International has had to stop treating malnutrition in 16 of its 17 centers, leaving more than 17,000 children without treatment.

In eastern Chad, Mali and Niger, malnutrition treatments are unavailable or in dangerously short supply. Clinics in northeast Syria, Burkina Faso and Kenya have closed down. In South Sudan, the International Rescue Committee estimates that it will have to close 62 static treatment sites and nine mobile clinics if funding is not restored by September.

In Afghanistan, I.R.C. warehouses are bare, despite 900,000 children who are in desperate need of treatment for severe acute malnutrition. Nepal has no supply in about half of its provinces, and is facing a nationwide shortage starting this month, endangering about 200,000 malnourished children, including about 25,000 who are at risk of death.

Several other countries, including the Democratic Republic of Congo, Ethiopia and Madagascar, similarly have only enough products to treat children for a few more weeks or months.

Several organizations, including Doctors Without Borders and the aid group Action Against Hunger, have reported deaths in children related to malnutrition. More timely and precise estimates of deaths are difficult, because many of the programs that track children in need have shut down, and most organizations dare not speak up against the administration, fearing retaliation.

“No one’s counting these children,” said Jeanette Bailey, director of Nutrition for the International Rescue Committee, among the largest of groups implementing the treatments.

“With pretty strong certainty, we know children are dying,” she added. But, “we don’t know how many.”

One global study has estimated that more than 160,000 childrenmight die each year if the funds are not restored.

Read complete article in NY Times.

IS CHARITABLE GIVING DEAD? NO, BUT IT IS FAILING. Caring world report by Patrick Wecal

In recent years charitable giving has undergone profound transformations since the “golden age” of giving, from the 1990s to early 2000s.  This has left a general feeling of pessimism not just in the populations that need assistance, but with the thousands of workers who dedicated their careers to humanitarian work and now are left with no job or path to help others

How did we get to this place?

 The landscape of charitable giving has drastically changed from the large-scale event like Live Aid that categorized the “golden age”. A little perspective might help though. As groundbreaking as Live Aid was in raising public consciousness of saving the world, $40 million was raised on the day of the concerts in London and Philadelphia. It’s an impressive number, but the budgets now for humanitarian projects are in the billions of dollars. You need big, big money to have an impact.

Modern charitable giving is done mostly through big-name NGOs such as Red Cross and UNICEF. Charitable giving is much more fragmented and has less participation among the “average person.” The percentage of U.S. households donating to charity fell from  66% in 2000 to just 49.6% in 2022. At the same time we are now in the billionaire era of philanthropy, just 1% of donors account for over half of total U.S charitable giving. High profile billionaires like Bill Gates dominate headlines and funding figures.

Platforms like GoFundMe also give actions to smaller donors and smaller causes allowing donors to give directly to a cause or a person. The charitable giving landscape has shifted drastically from large scale popular movements to more individualized giving and large scale philanthropy from NGOs and billionaires.

Is America no longer the benevolent world leader?

For decades, the United States has been a cornerstone of global humanitarian aid, particularly in Africa. Programs such as PEPFAR and USAID have helped provide aid by giving billions towards healthcare, agriculture, education, and infrastructure. Over half of USAID’s global health spending has historically gone to Africa, specifically Sub-Saharan Africa receiving a majority of the aid. Most Sub-Saharan African Nations are dependent on this aid and cannot sustain their population with their own economy and infrastructure. There will be a devastating shortfall in aid needed and aid received due to the recent budget cuts to PEPRFAR and USAID. There are estimates that diseases like AIDS will return unchecked and fatalities could reach 14 million in five years.

While U.S. cuts are severe and will hold dire consequences this does not need to signal an end to charitable giving for Africa but rather a cause for the shift in who gives and how it is done. The obvious answer is other governments pick up the shortfall particularly in the EU, United Kingdom, Canada, or Nordic countries. The obstacles with getting large donations from these countries are many. Budgets are already set and many have been reduced like in the U.S. Africa is in competition with other humanitarian needs at any given point in time. See Gaza. See the last natural disaster in each country. Then there is the elephant in the room: the Russia Ukraine war. As pressure has increased to support the Ukraine war effort financially, the money needs to come from somewhere. And that somewhere has been foreign aid.

African countries obviously are faced with taking on more of the responsibility of helping their own vulnerable populations. But their ability to raise more government revenue is hampered by their limited economies and comparatively small GDPs. The irony is that some African countries are indeed rich in resources but often the wealth of these resources are lost because of trade agreements made with countries like China, Russia and the United States. African nations have suffered because of corruption in their own governments and theft by illegal miners and smuggling of commodities like gold and Rare Earth Minerals.

 Which brings us back to the question, is charitable giving dead? Will private citizens take on more of the responsibility for humanitarian aid?  Should we expect corporations to step up, especially those that are selling their products in Africa?

Private philanthropy will always be an option and Mega-donors can move billions quickly into high-impact initiatives. The foundations like Gates and Rockefeller do this, but to have impact there needs to be focus. And when there is focus on a certain issue or population there is the risk you (in this case, Africa) are not the priority. Again, there is growing competition for the humanitarian dollar.

