THE CRUEL WORLD ACCORDING TO STEPHEN MILLER. David Klion reporting for The Nation

If the only thing one knew about Stephen Miller was that he was a white man, it might be sufficient to explain his alignment with Donald Trump—after all, 60 percent of that demographic supported Trump against Kamala Harris last fall. But identity is complicated, and every other aspect of Miller’s points to the opposite conclusion. At 39, Miller is a millennial (51 percent of voters age 30 to 44 voted for Harris); he was raised Jewish in a Reform congregation (84 percent of Reform Jews voted for Harris) and grew up in Santa Monica, California (Santa Monica’s precincts ranged from 71 to 86 percent for Harris); he has parents with advanced degrees and himself graduated from top-ranked Duke University (56 percent of college graduates and a likely 75 percent of students at Duke voted for Harris); and he has lived his entire postcollegiate life in the District of Columbia (92 percent of DC voters went for Harris).

Miller has the profile not of a typical Trump supporter but of a garden-variety liberal Democrat. Nevertheless, he is arguably one of the president’s most influential and ideologically fervent loyalists. Having previously served as chief speechwriter and a senior adviser for policy in Trump’s first term, this year he returned to the West Wing as deputy chief of staff for policy and Homeland Security adviser in Trump’s second—roles that mark him as one of the most powerful people in the Trump White House and, by extension, the world. As a January New York Times profile put it, “Mr. Miller was influential in Mr. Trump’s first term but stands to be exponentially more so this time.”

One of the architects of the attempted “Muslim ban” as well as the infamous child-separation policy during Trump’s first term, Miller has now pledged to oversee “the largest deportation operation in American history,” indiscriminately targeting the roughly 11 million undocumented immigrants believed to be living in the United States, with the full coercive power of the executive branch. To whatever extent he is successful, he will transform America demographically, culturally, and economically in ways he has fantasized about since his early teens; in many respects, he already has.

How to make sense of Miller and his trajectory? While he has made his share of public appearances to push his ultra-nativist views, he rarely speaks about his own political evolution. To date, the only authoritative biography of Miller is Hatemonger: Stephen Miller, Donald Trump, and the White Nationalist Agenda, by the reporter Jean Guerrero. Published in 2020, at the height of the Covid-19 pandemic and during a presidential election that saw voters reject Trump, the book was well received by reviewers but arrived at a moment when Miller seemed, mercifully, to be fading in relevance. But the story Guerrero recounts is an urgent one, packed with insights into the kind of personality that self-radicalizes toward the far right in the unlikeliest of circumstances. As we now know, Miller was only just getting started during Trump’s first term. The particular brand of virulent xenophobia he represents is now politically ascendant, and his biography is inescapably central to the history of the present.

Stephen Miller was born in 1985 and raised in the coastal paradise of Santa Monica—a semi-urban enclave of wealthy and mostly white liberals, undergirded by the omnipresent labor of immigrants who are neither white nor wealthy. “Laborers maintain this world,” Guerrero notes, most often laborers from Mexico and Central America. The rest of California in the 1980s and ’90s, however, was neither placid nor uniformly liberal. During Miller’s childhood and adolescence, the state was a hotbed of anti-immigrant sentiment and racial backlash.

Miller was 6 years old when the Los Angeles Police Department’s savage beating of Rodney King set off a wave of protests and riots across the city. California’s Republican governor, Pete Wilson, won reelection on an anti-immigrant platform when Miller was 9, campaigning on Proposition 187 to deny nonemergency services to undocumented immigrants. Right-wing talk radio, spearheaded by but not limited to Rush Limbaugh, took off nationwide during the 1990s and stoked racist and xenophobic sentiment for anyone inclined to listen to it. Santa Monica may have been a haven for well-to-do veterans of the New Left (Tom Hayden and Jane Fonda lived there for decades), but they were thriving amid the cognitive dissonance produced by a functional racial caste system upon which many of them relied and a state that was a harbinger of our ugly political moment.

Miller is a product of some of the same cognitive dissonance. The story of how he came to be born in Santa Monica, as Guerrero reminds us, begins with his ancestors’ immigration to escape antisemitism. Both sides of his family, the Millers and the Glossers, arrived in the United States from Russia’s impoverished Pale of Settlement in the early 20th century. From then on, they both had typically American Jewish social ascents. On the Miller side, one generation’s success selling groceries and rolling cigars in Pittsburgh led to the next generation’s success in law and real estate in Los Angeles; on the Glosser side, a family-owned department store served as a community pillar in Johnstown, Pennsylvania, until it was acquired and liquidated in a leveraged buyout in the 1980s.

Stephen’s father, Michael Miller, a Stanford-educated lawyer, cofounded a firm focused on corporate and real estate law; he also became deeply involved in his father’s real estate business and helped to reconstruct the world-famous Santa Monica Pier. Stephen’s mother, Miriam Glosser, graduated from the Columbia University School of Social Work and worked with troubled teens before eventually pivoting to the family real estate business as well. As a child, Stephen grew up in a $1 million, five-bedroom home in the North of Montana section of Santa Monica, one of the wealthiest neighborhoods in Greater Los Angeles. He had Latin American–born housekeepers who cooked family meals and cleaned up after him and his siblings.
This comfortable lifestyle was disrupted in 1994, when the Millers had a run of terrible luck: A major earthquake inflicted $20 billion in property damage in Southern California, including on a number of properties managed by the family firm. This came at a particularly inopportune moment, as Michael Miller was in the midst of an acrimonious legal battle with his former partners in the law firm he’d started, the upshot of which was that he found himself hundreds of thousands of dollars in debt.

In 1998, when Stephen was 13, the family sold its imposing home and moved to a smaller house by a freeway underpass near the working-class Hispanic neighborhood of Pico, though still in a majority-white middle school district. The area was beginning to gentrify, and the Millers would refinance the house three times over the next four years as their fortunes gradually recovered.

If there is a sociological explanation for Miller’s politics, Guerrero implies, perhaps it lies in this period. In the aftermath of the 2008 housing crisis, many of Miller’s peers found themselves downwardly mobile, locked out of the housing market and denied opportunities that prior generations had taken for granted—experiences that have inclined many millennials toward a more socialistic politics than previous cohorts. But Miller’s brush with downward mobility came much earlier, with his affluent boomer parents experiencing the shock of material insecurity during the 1990s, a decade that is more typically remembered as a period of unprecedented economic prosperity. Though Miller was never anywhere close to working-class, and his family’s finances rebounded in time for him to enjoy the benefits of an elite university education and a parentally subsidized down payment on a DC condo (though recently his parents had another bit of bad luck, as their home was destroyed in the Los Angeles wildfires in January), he did pass through a period of acute economic and status anxiety during a very impressionable age.

But sociology can only explain so much; it is hard to escape the sense that there was something fundamentally malevolent about Miller from the start. Another person in his shoes might have grasped that this anxiety was the product of his parents’ business difficulties and sheer geological misfortune, but the adolescent Miller sought out other culprits. With his economic privilege in seeming jeopardy, he leaned much harder into his privilege as a white, native-born American.

Guerrero spoke with Jason Islas, a working-class Mexican American who was Miller’s friend in middle school and attended his lavish bar mitzvah. Though the two initially bonded over Star Trek, Miller abruptly ditched Islas as a friend the summer after middle school, citing his Latino heritage as a justification. “The conversation was remarkably calm,” Islas told Guerrero. “He expressed hatred for me in a calm, cool, matter-of-fact way.”

In middle school, Miller was already drawn to right-wing subcultures that distinguished him from his peers, purchasing a subscription to Guns & Ammo magazine and finding himself inspired by the writings of Charlton Heston and Wayne LaPierre on the Second Amendment. His father was also moving right, alienated by bad relationships and burned bridges with his liberal Santa Monica cohort, and Stephen seems to have inherited his father’s contrarian streak. By the time he enrolled in the public Santa Monica High School, which Guerrero portrays as neatly internally segregated between professional-class, college-bound whites and working-class Hispanics, he was a full-fledged conservative provocateur.

For Miller, a key entry point to the right was The Larry Elder Show, whose Black host had built a following among right-wing Angelenos for his verbal assaults on political correctness and liberal shibboleths. Miller called in to the show and invited Elder to speak at his high school, and he subsequently became a frequent guest, a precocious teen reactionary holding forth on his high school’s alleged anti-Americanness in the wake of the 9/11 attacks before an audience that spanned Southern California.

Miller’s provocations became more outlandish as he advanced through his teens. He cultivated a mid-century gangster affect: He listened to Frank Sinatra, enjoyed gambling, and styled himself after Ace Rothstein, the Robert De Niro character in Casino. He was known for arguing with teachers, hijacking school events, and winning attention with his outrageous antics. In both high school and college, he would be repeatedly observed throwing trash on the floor and then insisting that the custodial staff pick it up. (“Am I the only one here who is sick and tired of being told to pick up my trash when we have plenty of janitors who are paid to do it for us?” he is quoted as saying at one point.) A number of students and faculty found this behavior appalling, but Miller’s shameless transgressiveness at least got him a lot of attention.