What about those global companies who are taking money out of a country, who are selling products to the very people who need their help? Corporate social responsibility (CSR) could help generate funds from a multitude of companies that deal in Africa. Again the challenge is scale. CSR budgets are typically in the tens of millions for large companies where the shortfall is in the billions so either lots of companies would need to donate or budgets would need to be increased. (Don’t forget America and a growing number of EU countries are going through an “anti-woke” period and thought of anything except growth and profit is becoming less popular in boardrooms.)

Several major charity organizations play a critical role in supporting health, food security, and humanitarian efforts across Africa. The Global Fund works closely with African governments to combat HIV/AIDS, tuberculosis, and malaria, providing medicines, preventive care, and community health programs. GAVI, the Vaccine Alliance partners with countries to expand immunization access, helping to prevent outbreaks of preventable diseases and strengthen local health systems. UNICEF focuses on child health, nutrition, education, and emergency relief, often operating in hard-to-reach areas. The World Health Organization (WHO) supports disease surveillance, outbreak response, and long-term health infrastructure development. Private foundations such as the Bill & Melinda Gates Foundation also have a large footprint, funding vaccine research, agricultural innovation, and initiatives to improve maternal and child health. Elon Musk, on the other hand runs a foundation that basically operates like a research and development arm for his For-profit companies.Unfortunately the richest man in the world has had a negative impact on the state of humanity. His creation of DOGE, the infamous Department of Government Efficiency, started many of the issues with aid relief in Africa and the world. Musk must recognize his legacy right now is about pain and suffering as much as it may be about electric cars and space travel.

What can one average person do?

Everyday citizens can make a meaningful impact in addressing Africa’s humanitarian and development challenges. Small contributions, when pooled together, can fund vital services like vaccinations, clean water projects, and school programs. One way to maximize impact is by giving to reputable organizations that clearly report how donations are used and that have proven track records in health, education, and poverty reduction. Recurring monthly donations, even in small amounts, help organizations plan long-term and maintain stability in their programs. In addition to donating money, everyday citizens can advocate for policy change by contacting elected representatives, raising awareness on social media, and supporting legislation that maintains or increases foreign aid. While one person’s donation or effort may seem small, collective action by thousands of individuals has the power to keep life-saving programs running and ensure that vulnerable communities are not left behind.

A few suggestions for organizations that would welcome your support:

Nyumbani Village

Youth Advocates Zimbabwe

Save the Children

SNAPSHOTS: HUMANITARIAN AID IN AFRICA research and analysis by Patrick Wecal

When you look at some of the data as it relates to aid in African countries, some insights begin to present themselves. 1. All of Africa spends too much on debt and that severely inhibits their ability to serve the health needs of their population. 2. As the U.S. and other wealthy nations cut back on foreign aid budgets, African lives will be lost and those statistics are staggering, bringing back the dark days of the 1980’s when AIDS first hit the continent. 3. More revenue must be generated and greater manufacturing capabilities must be built in Africa. The continent must move closer to achieving its economic potential. U.S. and China, the two most promising development partners, are interested in getting a return on their investments, be that aid or trade.

In 2025, Africa is expected to pay ~$89B in debt. 30 of 49 African countries spend more on debt interest than on healthcare. Kenya spends ⅓ of its government budget on debt.

Rich nations are cutting crucial funding for humanitarian aid and health care in Africa, especially HIV services. These poorer countries lack the capacity to instantly absorb these losses. U.S. has current plans to cut 25% of humanitarian aid budget. EU countries have cut 15-20% of their aid budgets.

UNAID warns that the number of 3,500 new HIV infections per day could now jump 5,800 per day leading to 6 million new infections per year and 4 million more with AIDS by 2029. Domestic funding covers around 60% of HIV response in Africa. 

Kenya pays around $75 per person per year for the ARV regimen. Costs for Zimbabwe are around $200 per person.

Top American companies doing business in Africa: Exxon, Microsoft, IBM, JP Morgan Chase, Pepsico.

Top African pharma and healthcare companies:

-Aspen Pharmacare (South Africa): Africa’s largest pharmaceutical company, Aspen produces life-saving medicines and medical equipment.

-Netcare (South Africa): Known for healthcare services and medical equipment manufacturing.

-MediKredit (South Africa): MediKredit manufactures essential diagnostic equipment and healthcare technology.

-Biovac Institute (South Africa): Biovac manufactures vaccines locally, focusing on preventing infectious diseases.

-Linx Pharmaceuticals (Nigeria): Specializing in malaria and infectious disease treatments.

China’s economic pledges to Africa:

Eliminated tariffs for all developing countries

Investing $51 billion in development projects

Pledged 30 infrastructural connection projects and 30 clean energy initiatives for Africa, as well as prospective collaboration in nuclear technology to alleviate the continent's power shortages.

U.S. economic pledges to Africa:

U.S. tariffs on African products range from 11-50%.