His willingness to upset liberals and thrive on their outrage put Miller on the radar of David Horowitz, the nationally notorious firebrand whose red diaper upbringing and early career involvement with the Black Panthers were followed by an abrupt rightward turn beginning in the 1970s. By the early 2000s, Horowitz had become a leading conservative ideologue who specialized in identifying and recruiting young talent. After discovering Miller on The Larry Elder Show, Horowitz went on to serve as something of a career guru to him. He helped Miller craft an image as an outspoken champion of free speech at a hostile liberal high school, which Miller exploited to secure a photo spread in the Los Angeles Times. This publicity, Guerrero speculates, might also have helped Miller gain admission to Duke University despite an antagonistic relationship with his high school administration.

In 2003, Miller entered Duke, where he continued the shtick he’d developed at Santa Monica High: the performative littering, the trolling classroom monologues, the Larry Elder Show appearances lambasting the university administration for its supposed leftism, and the fruitful relationship with Horowitz. He quickly established a Duke chapter of Horowitz’s Students for Academic Freedom, which he used to assail the Palestine Solidarity Movement, to attack feminism and multiculturalism, and to champion the white members of the Duke lacrosse team who were accused (falsely, it turned out) of raping a Black stripper in 2006. This last incident, which drew sustained national attention, gave Miller the opportunity to appear on The O’Reilly Factor and Nancy Grace while he was still an undergrad.

Miller’s TV appearances proved to be the perfect launchpad for a career in Republican politics after graduation. Horowitz helped, too, introducing Miller to Representative Michelle Bachmann, from whose office Miller quickly rose to serve as press secretary for Alabama Senator Jeff Sessions. It was in this job that Miller met Steve Bannon, then affiliated with the emerging right-wing tabloid site Breitbart; Bannon, a longtime Los Angeles resident, recognized Miller from his Larry Elder spots. Breitbart and an increasingly extensive network of alternative right-wing media outlets enabled Miller, working with Sessions, to play a central role in the successful effort to kill the Obama administration’s effort at bipartisan immigration reform in 2014.

By this point, Miller had become much more deeply immersed in the literature and online forums of the extreme right and was taking direct inspiration from Jean Raspail’s novel The Camp of the Saints, with its dystopian vision of a horde of nonwhite migrants invading the West. Soon he also began to develop ties with leading right-wing media figures like Ann Coulter, Laura Ingraham, Tucker Carlson, and the anti-immigration think tanker Mark Krikorian.

Perhaps the most vocal advocate against immigration in that media space was one Donald Trump, who had leveraged his celebrity to become the leading exponent of the “birther” conspiracy theory during the Obama years, impressing Miller greatly in the process. “Our whole country is rotting, like a third world country,” Trump told Breitbart in the wake of the Obama immigration bill’s defeat, prompting Miller to e-mail his friends that “Trump gets it…. I wish he’d run for president.” When Trump began his long-shot campaign the following year, Miller, barely 30, joined up, and the two quickly hit it off. Where more traditional young Republicans might have spent their early careers preparing to work for a more conventional Republican candidate like Jeb Bush or Chris Christie, Miller had presciently spent his preparing for a candidate like Trump. And with Trump’s victory came opportunities to do the kinds of things that his more seasoned peers might never have proposed.

Literally from Day 1, Miller set the tone for Trump’s first presidency: “This American carnage stops right here and stops right now,” the most memorable line in Trump’s 2017 inaugural address, came from Miller’s pen. A wave of executive orders empowering Immigration and Customs Enforcement, targeting sanctuary cities, ordering the construction of a border wall, and suspending immigration from seven Muslim-majority countries soon followed, all of them pushed and heavily shaped by Miller. It was Miller who made the once-obscure Salvadoran gang MS-13 
an obsession of the Trump administration, and Miller who emerged as one of the top internal advocates for the family separation policy that became a national scandal in 2018.

In addition to the president himself, Miller built a close relationship with Jared Kushner and Ivanka Trump, ensuring a level of family trust that protected him from the turnover for which the Trump administration became infamous. If xenophobia was the policy through line for most of Miller’s efforts, competent bureaucratic maneuvering and absolute loyalty to Trump were what empowered him to execute his agenda. Miller’s fingerprints are likewise all over the early initiatives of Trump’s second term, including turning legal refugees away from the United States, suspending foreign aid, launching ICE raids on major cities, and leaning on the major tech companies to ban diversity initiatives.

The world according to Stephen Miller is a cruel and callous one, in which America is strictly for unhyphenated Americans and those here “illegally” must be forcibly returned to the “failed states” where they were born. To Miller, the crumbling American heartland is being preyed on not by rapacious capital but by an invading army of gangsters, thugs, and terrorists waved in by coastal liberal elites—in other words, by exactly the kind of people he has always lived among.

Part of why Guerrero was able to speak with so many of Miller’s acquaintances—including his estranged uncle David Glosser, who has compared his nephew to the Nazis—is that Miller is so unrepresentative of the world he grew up in. Interviewees throughout Hatemonger regularly express shame and horror rather than pride at Miller’s steady climb to the heights of political power; one gets the sense that speaking to the media is a form of penance for some of them.

At the same time, Miller’s rise wasn’t exactly a fluke. It was facilitated not only by his family’s baseline wealth and privilege and the social capital they afforded, but by Miller’s demonstrated talent for hacking the weaknesses of liberal elite culture itself. Miller is an extreme case, yet anyone who grew up in similar communities or attended similar schools can recognize him as a very particular type of guy. His hateful tirades weren’t popular at Santa Monica High or at Duke, but they consistently drew attention; students and faculty often pushed back hard against his constant trolling, but in doing so they played right into his hands. Teachers who wanted to encourage open debate and free speech gave him a platform regardless of whether he was arguing in good faith; mainstream and liberal media outlets continued to promote him in the name of provocation and ideological diversity. Like Trump himself, Miller intuitively grasped that being hated in elite liberal environments was better than being ignored, and that embracing the language and tactics of conservative media offered a means for a strange and argumentative kid to stand out from a crowd of generic achievers and to fast-track his way to influence.

This isn’t to say that Miller’s act is entirely cynical. It’s clear that beneath all the performative cruelty and amoral careerism, there’s an authentic core of seething, visceral, unquenchable hatred that defies any easy explanation. It’s true, as Guerrero documents, that such bigotry circulated widely in Southern California and elsewhere in the 1990s, and it’s true that far-right voices on talk radio and later on the Internet continually grew in influence as Miller came of age, but none of that by itself explains why Miller is the way he is.

Despite his obvious intelligence and his elite pedigree, Miller didn’t arrive at his views via serious reading—his is not the classical conservatism of Edmund Burke, the libertarianism of Friedrich Hayek, the neoconservatism of Irving Kristol, or the paleoconservatism of Samuel Francis—and he’s never presented himself as an intellectual in his own right in the manner of, say, his White House colleague Michael Anton. His ideas are not just monstrous and reactionary but banal and simplistic; he lacks the imagination that is a prerequisite for empathy. But in a way, this makes him the ideal conservative for the Trump era: His ideology is not refined, abstracted, or euphemized away from its real object. He’s told us exactly what he intends to do.

CHINA AND THE AFRICAN UNION HOLD STRATEGIC DIALOGUE. Post from Friends of Socialist China.

On January 8, 2026 local time, Member of the Political Bureau of the CPC Central Committee and Foreign Minister Wang Yi and Chairperson of the African Union (AU) Commission Mahmoud Ali Youssouf jointly held the ninth China-AU Strategic Dialogue at the AU headquarters in Addis Ababa.

Wang Yi said that the AU is the “locomotive” driving African unity and cooperation, playing an important and unique role in China-Africa relations. President Xi Jinping has sent congratulatory messages to the AU Summits for 13 consecutive years, which fully demonstrates China’s high regard for developing relations with the AU. This year marks the 70th anniversary of the start of diplomatic relations between China and Africa, and also the 36th consecutive year for Africa to be the destination of the Chinese Foreign Minister’s first overseas trip in a new year. This diplomatic tradition reflects the continuity of China-Africa friendship, the stability of China’s policy toward Africa, and the solidarity of developing countries. The unity and concerted efforts of over 2.8 billion people in China and Africa will enable them to overcome any difficulties and challenges, accelerate their pace toward modernization, and contribute to a more just, equitable, harmonious and stable world.

Wang Yi said that both China and Africa are at a critical stage of development and are facing new and broad opportunities for cooperation. China is willing to leverage its own development to provide support for the vast number of developing countries, including those in Africa, to achieve modernization together and jointly safeguard the interests of the Global South. The Forum on China-Africa Cooperation (FOCAC) has played an important role in the common development of China and Africa, blazing a path of win-win cooperation between China and Africa. Both sides should continue to make good use of this platform to deepen practical cooperation and jointly tell the story of China-Africa cooperation well. Both sides should continuously enhance the strategic, exemplary, and practical nature of China-AU relations and ensure that the AU plays a better leading role in the overall China-Africa relations. China firmly supports the AU in uniting and leading African countries to uphold independence and defend the right of African countries to pursue independent development. China supports the African people in seeking African solutions for African problems and pursuing development paths suited to their own national conditions. China also supports the AU in playing a leading role in regional affairs.

Wang Yi said that the AU promptly and actively responded to and supported the Global Governance Initiative proposed by President Xi Jinping, reflecting the high alignment of ideas between both sides and their shared aspiration to shape international fairness and justice. China is ready to continue strengthening dialogue and communication with the AU on the four global initiatives, support Africa in playing a greater role on the international stage, jointly practice true multilateralism, and make the global governance system more just and equitable.

Mahmoud Ali Youssouf said that China is a partner that Africa can fully trust and rely on. The fact that the Chinese foreign ministers have made Africa the destination of their first overseas visit in a new year for 36 consecutive years fully reflects China’s strategic emphasis on Africa. Africa-China friendship, based on mutual respect and a shared vision for peace and development, has become a model of cooperation in the Global South. The AU appreciates China’s long-standing partnership with Africa across various fields and its selfless support for Africa’s development. The AU highly commends the fruitful outcomes of the FOCAC and the tangible benefits it has brought to the people of Africa and China. The AU adheres to the one-China principle, firmly supports China in safeguarding its core interests on the Taiwan question, and opposes any attempt to split China. The AU is willing to work with China to continue strengthening Africa-China cooperation through mechanisms such as FOCAC to deliver greater benefits to the people of both sides.

Mahmoud Ali Youssouf said that the AU congratulates China on successfully hosting the Commemoration of the 80th Anniversary of the Victory of the Chinese People’s War of Resistance Against Japanese Aggression and the World Anti-Fascist War. At a time when power politics and bullying are on the rise and multilateralism is under attack, Africa and China are at a critical moment to remember history, look to the future, and defend sovereignty. It is even more necessary for Africa and China to deepen their partnership. The AU highly appreciates the four global initiatives put forth by President Xi Jinping and is willing to join hands with China to safeguard the common interests of the Global South and promote global fairness, justice, peace and development.

U.S. CUTS HEALTH AID AND TIES IT TO FUNDING PLEDGES BY AFRICAN GOVERNMENTS. Stephanie Nolen for The NY Times.

The State Department is negotiating agreements with countries across the developing world to provide billions of dollars in health aid, an effort intended to replace the system of global health assistance that had for decades been offered through the now-dismantled U.S. Agency for International Development.

Over the past month the U.S. has signed agreements with 16 African countries to provide more than $11 billion in health aid over the next five years, and is negotiating dozens more deals with governments in Asia and Latin America as well as Africa.

The new commitments represent a steep drop in the health aid that the United States contributed before President Trump ordered a review of foreign assistance on his first day in office last year. According to an analysis by the nonprofit Partners in Health, health funding under the agreements would drop by 69 percent to Rwanda, 61 percent to Madagascar, 42 percent to Liberia and 34 percent to Eswatini, where a quarter of adults live with H.I.V.

Nevertheless, the deals are being welcomed by governments and some analysts in Africa as a significant shift that could increase country autonomy and make health systems stronger and less reliant on international largess. Others, however, say the agreements were negotiated with countries that had no leverage and demand conditions that are unattainable, especially in places where people are most in need of help.

The deals are guided by the administration’s global health strategy, announced in September, which emphasizes health spending that it says serves to make the United States safer and more prosperous. In Zambia, where negotiations are stalled, Washington is seeking to tie access to U.S. health funding — on which Zambia relies heavily to run a huge H.I.V. treatment program — to the signing of a separate deal for U.S. access to the country’s vast mineral resources. The proposed deal cuts Zambia’s health funding from the United States by more than 50 percent.

Jeremy Lewin, acting under secretary of state for foreign assistance, humanitarian affairs and religious freedom, said the agreements are the first phase of a reimagining of a failing and dysfunctional foreign aid system.

“That system was failing American taxpayers who were going to fund this in perpetuity,” Mr. Lewin said in an interview with The New York Times. “It was failing countries who didn’t have control over their own health sovereignty and their own health destinies. And it was failing patients, because ultimately we can only reach so many people with our foreign assistance funding and the thing that’s going to produce the best health outcomes for people in these countries is going to be for their national governments to build the capacity to take care of those populations.”

The overall large drop in the funding deals contrasts sharply with a push from Congress, where the House voted overwhelmingly on Wednesday to maintain funding for global health near the level it was in past years. The Senate will take up the bill later this month; the legislation proposes $9.4 billion in global health funding for the 2026 fiscal year, more than twice the $3.8 billion the administration had said it intends to spend.

The administration’s new mode of providing health aid differs significantly from the previous funding model. Now U.S. support is being conditioned on a cofinancing commitment from the partner country — Washington will give Nigeria about $2 billion over five years, for example, if the Nigerian government increases its current health budget by $3 billion in that period. In many cases, the new commitments that governments are making represent a large hike in their health spending — and it’s not clear, in countries with faltering economies and huge debt burdens, where those funds will come from.

“We will be punished sorely if the terms of the agreement aren’t met,” said Gift Trapence, who chairs a network of H.I.V. organizations in Malawi. “Yet Malawi is already struggling to finance its health system.” U.S. funding to Malawi will be cut by 35 percent.

The agreements frame the U.S. support as a direct exchange with the African governments, reducing or eliminating the role of nongovernmental organizations. Mr. Lewin and others at the State Department have been harshly critical of the large aid organizations — known as “implementing partners” — that the United States contracted to do much of the global health work it funded in the past.

Under that system, U.S.A.I.D. contracted those organizations to deliver goods and services in partner countries, sometimes working with the local health ministry, while other times acting independently. Trump administration officials have repeatedly characterized those organizations as a development mafia, saying they charged exorbitant overhead fees and were more preoccupied with ensuring their own survival than with helping countries end their reliance on foreign aid.

Under the new deals, more funds will go directly to governments to deliver services, and when they need the support of partners, they will choose them with the United States and have clarity about their budgets. The lack of transparency around those budgets, and the ability of implementing partners to set heath agendas, have been points of frustration for recipient governments in the past.

“There’s nothing not to like here,” said Ebenezer Obadare, a Nigerian analyst of African politics at the Council on Foreign Relations. “If there is any part of this that does not work for any African government, they are entitled to walk away.”

But Dr. Musoba Kitui, the Nairobi, Kenya-based regional director for a health rights advocacy group, said it was absurd to suggest that this was a fair negotiation between nations. After the United States abruptly froze funding to Kenya a year ago, “the health system was on its knees, and that vulnerability made it very likely that the state would sign on to any conditions, just to get some money into the Ministry of Health,” he said. Kenya’s funding from the United States will decline by 20 percent.

The deals have been negotiated under intense time pressure and with limited transparency. In Cameroon, the heads of key government health departments were unsure talks were even taking place until they learned a deal had been signed. In Kenya, the deal was negotiated with the Kenyan Treasury, and senior figures in the health ministry did not know its content until it was signed.

The compacts mean governments should be able to better integrate their health systems instead of having H.I.V. services run through one channel of U.S. funding, and malaria services another, said Dr. Kitui, who works with Ipas Africa Alliance. But what’s lost is the kind of solidarity that U.S.A.I.D. used to provide for marginalized communities — for women and girls, for people living in informal settlements or rural areas whose needs are often neglected by government. U.S.A.I.D. funded projects that provided health care to queer communities in places such as Uganda where homosexual activity is criminalized or persecuted.

Dr. Kitui said there is deep concern that the new deal could restrict abortion access, overriding national policies on reproductive health. A 1973 U.S. law prohibits the use of American foreign assistance funds to pay for abortion as a method of family planning, or to motivate or coerce any person to practice abortion. While abortion in Kenya is legal only when deemed necessary for the life or health of the pregnant woman, in practice medical personnel interpret this broadly and include the ways mental health can be undermined by an unwanted pregnancy.

Now, though, any aspect of the Kenyan health system that is getting U.S. funding support — such as the national medication supply chain — would theoretically be prohibited from supporting abortion, such as by stocking medications.

The new agreements will do more government-to-government transfer in countries where there is perceived to be greater transparency, and will continue to rely on “implementing partners” in places where accountability is weaker, Mr. Lewin said. The “implementing partner” model was developed in part because of concern about high levels of corruption in some developing countries’ governments, and fear of theft or waste of resources that were U.S. taxpayer contributions.

“We don’t see any way to make sure how this money is being used,” said Olivia Ngou, the director of Impact Santé Afrique, a health advocacy organization in Cameroon — a country with high corruption and an opaque, autocratic government.

U.S. SIGNS AID DEALS WITH AFRICAN COUNTRIES, WITH STRINGS ATTACHED. By Mogomotsi Magome And Michelle Gumede, Johannesburg AP

The U.S. government has signed health deals with at least nine African countries, part of its new approach to global health funding, with agreements that reflect the Trump administration’s interests and priorities and are geared toward providing less aid and more mutual benefits.

The agreements signed so far, with Kenya, Nigeria and Rwanda among others, are the first under the new global health framework, which makes aid dependent on negotiations between the recipient country and the U.S.