U.S.-Africa Business Summit Yields $2.5 Billion in Deals and Commitments

Major Deals and Commitments for U.S. Companies: 

Amer-Con Corporation & Angolan Cargo and Logistics Certification Regulatory Agency   

A U.S. consortium led by Florida-based Amer-Con Corporation signed a Strategic Partnership Agreement with the Angolan Cargo and Logistics Certification Regulatory Agency to construct and operate 22 grain silo terminals along the Lobito Corridor. The project is backed by the U.S. Export-Import Bank and is expected to significantly enhance Angola’s food security and agri-logistics capacity. 

Cybastion & Angola Telecom 

U.S. technology firm Cybastion and Angola Telecom signed a $170 million investment deal to expand digital infrastructure and cybersecurity through Cybastion’s “Digital Fast Track” initiative, providing local training and modern infrastructure for Angola’s digital transformation. 

CEC Africa & AG&P 

CEC Africa Sierra Leone Ltd. signed a Memorandum of Understanding to develop West Africa’s first U.S.-sourced LNG terminal, in partnership with AG&P and backed by the U.S. International Development Finance Corporation. The terminal will power the 108MW Nant Power Project in Sierra Leone and enable affordable energy for industrial and household use in Sierra Leone. 

Ruzizi III Holding Power Company & Anzana Electric Group 

The Ruzizi III Holding Power Company signed an Invitation to Partner with U.S.-based Anzana Electric Group, paving the way for a 10% equity stake in a $760 million hydropower project spanning Rwanda and the DRC. The project will deliver reliable energy to 30 million people across the region and promote regional integration and stability. 

Ethiopia Investment Holdings and U.S. International Finance Partners  

Ethiopia Investment Holdings signed a Memorandum of Understanding with U.S. International Finance Partners to invest more than $200 million in the development of luxury hotels, branded residences, and related tourism infrastructure in Ethiopia. The agreement aligns with the development priorities of Ethiopian President Taye Atske Selassie, who witnessed the signing. 

Hydro-Link and the Government of Angola 

U.S. energy investor Hydro-Link signed an agreement with the Angolan Government to develop a $1.5 billion private transmission line connecting hydropower sites in Angola to critical mineral mines in the DRC. This 1,150-kilometer transmission corridor will enable the delivery of up to 1.2 gigawatts of reliable electricity from Angola’s Luaca plant and other hydroelectric facilities to the Kolwezi mining region in the DRC, supporting the region’s mining operations and energy needs.  

SPEAKING WITH THE ENEMY. NY Times host Ross Douthat interviews DOGE’s Jeremy Lewin

DOGE’s cuts to U.S.A.I.D. aren’t just a case study in the Trump administration going after woke spending or trying to change the federal government’s bottom line. It was also crucial to a larger shift in foreign policy strategy.

The whole apparatus that the United States has used traditionally to exercise soft power is being gutted, redirected and transformed. And that means changes to how the United States does aid and development work, how it promotes democracy around the world and the way it relates to foreign governments.

My guest today is well positioned to bring some clarity to this shift in strategy and values.

Jeremy Lewin is a youthful veteran of DOGE, a 28-year-old with no government experience before January, who’s now a State Department official in charge of implementing the Trump administration’s sweeping changes to foreign aid and development work.

Excerpts have been edited from full interview.

Douthat: You’re not at all someone who worked in the diplomatic corps, worked in the State Department, worked on foreign aid. Part of the model clearly is bringing in, let’s say, smart, young generalists and setting them to work inside the bureaucracy.

Lewin: I think there’s tremendous value in having the objectivity that comes with not having been part of the diplomatic corps. But ultimately, again, it’s about working hard and executing faithfully the vision that’s set forward by the people who are elected, confirmed and are leading the policy vision. That’s always been my task, whether it was on DOGE or now, in a more formal role at the State Department. It’s to execute the secretary’s vision and the president’s vision and to do so faithfully. I think that’s the most important qualification. I happen to have certain skills or a certain mind-set that has allowed me, I think, to be effective in that.

Douthat: So were you assigned to the State Department after you onboarded with DOGE? How did you start?

Lewin: Backing up, the idea of taking U.S.A.I.D., which was this unaccountable independent institution that was doing foreign policy and foreign assistance out of alignment with the national interest, out of alignment with the diplomatic priorities of the State Department, out of alignment with what the president or the secretary of state wanted to be doing, that’s an idea that’s been kicked around for a long time. There’ve been various proposals to merge U.S.A.I.D. under State, and certainly, the secretary had been thinking about that for a long time.

That being said, DOGE did not go in with the idea that they would be part of this rapid change in the structure of foreign assistance. In about the second week — and Elon has talked about this before — we realized, sort of indicative of the lack of accountability and leadership at U.S.A.I.D., that they were making payments that were in violation of some of the president’s executive orders — foreign assistance pause, et cetera. Elon had been tasked by the president with investigating the situation, and then there was a determination that we would be much more rapidly implementing the restructuring of U.S.A.I.D. At that point, yes, I suppose in some sense I was assigned to assist with that.