Some of the countries that have signed deals either have been hit by U.S. aid cuts or have separate agreements with the Trump administration to accept and host third-country deportees, although officials have denied any linkage.

The Trump administration says the new “America First” global health funding agreements are meant to increase self-sufficiency and eliminate what it says are ideology and waste from international assistance. The deals replace a patchwork of previous health agreements under the now-dismantled United States Agency for International Development.

U.S. aid cuts have crippled health systems across the developing world, including in Africa, where many countries relied on the funding for crucial programs, including those responding to outbreaks of disease.

The new approach to global health aligns with President Donald Trump’s pattern of dealing with other nations transactionally, using direct talks with foreign governments to promote his agenda abroad. It builds on his sharp turn from traditional U.S. foreign assistance, which supporters say furthered American interests by stabilizing other countries and economies and building alliances.

The deals mark a sharp departure from how the U.S. has provided health care funding over the years and mirrors the Trump administration’s interests.

South Africa, which has lost most of its U.S. funding — including $400 million in annual support — due in part to its disputes with the U.S., has not signed a health deal, despite having one of the world’s highest HIV prevalence rates.

Nigeria, Africa’s most populous country, reached a deal but with an emphasis on Christian-based health facilities, although it has a slight majority Muslim population. Rwanda and Uganda, which each have deportation deals with the U.S., have announced the health pacts.

Cameroon, Eswatini, Lesotho, Liberia and Mozambique also are among those that have signed health deals with the U.S.

According to the Center for Global Development, a Washington think tank, the deals “combine U.S. funding reductions, ambitious co-financing expectations, and a shift toward direct government-to-government assistance.”

The deals represent a reduction in total U.S. health spending for each country, the center said, with annual U.S. financial support down 49% compared with 2024.

A faith-based deal in Nigeria, a lifeline for several others

Under its deal, Nigeria, a major beneficiary of USAID funds, would get support that has a “strong emphasis” on Christian faith-based health care providers.

The U.S. provided approximately $2.3 billion in health assistance to Nigeria between 2021 and 2025, mostly through USAID, official data shows. The new five-year agreement will see U.S. support at over $2 billion, while Nigeria is expected to raise $2.9 billion to boost its health care programs.

The agreement “was negotiated in connection with reforms the Nigerian government has made to prioritize protecting Christian populations from violence and includes significant dedicated funding to support Christian health care facilities,” the State Department said in a statement.

The department said “the president and secretary of state retain the right to pause or terminate any programs which do not align with the national interest,” urging Nigeria to ensure “that it combats extremist religious violence against vulnerable Christian populations.”

For several other countries, the new deals could be a lifeline after U.S. aid cuts crippled their health care systems and left them racing to fill the gaps.

Under its deal, Mozambique will get U.S. support of over $1.8 billion for HIV and malaria programs. Lesotho, one of the poorest countries in the world, clinched a deal worth over $232 million.

In the tiny kingdom of Eswatini, the U.S. committed to provide up to $205 million to support public health data systems, disease surveillance and outbreak response, while the country agreed to increase domestic health expenditures by $37 million.

South Africa is noticeably absent from the list of signatories following tensions with the Trump administration.

Trump has said he will cut all financial assistance to South Africa over his widely rejected claims that it is violently persecuting its Afrikaner white minority.

The dismantling of USAID resulted in the loss of over $436 million in yearly financing for HIV treatment and prevention in South Africa, putting the program and thousands of jobs in the health care industry at risk.

Agreements made with African countries that agree to accept U.S. deportees.

At least four of the countries that have reached deals previously agreed to receive third-country deportees from the U.S., a controversial immigration policy that has been a trademark of the Trump administration.

The State Department has denied any linkage between the health care compacts and agreements regarding accepting third-country asylum seekers or third-country deportees from the United States. However, officials have said that political considerations unrelated to health issues may be part of the negotiations.

Rwanda, one of the countries with a deportation deal with the U.S., signed a $228 million health pact requiring the U.S. to support it with $158 million.

Uganda, another such country, signed a health deal worth nearly $2.3 billion in which the U.S. will provide up to $1.7 billion. Also Eswatini, which has started receiving flights with deported prisoners from the U.S.

TRUMP GUTTED AIDS HEALTH CARE AT THE WORST POSSIBLE TIME. By Steven W. Thrasher and Afeef Nessouli for The Intercept.

On World AIDS Day 2025, humanity should be celebrating that there is a new shot available which offers six months of protection against the transmission of HIV, the virus which has already infected approximately 40 million living people and taken the lives of 44 million more.

Instead, public health workers are reeling from how President Donald Trump has helped HIV to circulate in more humans this year than last. The lethal ways the current U.S. health policy is harming the health and wealth of LGBTQ+ people worldwide will be felt for years, if not decades.

That’s because on the first day of his second term, Trump issued a stop-work order for all foreign aid and several orders that jeopardized the health outcomes of minority groups within the U.S.

The cuts were far-reaching yet highly specific. They reduced resources for short- and long-term health research conducted by the Centers for Disease Control and Prevention, universities, and community groups in the U.S. and around the world. Through the so-called Department of Government Efficiency’s gutting of the United States Agency for International Development, or USAID, the administration curtailed or ended funding for programs like the President’s Emergency Plan For AIDS Relief, also known as PEPFAR.

These cuts disparately harmed several distinct but often overlapping populations: LGBTQ+ people, immigrants, sex workers, and people living with HIV/AIDS. They were swift, halting scientific trials and critical services within days (or even mere hours) of their posting on January 20, 2025. And they were significant, contributing to acute medical crises, hunger, homelessness, or even death.

In the U.S., cuts to federal spending resulted in the cancellation of over $125 million in National Institutes of Health grants for LGBTQ-focused health research.

Across the globe, cuts to USAID are disrupting life-saving services and forced community organizations to close across the globe. In South Africa, transgender people immediately lost access to gender-affirming care, leading to forced detransitioning, body dysmorphia, depression, and even suicide. In Lebanon, USAID cuts are causing job losses among humanitarian aid workers, impacting medical care and disrupting development programs. In Uganda, people living with HIV have lost access to condoms, lubricants, medication, and even to the food that USAID once provided to people living with the virus (as those who are starving simply cannot take antiretroviral medication).

While there are lethal exceptions, often, the effects of these cuts are unfolding gradually over time. HIV is a slow-acting virus, and the deadliness of halting its prevention and treatment now will take years or even more than a decade to manifest.

But it’s possible to take a toll of the damage nearly 11 months later today on World AIDS Day, to better understand the damage done and the suffering and death still to come. By early 2025, Politico reported that the administration canceled 86 percent of all USAID awards. One analysis found that 71 percent of HIV-related activities globally were terminated, including several HIV treatment awards and most HIV prevention programs. Overall, there has been a huge drop in the number of people starting antiretroviral medication and a decrease in viral load testing, which is crucial for monitoring the virus and preventing transmission. Without the infrastructure of monitoring, documentation, and care, HIV is transmitting unchecked in the dark.

And it’s also possible to get a pattern of HIV’s rise by talking to people doing the work on the ground (or who recently returned from it), people living with HIV, and people who are both. In the United States, Europe, Africa, and the Middle East, Trump’s cuts are not merely harming these populations by reducing or eliminating services they receive; it is also harming them by taking away their jobs.

For instance, at one large university hospital we visited in the Midwestern United States, every single trans Black outreach worker — who had been integral in addressing high rates of HIV among Black LGBTQ+ Americans — had lost their job by May. In Europe, we found HIV nongovernmental organizations struggling not just with cuts from USAID, but cuts also dictated from Brussels and their own governments, as EU countries shifted money away from immigrants and foreign aid and toward NATO and Frontex, the ICE of the European Union.

In Lebanon, the executive director of an organization that helps some 600 people per month access HIV services and other care — including financial aid or case management for queer people experiencing violence — said they can no longer plan beyond eight months.

At a clinic in Uganda for “key populations” (the euphemism for LGBTQ+ people in a country where “aggravated homosexuality” is a capital offense), a medical assistant said the staff was cut from 15 to just four. When told that staff at a similar organization in South Africa had also been reduced to just four people — but from an original staff of 86 — one of the workers in Uganda could only laugh: “Wow, I thought we had it bad.”

OCT 30: AID CUTS ARE DEVASTATING HEALTH SERVICES IN AFRICA. Report by The Economist.

“It’s heartbreaking,” says Velontafa Jackia, a doctor based in Sambava, in the north-east of Madagascar. Until this year she was part of a project funded by the United States Agency for International Development (usaid) that helped send health workers to even the remotest parts of the impoverished island. But since the funding stopped, fewer patients have been seen. Ms Jackia lists the effects: more birth complications, more maternal deaths, more malarial deaths and “lots of outbreaks”. She sighs: “We’ve been reliant too much on aid and now it’s gone.”

Nine months after Donald Trump’s administration began dismantling usaid the effects are being felt across sub-Saharan Africa, where America supplied more than two-thirds of the bilateral aid for public health. The Trump administration says the largesse created a “culture of dependency”. Its America First Global Health Strategy, published in September, says recipient governments must do more of the work and pay for more of it themselves. This is a good idea in theory, but in practice many people are going to die as aid is reduced.