Douthat: You were assigned. OK. So U.S.A.I.D. then becomes a special focus. As you said, there had always been running critiques, from conservatives especially, that U.S.A.I.D. is basically building a kind of progressive-oriented matrix of programs and so on.

Lewin: It’s not even progressivism. U.S.A.I.D. viewed its constituency as the global humanitarian complex. It did not view its constituency as the American taxpayer or the national interest of the United States. You hear this and you see it in all of the documents that they prepare.

One of the biggest complaints is — and I’ve heard of this, I’ve talked to more than 30 ambassadors, most of whom were appointed by Biden or were or are members of the career foreign service — you would see examples where they would say: Hey, this country in Africa doesn’t actually want this program. It’s not in alignment with what the government wants. It’s not in alignment with what’s on the ground.

But you know who wanted it? Some nongovernmental organization or international organization that a bunch of Obama-Biden alums or all these people that worked at U.S.A.I.D. were at. So they would push, and you’d have senior Biden officials traveling to countries and batting down career ambassadors, telling them: No, you don’t understand the diplomatic priorities. What matters here is what the U.N. is telling you.

And so you’ve got America’s representative on the ground saying: The country that we are implementing this foreign assistance in doesn’t even want it, and it’s not advancing our interest; to the contrary, they’re upset about it. And yet we are still paying, we’re still using American taxpayer dollars to pay for a program that our ambassador on the ground doesn’t want, that the country doesn’t want. What conceivable benefit are we as Americans getting for the national interest of this country by funding that program?

Douthat: A lot of the critiques of what happened with DOGE was that speed basically became a license to have programs stop working for a while, because you’re trying to change things so quickly, or you’re canceling grants that then have to be restarted, and so on. In the case of foreign aid, you have a promise that lifesaving aid would get a waiver from the suspensions. But then there were all kinds of questions, like, well, how are you delivering aid if you are cutting staff over here, or if this system isn’t working over there?

Again, before we get into the specifics, why did it need to happen so rapidly?

Lewin: A couple of points. I think it’s first worth noting what the secretary said at his budget testimony a couple of months ago. He was in the Senate for more than a decade, and people had talked about these various ideas, including the restructuring of U.S.A.I.D. and the restructuring of foreign assistance. Many of these ideas were talked about in the first Trump administration, and they didn’t get done because of how entrenched the bureaucracy is, how difficult it is to get these things done. So if you don’t move quickly, there’s sort of a tremendous — you could think about the laws of physics, but you need to move quickly and with a lot of energy to get a lot of these things done. That’s the first observation. The second observation is — well, first of all, we have always tried our best to mitigate the ill effects. That doesn’t mean you’re going to be perfect — no one’s perfect in everything — but I think there’s this narrative that the administration or the secretary don’t care about these stoppage effects, these costs that happen when there’s tremendous change.

On the one hand, the mainstream media coverage has talked about, in a vague sense, the historic nature of some of these reforms, but it hasn’t talked about what they mean for the next 30 to 40 years of engagement in the world. When the secretary is thinking about these reforms, he’s thinking with that lens — a historical lens, a generational lens. And when you think about reforms in that way, the cost-benefit of some disruption in the short term versus the long-term benefit of significantly realigning foreign policy and foreign assistance for the American people, it makes a lot more sense why you’re willing to tolerate some degree of disruption.

We can argue all of these various specifics. We can engage in the hand-to-hand combat that many of your colleagues on the reporting side would like to engage in. But ultimately, the point here is the secretary has the vision of what this means.

The point is to do diplomacy — real diplomacy, bilateral relationships. You want this? I want that. Let’s get a deal done. How are we dealing with this security situation? How can we talk to each other so we avoid war?

The last reorganization of the department, ironically, occurred under Clinton. And where do they reorganize it around? They reorganize it around the growth of policy offices, the growth of these issue offices, the growth of this sort of: Well, let’s promote all these ideas. Let’s engage with these international organizations. Let’s build all these complicated bureaucratic multilateral constructs, both inside the U.S. government and on a global scale.

Douthat: I just want to give a due explanation of that theory, because part of what makes the Trump administration shift meaningful is it is not just a bureaucratic reorganization. It is reorganized around a change in the vision of U.S. foreign policy, where basically the argument that you’re making is that a network of civil society promotion, nongovernmental organizations and so on, funded by U.S. tax dollars around the world, doesn’t help the U.S. get its way around the world.

Lewin: It demonstrably failed. Just go look back at history, and look at what happened. What you see is the growth of these civil society organizations — well intentioned, I’ll grant you — but what have they actually accomplished? Where have they gone? We’ve seen how they’ve moved themselves toward authoritarianism with some of these critical ideas that have grown in this progressive left, how a lot of these international organizations have turned to censorship on a global scale and have turned to regime change.