America became the “indispensable nation” for African public health, notes Jeremy Nel, a South African doctor specialising in hiv. In 21 African countries its aid equalled at least 20% of government health spending; in eight it was over 50%; and in three countries (Somalia, South Sudan and Malawi) it exceeded government spending (see chart). America was also the largest single donor to global bodies like the Global Fund to Fight aids, Tuberculosis and Malaria, and un agencies like Unicef (which helps children), the World Health Organisation (who) and the World Food Programme (wfp).

These contributions have “collapsed”, notes Charles Kenny of the Centre for Global Development (cgd), a think tank. According to estimates of disbursals for the 2025 fiscal year (which runs from October to September), wfp received $326m v $4.3bn in the previous fiscal year. Also cut were funds for the who ($133m v $553m), the Global Fund ($1.3bn v $2.3bn) and Unicef ($265m v $1.1bn).

The fate of bilateral aid—ie, money not spent via international groups—is harder to gauge. Typically this aid was disbursed via thousands of contracts with third parties, usually ngos, who then implemented programmes in the relevant country. As of August 1st, 86% of usaidcontracts (and 77% of those related to health) had been terminated. Since some of the largest contracts remain in place, the percentage drop in funding is less dramatic. Mr Kenny estimates that there will be a 38% drop in aid spending in 2025 from 2024.

Foreign aid could be constrained for many years; 2024 and 2025 will probably mark two years of consecutive bilateral aid cuts by the four largest donors (America, Britain, France and Germany) for the first time since the oecd, a club of mainly rich countries, started collecting data. Britain is cutting its aid spending from 0.5% of gross national income to 0.3% by 2027. Mr Trump’s proposed budget for 2026 has a two-thirds cut in bilateral health funding relative to 2025, and no money for the who, gavi (a vaccine funder) or the Global Fund.

The impact of aid cuts on Africans’ health is obscured by the fact that the data systems used to track disease were paid for by American aid—and have largely been shut down. But two sources of information suggest reasons to worry. The first are analysts’ estimates that take the relationship between previous aid spending and the deaths that it averted, then in effect undo it to estimate the additional mortality. Mr Kenny and Justin Sandefur, another economist, reckon that Mr Trump’s recent budget proposals would put as many as 1m lives at risk, mostly from more untreated cases of hiv, tuberculosis and malaria.

The State Department, which has absorbed some of usaid’s functions, has said it would maintain “life-saving” work. This includes antiretroviral drugs for hiv and salaries for health workers who administer them as part of pepfar, America’s flagship anti-aids programme. But another analysis for cgd found that contracts for these elements affecting 2.3m people had still been cancelled. In addition, cuts to preventive programmes put hundreds of thousands at risk of new hiv infections.

State has said it will provide “bridging” funding for countries until they strike new bilateral deals with America, but there is little sign of the money. And many of the ngos best placed to spend it have closed down operations. Meanwhile, the European governments that many Africans hoped might help fill gaps are, at least in some cases, doing the opposite.

The second source of information comes from on-the-ground reports of chaos across Africa. In South Africa, where pepfar paid for only a minority of anti-hiv programmes, clinics have been receiving “hivmigrants” from neighbouring Eswatini, Lesotho, Mozambique and Zimbabwe, unable to find drugs in their countries. “We are going backwards,” says Olive Shisana, a South African epidemiologist, who cites estimates by the un that there could be more than 6m new hiv infections and 4m more deaths from aids by 2030 than would otherwise be the case.

In Madagascar people who used to work for American-funded projects worry about a looming crisis in the island’s south. The area is subject to regular drought and mass hunger. But the supply of emergency food is “a tenth of what it was” last year, says a senior humanitarian figure.

Across Africa, refugee camps are vulnerable. In Kiryandongo, in Uganda, America paid for about 60% of the wfp budget. Ronald Onen, from South Sudan, says that in April he was told he no longer qualified for food rations. “You can imagine the problems, the stress, this has caused,” he says.

In July hundreds of South Sudanese refugees with sticks and machetes attacked a compound housing newcomers who had fled the war in Sudan—and supplies. Over a hundred were injured and one killed. One mother said the attackers stole food, including the dinner her children were about to eat, which was part of their food aid.

Similarly troubling reports come from north-eastern Nigeria, where America footed the bill for 60% of humanitarian costs. ngos say they are turning away famished children. In Somalia the wfp says it must cut the number getting food aid from 1.1m in August to 350,000, less than a tenth of those the agency says require help.

Basic preventive health care has suffered too. In early October cgdnoticed a rise in cholera in Angola, Congo, Sudan and South Sudan. In each case there was a reduction in American funding for “wash” projects—water, sanitation and hygiene.

African policymakers are paying lip service to the idea that the crisis offers an opportunity. “We cannot build healthier populations purely on the generosity of other nations,” said Muhammad Ali Pate, the Nigerian health minister, in August. But the ngos and local officials dealing with the fallout are gloomier. Seramila Teddy, who governs the Madagascan province where Dr Jackia works, says he has no money to dispatch health workers to remote areas. South Africa’s government has said it will replace the lost pepfar funding, but ngos say no cash has arrived.

A silent crisis could be dangerously convenient for both sides. America does not want to be blamed for contributing to the deaths of Africans; African governments do not want to look weak and incompetent. All the while, the signs are growing that America First also means Africa last. ■

FOREIGN AID IS MOSTLY GONE. IT COULD BE REPLACED BY SOMETHING BETTER. Opinion by Rajiv Shah, President of the Rockefeller Foundation.

Mr. Shah is former leader of U.S.A.I.D. and the author of “Big Bets: How Large-Scale Change Really Happens.” This opinion was originally printed in N.Y. Times.

Over the past year, wealthy countries around the world have undermined a decades-old consensus that human dignity is universal and that nations have a responsibility to further it. The shuttering of the United States Agency for International Development, which I led for five years, is just one piece of a broader, tragic retreat from a system of foreign aid that helped cure the sick, feed the hungry and empower the poor.

Countries, including the United States, Canada, Britain and Germany, have slashed billions in assistance. Research published by The Lancet estimates that more than 14 million people could die as a result of American aid cuts alone — 4.5 million of them children younger than 5. This is a moral failure that will make the whole world less safe, less secure and less prosperous.

Amid the tragedy, it is tempting to defend what we know. Fortunately, leaders in Africa, Asia, Latin America and elsewhere are building something new. They are taking ownership of their countries’ own development, figuring out ways to leverage new technology and, most important, encouraging private investment — long the single biggest challenge for development projects. Their initiatives are modeling a way to lift up the vulnerable that will be more sustainable in the 21st century.

Eighty or so years ago, powerful nations came together around the concept of universal dignity, codifying that idea into institutions like the United Nations, the World Health Organization and the World Bank. This system helped usher in an era of extraordinary progress: transforming AIDS into a manageable condition, saving millions of children from dying of preventable causes and helping to cut hunger in low-income countries by more than 60 percent from 1970 to 2015. It also benefited donor countries by fighting diseases like Ebola abroad to protect lives at home and turning poorer countries into trade partners that created jobs.

Yet while the system did enormous good, it also faltered as the world changed. That model was funded and thus directed by wealthy countries and centralized in large institutions. Over time, donor support and public support for international institutions proved inadequate, yet aid projects remained dependent on them. The work also increased as overlapping yet siloed initiatives proliferated in large part because the best way to find funding was rallying excitement about each new idea.

In recent years, the African country of Malawi received about 55 percent of its health funding from an estimated 166 external sources. To keep the money flowing in, Malawi had to write at least 50 strategic plans to secure financing.

Recipient governments and domestic resources were also often bypassed by donor nations and NGOs. Meanwhile, the effects of climate change created new challenges for which the system was unprepared. The data makes that clear: Ten years after the United Nations member states committed to comprehensive goals on human well-being, including ending extreme poverty and malnutrition, only about 18 percent of the targets are on track.

As that system was defunded over the past year, a new way to advance human dignity has been revealed in initiatives across the world. It is increasingly led by developing countries, not donors. It prioritizes underlying issues, like electricity access, that improve economic growth and life in many ways rather than just one. It leverages new technology: A.I. chatbots that teach farmers new methods, battery storage systems to enable use of clean energy, and drug therapies that reduce the number of dosages as they increase the length of coverage. This model uses philanthropic capital to get started, entices private investments and commits countries themselves to long-term investment.

In January, I joined more than two dozen African leaders who came together in Dar es Salaam, Tanzania, to commit to connecting 300 million people on the continent to electricity by 2030. This effort exemplifies the new model: It’s driven by African countries’ commitments to reform and to provide the electricity essential to modern jobs, health, education and nutrition. This is possible because of new technologies, such as localized grids that create electricity and internet connectivity for remote communities. Above all, this effort is focused on making commercial investment less risky, thereby mobilizing private-sector capital to drive sustainability.