One of the key things about realigning foreign assistance is a few general principles: The program has to work. It has to be accountable. It can’t be funding — I mean, we talk about, people talk about fraud: DOGE didn’t find that much fraud at U.S.A.I.D. This is really a definitional question — What is fraud? — in the sense of: Well, maybe I defrauded you. The grant says I do X and I do Y. That’s a very narrow conception of fraud. But is it a fraud to say you have this organization that The New York Times has painted as feeding all sorts of poor and destitute people around the world, but money is going to pay $400,000 salaries at [places like] U.C. Berkeley to do things like climate and race science research? Is that a fraud on the American people? I would say it kind of is.

Douthat: So you have two things going on, it seems, that you’re suggesting. First, you have a pivot ——

Lewin: And at the same time, by the way, China has eaten our lunch, right? I mean, we talk about soft power ——

Douthat: So part of what you’re arguing is that essentially the U.S. can do a fairer, better, more equitable version of the kind of investment that China has been promising Africa. So you’re saying, basically: We’ve gone in with aid and grants and NGOs, and they’ve gone in and promised to build trains, ports and — to use your example — maybe now, drone infrastructure. And so you’re saying: We can beat China by promising those kinds of deals on better terms. That’s part of it, right?

Lewin: That’s part of it. With an assistance component, too — where it’s strategic, right? I mean, I just approved a program to deploy small modular nuclear reactors built in the United States to an allied country to help with their energy infrastructure. We are building ports we just announced on the back of ——

Douthat: Can you confirm, out of all of these pots of money, in different aspects, the administration is ——

Lewin: The secretary has been very clear: We’re continuing to spend on PEPFAR and on malaria and on ——

Douthat: But the administration wants to spend less money on treating some of ——

Lewin: No, no, no.

Douthat: No?

Lewin: I think when you look at what PEPFAR was spending its money on, those cuts — a very modest amount of money was cut from PEPFAR — it was not for direct treatment, treating people with H.I.V. and stuff like that. It’s on, like, L.G.B.T.Q. education programs or whatnot that were funded because PEPFAR was a tremendously successful project and one of the most successful humanitarian projects in the history of the United States. But it became so successful that it outgrew some of its need. Countries graduated, their infection rates came down, some of them became wealthier enough that they could take more of the burden themselves because it was so successful.

This is a classic D.C. story. You keep on appropriating money to PEPFAR and then you don’t know what to do with it. So you start spending it on things that are non-core. You start spending it on things that are outside of the scope of what it’s supposed to be doing. Anyone in D.C. who’s thought seriously about these issues will admit that PEPFAR had more money than it really needed to accomplish its core H.I.V. treatment and disease prevention mission.

Douthat: Presumably a lot of the extra money was spent on the assumption that ideally you’re not just treating cases of the disease. You mentioned education — maybe you’re trying to educate people about not having the kind of sex that transmits H.I.V., right?

Lewin: Sure. And there’s a question about whether those things are abstractly good or whether the American taxpayer needs to pay for all of them, or whether other countries, whether other multilateral partners, et cetera, can pay for some of these things.

But the secretary is absolutely committed to PEPFAR’s mission and to beating H.I.V. around the world. He committed — I was part of that — more than $1 billion to honor the U.S. commitment to the global fund to fight H.I.V. We just obligated more than $1 billion across PEPFAR’s global programming to continue all of these key programs around the world through the next few months.

There’s no question that we remain committed to the program. We think we can do it more efficiently and with a different model.

For full interview and audio, go to NY Times.

THE CARING WORLD EXISTS IN A PLACE CALLED NYUMBANI. Reported by David Wecal

Before the DOGE cuts, before the pandemic, before Trump even, we spent three years off and on in Africa investigating the HIV/AIDS crisis for Johnson & Johnson. Our travels took us to Kenya. South Africa and Zimbabwe. We saw how complex the issue is from extreme poverty to gender violence to a population that got the short end of the stick because where they were born. One shining and inspiring example of success we found was Nyumbani. Nyumbani is a relatively self-sufficent village of now 800 children and adults impacted by AIDS that could be a model for how to address displaced populations and a future with less humanitarian aid. We’ve edited an article that was written a few years ago to give you a sense of this unique place.

The first impression isn’t what you expect it to be.

When you walk into a village of 1,000 children who have been abandoned by their parents, infected or otherwise had their lives turned completely upside down by HIV/AIDS; you expect to feel something profound, something sad perhaps, certainly something on a very powerful level.

Thomas will have none of that. He just wants to look at my iPhone. Actually he first wants me to take a photo of he and his buddies, so they can see themselves on my iPhone.
Kids are kids. That is the first lesson.

Sister Mary Owens, former Executive Director of Nyumbani:

They come in groups. It's not very often that one single child comes but you see that they are very insecure. They are afraid even, fear, they have nothing. Some of them have come just carrying whatever belongings they have just in their hands. They are just totally traumatized.

When they see that there's a roof over their heads, there's food to eat, there's clothes to wear, they can go to school without any worries, they just gradually become secure.

The world moves forward with Mercy, who is eight years old. Mercy lost her parents to AIDS. She lives in a small home in Nyumbani Village with her grandfather, her sister, a brother, and six other children. They’ve formed a family in every sense of the world and have renewed the African tradition of taking care of one another. Mercy loves to read. Her sister quietly teaches her while the boys prepare dinner, picking vegetables from the garden.

Sister Mary:

The way we envisioned the operation of the village was that what we would ask of the grandparents is that they're there for the children. Not just for their own biological grandchildren but also for the grandchildren of other families. They care for them, bond with them, love them, pass on the values of life and the traditions. We provide what is necessary for the household but we also challenge them to grow some vegetables and fruits because each family has about half an acre around their house.

The goal of the village is sustainability: making the community a viable operation but also helping the children build lives they can support. There is a clinic and a church, as well as a farm that raises livestock and vegetables. There is a primary school and a high school. Many graduates go onto college (40%). Many receive scholarships from programs supported by donors like Johnson & Johnson.

There is a polytechnical school where students learn a trade. The students make their own clothing, build their own furniture, learn how to weld, and are taught stonework and masonry.

Sister Mary:
You see that the children are very invested in education. The primary school education is our hope and our future, and that's a fact, because when they were at home while their parents were very sick and passing away, their education was very much interrupted. Some of them wouldn't have gone to school even. When they come into the Village and there's school, there's no worries about fees, no worry about uniform or stationery. "I just have to go to school and learn." Our hope. Our future.

Clean water is critical to everyday life in Africa. Safe water to drink and cook with is essential to Nyumbani Village. The homes and school buildings employ a rain capturing system that channels rain from the roofs to tanks that protect and store water for use throughout the year.

The children at Nyumbani are constantly asked to think of their lives beyond the village, beyond where they are today. What do you want to be when you grow up? The answers come back with as much imagination as you’d expect from children who have been given the freedom and opportunity to dream. Doctor, lawyer, pilot, teacher. These kids are making plans.

Reaching this place, this level of accomplishment, has been a long and twisting road. The idea of Nyumbani came from the necessity of the AIDS crisis in Africa and the vision of a priest from Providence, Rhode Island. Father D’Agostino and Sister Mary Owens were doing missionary work in an orphanage in Nairobi when HIV landed in Kenya like an atomic bomb. Parents were dying. Children were being abandoned at hospitals and schools. Violence was breaking out as people were fighting for food. Father and Sister started by creating a home that was basically a hospice.

There were no treatments for the disease so the goal was to care for the children as they died, giving them comfort and dignity as much as they could.

When the first AIDS treatments were discovered, Nyumbani was able to become a place where children could be helped. The collection of small buildings became a clinic and home to about 100 children. Today, the same amount of kids from toddlers to young adults live at the home located on the edge of Nairobi. Each child having their disease managed. The home also has a lab to do testing, which helps the facility and local community monitor patients.

Nyumbani had also created a network of clinics to help the thousands of children who live in the shadows of the slums of Nairobi. But costs and funding cuts forced the closure of those clinics this past year. Thousands of children have no place to turn now. Nyumbani home and the larger village outside of the city are at capacity.

When we spoke to the new leadership at Nyumbani (Sister Mary retired last year) we asked about the impact of the U.S. aid cuts which had just been made. The healthcare system of Kenya had not yet run out of meds for those battling AIDS, but many of the clinics had already closed. Nymbani was already seeing a few children brought in by parents who could no longer care for their child’s illness or their own. They were giving up their kids to Nyumbani so they might survive. The dark days were beginning again, everyone feared.

YOU SHOULD KNOW THE BILLIONAIRES WHO’LL BENEFIT FROM THE GUTTING OF US HUMANITARIAN AID. The caring world report.

The U.S. GOP Congress, with few exceptions fell in line, to pass Donald Trump’s Federal budget that not just cut key social services to vulnerable Americans, but also obliterated U.S. humanitarian aid. Trump promised his billionaire donors massive tax breaks and he delivered on those breaks, risking the economy by irresponsibly raising the deficit and almost guaranteeing  that upwards of 14 million will die because of disease and starvation.

Let’s look at a list of some of the Trump billionaire posse.

Elon Musk. He contributed $300 million to the Trump 2024 campaign and turned Twitter/X into a propaganda machine. Musk’s impact cannot be overestimated. Now that he and Donald are no longer political bros, we’ll see where Elon’s moneu goes. But he will still benefit from the tax cuts.

Steve Schwarzman. The Blackstone CEO has donated millions to Trump as well as multiple GOP candidates.

Miriam Adelson. She received the Presidential Medal of Freedom from Trump and reportedly donated $90 million to his ’24 campaign.

Bill Ackman. The CEO of Pershing Square has been a vocal advocate of Trump. It is unknown how much he has donated but regardless Ackman will see a sizable reduction in his tax bill.

Paul Singer. The hedge fund investor, worth $6 billion, donated $5 million to MAGA Inc Superpac. In 2023, he gave 440 million to Republican political groups.

“Ike” Perlmutter. The former Chairman of Marvel entertainment and Mar-a-Lago member has donated $20 million to GOP groups.