Last month about 80 nations spanning sub-Saharan Africa, Southeast Asia, Western Europe and Latin America met in Brazil to advance one of the most effective ways to save kids from hunger: school meals. About 466 million children benefit from school meal programs. These meals also improve students’ learning and attendance (particularly girls) while creating jobs for local cooks and food suppliers and generating predictable demandfor local farmers.

One dollar invested in school meals can yield up to $35 in economic returns. In recognition of this remarkable potential, global funding for school meals doubled from 2020 to 2024 — with 99 percent coming from national budgets. When a country provides its own safety net, it creates a bulwark against droughts, climate stress and other shocks that otherwise cause famine.

And last month, as world leaders gathered in New York at the United Nations, African leaders, including Ghana’s president, John Mahama, met to commit to redesigning their health systems to be less dependent on external aid. By necessity, Mr. Mahama and other leaders are committing to paying for more of it themselves and attracting more private investment. Combine this political will with new technology — integrated data systems, A.I. support to help community health workers identify patterns and treatments, and long-lasting new drugs, such as the H.I.V. treatment lenacapavir — and the possibilities are significant.

Of course, this model faces challenges. Leaders have to want to do the right thing and stay on guard against corruption and inefficiency. Amid rash budget cuts, the field of global development has lost valuable expertise. And these nations are trying to take on more responsibility even as many face crippling debt crises. To help these countries make this modern model succeed, donors should forgive debt and target available — and even expanded — aid accordingly.

A new poll by the Rockefeller Foundation of more than 36,000 people in 34 countries gives reason to think that’s possible. Though only slight majorities said they trusted long-running international institutions such as the U.N., support for their sort of work — like international collaboration in feeding the hungry and preventing disease — was above 90 percent. The reason? Support for global cooperation is deeply linked not to a system but to results; up to 75 percent would support initiatives if they proved to be effective.

As needs increase around the world, that poll showed that Americans and many others still want to advance human dignity. We just want to do it well. These leaders are showing us how, and the world should help them.

THE TAX ON BEING A GIRL. Opinion by Nicholas Kristof in NY Times.

President Trump’s cuts to humanitarian assistance abroad have hurt all kinds of people. But from what I see on the ground, those suffering the most are women and girls — and that will leave all of us, including men and boys, worse off.

Sometimes the cuts don’t directly target girls, but when families are stressed it is girls who pay the highest price. In a Congolese refugee settlement I visited in southwestern Uganda, Rwamwanja, aid cuts led to reduced food assistance and to the layoffs of 88 teachers; the result was that thousands of students dropped out of school in the last few months, and the great majority of the dropouts were girls.

“Only about one-quarter of our schoolchildren are girls now,” David Mugenyi, the settlement’s commandant, told me. Until a few months ago, it was close to 50-50, he said.

He explained that 70 percent of families in the settlement lost their food assistance around May, and when households are economically pinched, they pull their daughters out of school to fetch firewood and water, to mind younger siblings, to work in the fields or to sell vegetables in the market.

To travel through these impoverished villages east of the Congolese border in the aftermath of aid cuts is to see a kaleidoscope of pain shared by all but felt most acutely by women.

Karungi Kevin, 46, survived sexual assault in the Democratic Republic of Congo that left her with serious health complications. She fled in February to Uganda, where cuts in health services have left her struggling to get care. Women’s health programs have been particularly hurt by funding cuts.

As medical care evaporates, it is moms who die in childbirth. As food disappears and babies cry from hunger, some overwhelmed husbands abandon their wives and children. As social order unravels, it is mostly girls who are raped — and then are scorned for having been raped. And when times are desperate, it is girls like Alice Mugisha who are married off against their will.

“I cried when my dad told me to get married,” Alice told me. “But when the food aid got cut off, he said I had to marry.” So three weeks before I arrived, she married.

I gingerly asked how she was doing.

“I’m happy,” she told me dully, although she seemed near tears. She hadn’t eaten in 24 hours and had little hope that her husband would return from the fields that evening with something to eat.

Alice didn’t know her birth date but thought she might be 17 or 15. So I drove to her family home to check refugee documents that might indicate her age. That remains uncertain: Her father, Francis Twagira, showed me a not-very-reliable document suggesting she was 18 or 19.

I asked him why he had married Alice against her wishes. He was regretful but unapologetic.

“It was important for her to get married because we were broke,” Twagira said, adding that he had received a bride price from the husband’s family of $140. “If aid was still coming, Alice would remain with us.”

He then pointed to a younger daughter, Muhawe, who the documents say is either 12 or 13.

“If the situation continues like this, I will have to marry Muhawe off as well,” he said.

I tried to ask Muhawe what she thought of that, but she was too terrified to say anything at all.

As I’ve noted many times, there are reasons of self-interest to be alarmed about Trump’s aid cuts. Diseases are global, so if we lose health surveillance abroad we are more vulnerable to epidemics at home. Failed states produce waves of migration that eventually reach us. Humanitarian assistance is a tool of foreign policy: We confront China with submarines but also with humanitarian assistance programs meant to cultivate soft power.

But to me the most powerful argument is ethical: If we can easily and cheaply save children’s lives, we should do so. And after decades of providing assistance that people rely on and that saves an estimated 3.3 million lives a year, we shouldn’t suddenly pull the rug out from under them with no time to adjust.

Men and boys are hurt as well by the collapse in medical assistance, but women seem to be particularly suffering because of a crisis in reproductive health care — and already one of the most dangerous things a girl can do in places like this is to reach puberty or, even more perilous, become pregnant.

In one health center, I came across a 14-year-old girl, Shamim, who was pregnant, expecting in October, and as a result had dropped out of school. I asked about her boyfriend, but it turned out there wasn’t one.

“I was raped,” she explained. “He used force.”

Shamim said that the sharp curtailment of aid had increased crime of all kinds, from theft of food to assault. She used to be safe with others in school or at home, but with the shortages everyone was toiling in the fields and she was alone at home when a man in his 20s found her.

“I didn’t know about sex,” she said softly. “I didn’t know how babies are made.”

There has always been rape and other crime, so I don’t want to overdo the link to curtailing aid. But there does seems something to the idea that desperation has eroded the social fabric and left girls particularly vulnerable. In one village, I found a 9-year-old girl, Provia, who had been left alone for a week in the family hut to care for her 3-year-old brother, Paul, because their mother was at the hospital with their severely malnourished infant brother.

The Trump administration has been particularly hostile to reproductive health. It not only defunded the U.N. Population Fund, a leading supplier of contraceptives and major force for reducing maternal mortality, but also slashed funding for family planning and even has said it will incinerate almost $10 million worth of I.U.D.s, implants and birth control pills. The Guttmacher Institute estimates that each $10 million reduction in spending on international family planning leads to an additional 362,000 unplanned pregnancies and 718 maternal deaths.

Family planning is now becoming harder to find, patients and doctors told me, and when women become pregnant they can’t always get an H.I.V. test — which is necessary to prevent transmission of the virus to babies.

Antiretroviral drugs, often provided by the United States at a cost of 12 cents per day per person, are now also becoming more scarce. Judith Mbabazi, 47, told me that she had tested positive for H.I.V. in March, but still was unable to obtain treatment.

“I was told that I couldn’t get medicines because there’s a shortage and they have to prioritize those who’ve been in care longer,” she said. She began weeping. “My life is in danger,” she said, “and I want to be able to take care of my children and see my grandchildren one day.”

In addition, cervical cancer kills a growing number of women — roughly as many as maternal mortality — and is a horrific and painful ailment. It is sometimes diagnosed by the stink of rotting flesh.

One of the exciting steps forward in global health has been a growing effort to eliminate cervical cancer with vaccinations through GAVI, the Vaccine Alliance, and with screenings. Pap smears are not widely available in poor countries, but an inexpensive alternative is a “vinegar test” in which vinegar is brushed on the cervix, revealing precancerous lesions that can be frozen off with a simple device. This lifesaving care is offered by MSI Reproductive Choices and many other caregivers — but with the United States cutting off support for both GAVI vaccinations and for reproductive health, more women may be destined to suffer excruciating deaths from cervical cancer.

Women in developing countries already often face unimaginable burdens. “Appeasement marriages” in Mozambique to settle quarrels. Breast ironing in Cameroon, maiming girls so that they will be less vulnerable to assault. Extreme genital mutilation in Sudan and Somalia. Murders of young wives in India over dowry disagreements. Acid attacks in Pakistan. Obstetric fistulas, human trafficking, denial of education, anemia (because of menstruation and poor diets) endured by some 30 percent of women of reproductive age worldwide. And a child marriage somewhere in the world about once every three seconds.

Over the last quarter-century there have been growing efforts to invest in educating and empowering girls, for reasons of justice but also because educated girls are the building blocks of more prosperous and peaceful societies. Yet now there seems a retreat from that vision. The cost will be more women dying unnecessarily, but men and boys will also be losers.

These women are not helpless. Never forget that impoverished women in these circumstances show extraordinary grit. With a bit of assistance, they are capable of superhuman accomplishments, lifting up themselves and their communities.