Woody Johnson. Jets owner has donated over $2 million to trump and got himself the US Ambassador job during Trump’s first term.

Linda McMahon. The Co-founder of WWE has given more than $15 million to Trump and in return was appointed to lead the Small Business Administration in Trump’s first term.

34 AFRICAN COUNTRIES SPEND MORE ON DEBT THAN HEALTHCARE. Winnie Byanyima, Executive Director of UNAIDS reports.

If Africa cannot take ownership of the HIV responses in the face of cuts, our continent could return to the darkest days of AIDS.

The cost of inaction? Lives lost.

We are seeing a humanitarian disaster unfold simultaneously at breakneck speed and in slow motion.

In 2023, 3,500 people acquired HIV every day. According to our latest estimates, if the US President's Emergency Plan for AIDS Relief (PEPFAR) is not reinstated, and nothing comes in its place, that figure will grow to 5,800.

The world will see 4 million more AIDS-related illnesses and 6 million more HIV infections by 2029.

We cannot address the aid crisis if we do not address the debt crisis.
First, the poorest countries in greatest need should have their debts cancelled. These are low-income countries in or close to debt distress, many facing default.

Fragile public services are already barely able to keep people alive, but debt obligations could force governments to gut what remains.

The world has a moral duty to act in solidarity.

Second, lower-middle income countries that have faced multiple shocks need breathing space to recover and invest in their economies.

African countries are facing debt interest payments up to nine times higher than those paid by wealthy countries. For these countries, debt restructuring is needed to curb interest rates and reschedule payments into realistic timelines.

Third, African governments must ramp up efforts to increase revenues through progressive taxation. Africa loses $89 billion every year to illicit financial flows, mostly aggressive tax planning enabled by tax incentives, exemptions, and loopholes. Health levies on tobacco, alcohol, and sugary beverages pose an opportunity to generate short-term revenue, while helping to curb unhealthy behaviours.

But the richest should shoulder the greatest burden, and that can only be achieved through taxing wealth, corporate profits, inheritance, and capital gains.

If Africa cannot take ownership of the HIV responses in the face of cuts, our continent could return to the darkest days of AIDS.

African leaders are rising to meet this critical moment with action. But the scale of the challenge means that we cannot simply reallocate existing budgets – we need more money in government coffers.

Ultimately, tackling debt and taxation head-on is the only path forward.

NEW DRUG PROVEN TO PREVENT AIDS, BUT U.S. CUTS FUNDING TO DELIVER IT. Stephanie Nolan reports.

A new drug that gives almost complete protection against the virus was to be administered across Africa this year. Now, much of the funding for that effort is gone.

EXCERPTS FROM THE NY TIMES

This was supposed to be a breakthrough year in the 44-year-long struggle against H.I.V. A breakthrough preventive drug, lenacapavir, a twice-yearly injection that offers total protection from H.I.V., was to be rapidly rolled out across eastern and southern Africa. The main target: young women. About 300,000 of them were newly infected with the virus last year — half of all new infections worldwide…

There is more potential than ever before to end the H.I.V. epidemic, scientists and public health experts say. But now, H.I.V. programs across Africa are scrambling to procure drugs that the United States once supplied, replace lost nurses and lab technicians, and restart shuttered programs to prevent new infections.

“We imagined we would be in a different world right now,” said Dr. Leila Mansoor, a senior research scientist at the Centre for the AIDS Program of Research in Durban, South Africa. She had planned to spend 2025 analyzing data from one H.I.V. prevention trial, preparing for another and tracking how lenacapavir was transforming the epidemic — alongside colleagues testing new vaccines and cure strategies.

“And instead we’re moving backwards at warp speed,” she said…

Already, there are fears that H.I.V. infection rates are rising in the hardest-hit countries, but there is no clear way to measure the damage because data collection was mostly reliant on the terminated U.S. funding. Stocks of prevention drugs once supplied by the U.S. are running out across Africa.

The Trump administration says that too much foreign aid is wasted by corrupt governments and bloated programs. The president and his allies have repeatedly said that the United States has shouldered an unfair share of responsibility for global health support and that other countries must do more…

Among the prevention programs cut is U.S. support for an ambitious plan to distribute lenacapavir, which the U.S. Food and Drug Administration approved this week. Rapid rollout of the new injection is seen by many public health experts as the best opportunity the world has yet had to stop the spread of H.I.V. in the United States and abroad.

Lenacapavir was supposed to be the product that showed that the world was finally doing things differently, said Dr. Linda-Gail Bekker, director of the Desmond Tutu H.I.V. Centre at the University of Cape Town, who was a principal investigator in the trial that proved the drug’s extraordinary effectiveness.

The company that makes the drug, Gilead Sciences, applied for regulatory approval in African countries where it was tested at the same time as in the United States. The company also issued a voluntary license to makers of generics, including companies in India and Egypt, so that an affordable product would be available in a few years.

To bridge the gap until that time, Gilead committed to producing enough of the drug to protect two million people over three years, to be sold at “a no-profit price.”

However, about half of those doses from Gilead were supposed to be purchased by the President’s Emergency Fund for AIDS Relief, known as PEPFAR. But the Trump administration has decided that PEPFAR should no longer support H.I.V. prevention for anyone except pregnant and breastfeeding women, and will most likely fund only a sliver of the planned Gilead purchase. The other half of the doses were meant to be bought by the Global Fund to Fight AIDS, Tuberculosis and Malaria, a multilateral donor agency to which the United States has historically been the largest funder. But the Trump administration is also cutting deeply into its support to the Global Fund…

“The promise of lenacapavir for prevention was — everybody thought this is the last stage to bring the H.I.V. epidemic down to its knees, and there was such enthusiasm for what we would see,” said Dr. Ntobeko Ntusi, the chief executive of the South African Medical Research Council. “That’s now all up in the air.”

READ COMPLETE ARTICLE.

THE WASTE MUSK CREATED. Nicholas Kristof of NY Times reports from Africa.

Excerpts from original NY Times article

I’ve been traveling through Sierra Leone and Liberia to gauge the impact of Trump’s closing of U.S.A.I.D., to see how bad things have gotten. Here’s what I see: Children are dying because medicines have been abruptly cut off, and risks of Ebola, tuberculosis and other diseases reaching America are increasing — while medicines sit uselessly in warehouses…

Join me in the village of Kayata, Liberia, where in April a pregnant mother of two, Yamah Freeman, 21, went into labor. Freeman, a lively woman known for her friendliness to all, soon hemorrhaged and began bleeding heavily, so villagers frantically called the county hospital to summon an ambulance. U.S.A.I.D. previously supplied ambulances to reduce maternal mortality, but this year the U.S. stopped providing fuel, leaving the ambulances idle. Ambulance crew members said they’d be happy to rescue Freeman, if someone would only come and buy them gas.

It’s more than 10 miles through the jungle on a red mud path from Kayata to the hospital, but villagers were determined to try to save Freeman’s life. The strongest young men in the village bundled her in a hammock and then raced down the path, shouting encouragement to her as she lay unconscious and bleeding. They didn’t make it: She died on the way, along with an unborn son.

So when I hear glib talk about waste and abuse in U.S.A.I.D., I think of how we American taxpayers purchased ambulances for Liberia at a cost of more than $50,000 each and then abruptly cut off gasoline funds, leaving a young mom to bleed to death…

Come also to the village of Vonzua in western Liberia, where a woman named Bendu Kiadu is mourning her child Gbessey, who was just 1 year old.

Gbessey caught malaria in March. In normal times, a community health worker would have administered simple medicines for malaria, and the United States noted just last year that it provided “vital” and “critical” support to fight malaria in Liberia. But the closing of U.S.A.I.D. led to the collapse of some supply chains, so health workers had no malaria medicine to offer Gbessey.

Kiadu rushed the child to a clinic, but it, too, had run out of malaria medicine. The next day, Gbessey died…

How often does this happen? The Trump administration is also dismantling data collection, making it difficult to count the deaths it is causing. By one American economist’s online dashboard, about 350,000 people worldwide have died so far because of cuts in American aid. My guess is that the figure isn’t so high, partly because it takes time for children to weaken and die, but that the rate of deaths will accelerate.

We can’t save every child in the world, I realize, and it’s fair to note that not every U.S.A.I.D. program was brilliant and lifesaving. The agency could have used reforms. Yet it’s also true that at a cost of only 0.24 percent of gross national income, we provided humanitarian aid that saved about six lives every minute around the clock, based on rough estimates from the Center for Global Development. That is what we have undone.

One of America’s most heroic achievements in the past half-century was turning the tide of AIDS and saving, so far, some 26 million lives through the President’s Emergency Plan for AIDS Relief, or PEPFAR, started by President George W. Bush in 2003. In particular, PEPFAR made much less common the horror of H.I.V.-positive women inadvertently infecting their babies during childbirth.

And now mother-to-child transmission may be rising again…

In Totota, Liberia, midwives are caring for three pregnant women with H.I.V. but have only enough medicine to prevent mother-to-child transmission for one of them. They don’t know what they will do or what to tell H.I.V.-positive people worried about whether antiretrovirals will continue to be available.

“I asked my supervisor what to do,” said Telmah Smith, one of the midwives. “And he said, ‘Pray that U.S.A.I.D. will come back.’”

Some readers may think: Of course it’s sad that children are dying, but why is it our job to save their lives?

To those unmoved by moral arguments, I’d note that President John F. Kennedy created U.S.A.I.D. in 1961 to advance our interests as well as our values. Aid programs also protect Americans from a threat that aircraft carriers are helpless to combat: disease. U.S.A.I.D. and the World Health Organization (which the United States is now withdrawing from) track outbreaks of diseases like Ebola to extinguish them before they can spread.

So aid cuts are at a level where they undermine our national interest as well as corrode our souls. They are a braid of recklessness, incompetence and indifference — and “indifference” is generous, for the disregard is so deliberate that it bleeds into cruelty.

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