I thought of that when I met a Congolese refugee named Anna Arakaza, 23, outside her hut in a refugee settlement. She was sitting on the ground with her 4-year-old son, and I gradually realized that she was unable to stand or walk. She explained that she had had a sickness at the age of 10 that cost the use of her legs; she didn’t know what the sickness was.

In April of this year, the M23 militia rampaged through her village, killing her parents and taking away her husband, who hasn’t been seen since. Five of the soldiers gang-raped her, she told me, and one stabbed her in the leg. They also robbed her of her wheelchair.

“So I decided to flee,” she explained — by crawling.

Sometimes she got motorcycle rides, but for much of the 100-mile journey she crawled, her son beside her. Now that she has arrived in Uganda, the U.N. refugee agency is helping her, but budget cuts mean that it no longer has funding for wheelchairs or other support for disabled people like Arakaza. (Readers can help here.)

Arakaza is still in pain from the stabbing, and sometimes she is incontinent. But I look at her and see not just the suffering but also above all her fortitude. She saved her son and, against all odds, found a path to safety. Imagine what women of her determination and pluck could do with education, resources and help as simple as a wheelchair.

U.S. PLEDGES BREAKTHROUGH AIDS DRUG FOR 2 MILLION. 20 MILLION NEED IT. Press Release from UNAIDS.

GENEVA, 5 September 2025—UNAIDS welcomes the announcement by the US State Department that the President’s Emergency Plan for AIDS Relief (PEPFAR) will be supporting an initiative by the Global Fund to Fight AIDS, TB and Malaria to provide lenacapavir to up to 2 million people in countries with high burdens of HIV.

Lenacapavir, an American-based innovation, is one of the most promising new HIV prevention tools that has emerged in the HIV response, offering protection against HIV with just twice-yearly injections. The breakthrough medicine will save thousands of lives if made widely available for all people and populations at risk of HIV including young women and adolescent girls as well as sex workers, people who inject drugs, and men who have sex with men in high burden countries and geographies.

"This deal offers hope that many more people around the world who are at risk of HIV will have access to this revolutionary HIV medicine. More global work will be needed to increase scale and rapidly make lenacapavir available, affordable and accessible in all low and middle-income countries. But at this critical moment, the United States’ backing of this breakthrough medicine is an important signal to the world that by investing in the HIV response we can stop new infections,” said Winnie Byanyima, Executive Director of UNAIDS.

An initial roll-out of 2 million is an important start toward a broader ambition and i t is important that lenacapavir be available to all people in need, not only to some. UNAIDS estimates that 20 million people will need to be reached with antiretroviral-based prevention such as lenacapavir as part of efforts to achieve the 2030 global HIV prevention targets. UNAIDS also estimates that for every US$ 1 invested in HIV prevention, US$ 7 will be saved in treatment and care costs later.

The price for lenacapavir in France, Norway, Spain and the United States in late 2024 exceeded US$ 28 000 per person per year. For this initiative, manufacturer Gilead has pledged to supply the medicine at no profit. Research published earlier this year showed that lenacapavir can be made and sold for just US$ 40 per person per year, falling to US$ 25 with sufficient scale.

To successfully expand access to lenacapavir, community engagement will be essential. To advance progress in the roll-out, populations most impacted by HIV must play a central role in its delivery and people most at risk of HIV must have access.

UNAIDS will continue to support countries and partners in driving the response to HIV forward to ensure that everyone, everywhere has access to the HIV services they need and that AIDS is ended as a public health threat by 2030.

U.S. RELEASES “AMERICA FIRST GLOBAL HEALTH STRATEGY.” U.S. Department of State official communication.

To the American People:

The United States is the world’s health leader. More innovative drugs and medical devices

are developed in the United States than anywhere else in the world. If you are sick, there is

nowhere you would rather be cared for than in the United States.

Over the past several decades, we have extended our health leadership globally. We have

helped contain thousands of infectious disease outbreaks around the world, stopping

numerous potential pandemics in their tracks before they could reach our shores. Our

health foreign assistance programs, most notably the President’s Emergency Plan for AIDS

Relief (PEPFAR), have saved over 26 million lives and prevented 7.8 million babies from

being born with HIV / AIDS. There is much to be proud of.

But there are also many problems – our foreign assistance programs are deeply broken.

Our health foreign assistance programs in particular have become inefficient and wasteful,

too often creating parallel healthcare delivery systems and a culture of dependency among

recipient countries. Many of the NGOs who support these programs have committed many

times to helping transition the work to local governments, but little progress has been made.

This is often not because of a lack of willingness on behalf of recipient countries but rather

because of our broken foreign aid system and the perverse incentives that encourage NGOs

to self-perpetuate.

We must keep what is good about our health foreign assistance programs while rapidly

fixing what is broken – and this strategy lays out a plan to do just that. We detail an America

First Global Health Strategy that uses global health diplomacy and foreign assistance

to make America safer, stronger, and more prosperous. We lay out a vision to end the

inefficiencies, waste, and dependency of our current system. In its place, we cast a positive

vision for a future where we stop outbreaks before they reach our shores, enter strong

bilateral agreements that promote our national interests while saving millions of lives, and

help promote and export American health innovation around the world.

We will continue to be the world’s health leader and the most generous nation in the world,

but we will do so in a way that directly benefits the American people and directly promotes

our national interest. We look forward to making this vision a reality in the months and

years ahead.

Sincerely,

Marco Rubio

United States Secretary of State

Executive Summary

The United States is the world’s global health leader. Over the last 25 years, the United

States’ global health programs have prevented thousands of infectious disease outbreaks

from reaching American shores, saved over 26 million lives, and prevented 7.8 million babies

from being born with HIV / AIDS.

However, our global health programs have become inefficient and wasteful. Today, less than

40% of health foreign assistance funding goes to frontline supplies and healthcare workers.

This includes approximately 25% of funds that are used for the purchase of commodities

(e.g., diagnostics, drugs) and approximately 15% of funds that are used to employ over

270,000 frontline healthcare workers (e.g., mostly nurses and community health workers).

The remaining 60% of funding is spent on technical assistance, program management, and

other forms of overhead.

This inefficiency has built up over time for a number of reasons. In the early days of the

HIV / AIDS response, there was minimal health delivery capacity in many of the most

affected countries. As a result, the United States often chose to invest in directly building

health delivery capabilities, often minimally connected to national health systems. While

this strategy was successful in dramatically improving health outcomes, it has also too

often resulted in parallel procurement systems, parallel supply chains, program-specific

healthcare workers, and program-specific data systems.

This problem has only been exacerbated by the significant amount of funding Congress has

continued to dedicate to global health programs in recent years, which has provided little

incentive to change. The problem is further exacerbated by NGOs who are the recipient of

much of this funding (especially for technical assistance and program management) who

have perverse incentives to self-perpetuate rather than work towards turning functions over

to local governments. As a result, even though the last three presidential administrations

have developed strategies to transition global health programs to increased local ownership,

very little progress has been made. It is time for that to change.

In the following pages, we lay out a positive and forward-looking vision for United States

leadership in global health – an America First Global Health Strategy. We lay out a plan

that will prioritize the interests of Americans and make America safer, stronger, and more

prosperous. And as we do so, we will help save millions of lives around the world and assist

foreign countries in developing resilient and durable health systems.

SAFER. We will keep Americans safe by continuing to support a global surveillance system

that can detect an outbreak within seven days. We will accomplish this through bilateral

relationships with countries that include having a U.S. government staff presence on the

ground where possible, with a larger number of staff dedicated to geographies with the

highest risk of an outbreak. When there is an outbreak, we will be prepared to work with

local governments to respond promptly. We will be prepared to surge resources to ensure

the outbreak is contained, travelers are appropriately screened, and – to the maximum

2025 America First Global Health Strategy | 4

extent possible – the outbreak does not reach American shores or harm Americans living

abroad.

STRONGER. Our global health foreign assistance program is not just aid – it is a strategic

mechanism to further our bilateral interests around the world. Moving forward, we will

utilize our health foreign assistance to advance U.S. priorities and move countries towards

resilient and durable local health systems. We will do this thoughtfully, by entering multi-year

bilateral agreements with recipient countries that lay out clear goals and action plans.

These bilateral agreements will ensure funding for 100% of all frontline commodity

purchases and 100% of all frontline healthcare workers who directly deliver services to

patients. We will also partner with each country to ensure there are data systems in place

that can both monitor potential outbreaks and broader health outcomes. We will ensure

these systems are integrated into the long-term health information systems of a country

so that we can monitor outbreaks and health outcomes well into the future. We will also

work to rapidly transition technical assistance from supporting individual clinical sites

to supporting governments in taking over key functions. This will include more govern-

ment-to-government assistance as well as leveraging the private sector and faith-based

organizations. Finally, we will ask governments to co-invest in these efforts and work with

the United States to align on performance benchmarks that will be required for releasing

future U.S. health foreign assistance funding.

We aim to complete bilateral agreements with recipient countries receiving the vast

majority of U.S. health foreign assistance by December 31, 2025 with the goal of beginning

to implement these new agreements by April 2026.

MORE PROSPEROUS. We will first and foremost make America more prosperous by

helping contain outbreaks at their source, protecting American lives and the American

economy. We will also leverage our foreign assistance to promote American companies

and American innovations abroad, including continuing to procure goods from American

companies as part of our foreign assistance programs. We will also leverage our bilateral

relationships with countries to promote American health innovations and products more

broadly globally, helping ensure that American innovation becomes a cornerstone of health

systems around the world.

READ AMERICA FIRST GLOBAL HEALTH STRATEGY

LET’S THINK THROUGH A 1% SUPER WEALTH TAX TO FUND CRITICAL SOCIAL AND HUMANITARIAN PROGRAMS. White Paper from The caring world.

As President Trump seeks to control spending on Congressional approved budgets for social services and humanitarian aid, the American people need to investigate and seriously consider alternative funding for programs and agencies that impact human life in this country and in foreign nations that we have helped for decades. We are looking at a 1% super wealth tax on the richest of richest Americans that could raise in excess of $70 million per year. The rationale is that these richest of richest have made their fortunes because of the U.S. economy. Many have made billions doing business with the U.S. government. Also the lifestyles and business operations of this group has a much greater effect on the environment and climate change that the average American. What follows is an executive summary followed by a more detailed white paper.

Executive Summary: A 1% U.S. Billionaire Wealth Tax to Close the Humanitarian Aid Gap

Objective. Create a dedicated, stable revenue stream to permanently eliminate the current $9 billion shortfall in U.S. humanitarian aid by enacting a narrowly targeted 1% annual tax on the net wealth of U.S. billionaires.

Scale. As of 2025, America has roughly 900+ billionaires. Their combined wealth surpassed $7 trillion in June 2025 (based on Forbes data compiled by Americans for Tax Fairness). A 1% levy on that base yields about $70 billion per year—nearly 8× the identified shortfall, even before behavioral or market adjustments. ForbesAmericans For Tax Fairness

Use of funds. Establish a Humanitarian Aid Stability Fund (HASF) at Treasury that:

• Automatically transfers the first $9 billion each fiscal year to USAID/State humanitarian accounts (IDO/Humanitarian Assistance, Migration and Refugee Assistance, Global Health, etc.).

• Smooths volatility via a rolling three-year reserve so appropriations remain steady through market cycles.

Administration & design. The tax applies to U.S. tax residents with net worth ≥ $1 billion, defined as worldwide assets minus liabilities. Public assets are mark-to-market; private assets follow standardized valuation safe harbors with third-party reporting and audit. Anti-evasion tools include information reporting, penalties for under-valuation, and an exit taxto discourage tax-motivated expatriations (modeled on prior proposals). OECDElizabeth Warren's Senate Website

Legality. The Supreme Court’s 2024 decision in Moore v. United States upheld a tax on undistributed, realized business income and explicitly did not resolve whether “realization” is constitutionally required for all income taxes, leaving space for alternative designs (e.g., minimum-tax approaches, mark-to-market) and for a direct wealth tax debate in Congress. Multiple legal analyses argue a properly drafted federal wealth tax is constitutional. Supreme CourtPoliticoRoosevelt InstituteGeorgetown Law Scholarship

Revenue reality check. Even under conservative assumptions—−20% market drawdown and 15% avoidance/non-collection—a 1% levy still nets about $50–60 billion/year, leaving ample headroom to fully backstop the $9 billion aid gap. (Baseline: ~$70 billion.) Global work for the G20 suggests a 2% minimum levy on billionaires could raise $200–$250 billion/year—scale that underscores feasibility. Americans For Tax FairnessGabriel Zucman | Professor of economics

Why 1%. International evidence shows that low-rate, broad-base designs minimize distortions and are administratively manageable—particularly with modern information reporting. The OECD’s design guidance and European experience inform the safe-harbor valuation, reporting, and audit playbook proposed here. OECDTax Foundation

White Paper: Designing a 1% Billionaire Wealth Tax to Permanently Fund U.S. Humanitarian Aid

1) Policy Goal & Rationale

• Goal: Permanently close a recurring $9 billion humanitarian aid funding gap without touching middle-class taxes or annual appropriations battles.

• Mechanism: 1% annual tax on the net wealth of U.S. billionaires (≥ $1 billion), with proceeds dedicated to a new Humanitarian Aid Stability Fund (HASF).

Scale & sufficiency. U.S. billionaire wealth topped $7 trillion in 2025; 1% produces ~$70 billion gross annually. Even with conservative haircuts, net collections handily exceed needs, ensuring predictability in aid budgets and allowing a reserve to buffer market swings. Americans For Tax Fairness

2) Tax Base, Rate, and Threshold

• Threshold: Net worth ≥ $1 billion (averaged over two consecutive year-ends to reduce cliff effects).

• Rate: 1.0% on net wealth above $1 billion.

• Base: Worldwide net wealth (all asset classes) less bona fide liabilities.

• Included: Public equities and bonds; private business equity; carried interests; derivatives (net); cash; real estate; alternatives (PE/VC funds, hedge funds); art/collectibles; trusts and foundations where the taxpayer retains beneficial interest or control.

• Excluded: Personal-use household goods under a de minimis threshold; defined-benefit pension rights already taxed at entity level.

• Residency: U.S. citizens and long-term residents; treaty provisions respected.

International context. Only a handful of OECD countries levy recurrent net wealth taxes today; the OECD provides detailed design guidance, which this proposal follows (broad base, low rate, robust reporting). OECDTax Foundation

3) Valuation & Information Reporting

• Publicly traded assets: Daily mark-to-market; end-year valuation for liability, with average-of-quarter option to dampen volatility.

• Private business equity: Safe harbors: (i) last arm’s-length financing valuation, (ii) formula based on EBITDA and industry multiples, or (iii) NAV for investment entities; taxpayers may elect the highest to deter under-valuation.

• Real estate: Assessed using appraisal safe harbors (recent transaction; standardized capitalization rate tables).

• Alternatives, art, and collectibles: Certified appraisals or fund manager NAVs; penalties for lowballing.

• Reporting: Create Form 1099-W ecosystem (brokers, banks, custodians, funds, registries) with automatic information exchange; leverage post-FATCA frameworks and beneficial-ownership registries. OECD

4) Administration, Compliance & Anti-Avoidance

• IRS Wealth Tax Unit: Specialized valuation teams; ≥ 30% audit rate within the covered population during rollout, then risk-based selection.

• Under-valuation penalties: Accuracy-related (20%); gross misstatement (40%); civil fraud (75%).

• Trusts & pass-throughs: Look-through rules to beneficial owners; attribution rules for family/entity webs.

• Cross-border: Matching with CRS/FATCA data; penalties for non-filing; cooperation agreements.

• Expatriation deterrent: An exit tax assessed on net wealth above the threshold for covered expatriates (modeled on prior federal proposals at ~40%), which evidence suggests materially reduces avoidance via migration. Elizabeth Warren's Senate WebsiteEconometrics Laboratory

5) Alternative Legal Framings (If Desired)

While a direct net wealth tax is a straightforward instrument, lawmakers can also consider:

• A billionaires minimum tax pegged to a percent of wealth (e.g., “effective tax = max[regular income/capital-gains tax, 1% of wealth]”), which can be administered through income-tax machinery and reduce constitutional risk.

• A mark-to-market regime for ultra-high-wealth taxpayers’ tradable assets with a deferral charge on non-tradables—approaches debated around Moore and in Senate proposals. Moore left the “realization” question open, preserving congressional flexibility to design such instruments. Supreme CourtPenn Wharton Budget Model

Multiple constitutional analyses (Roosevelt Institute, leading academics) argue a well-drafted federal wealth tax can pass muster; Moore did not foreclose these paths. Roosevelt InstituteGeorgetown Law Scholarship

6) Revenue, Volatility, and Sensitivity

• Baseline: ~$7 trillion × 1% = $70 billion.

• Conservative case A (market −20%): $56–60 billion (depending on base composition).

• Conservative case B (−15% enforcement haircut): ~$59.5 billion.

• Double-stress (−20% markets & −15% haircut): ~$47–51 billion.

Global modeling for the G20 suggests a 2% billionaires minimum tax would raise $200–$250 billion annually worldwide—consistent with the scale implied by U.S. estimates. Gabriel Zucman | Professor of economics

7) Humanitarian Aid Stability Fund (HASF): Guardrails & Governance

• Structure: Treasury account with statutory first-call transfer of $9 billion each FY to USAID/State humanitarian lines (sub-allocations set by Appropriations).

• Stabilizer: Three-year rolling reserve target of $12–18 billion to cover downturns.

• Transparency: Quarterly public reports (collections, fund balance, transfers); GAO audits; Inspector General oversight.

• No crowd-out clause: Wealth-tax funds supplement, not supplant, base humanitarian appropriations.

8) Economic Effects & International Experience

• At 1%, with a narrow base (billionaires only) and modern information reporting, expected distortions are modest. OECD work emphasizes that design (reporting, valuation, base breadth) is the driver of administrative success, not merely the label “wealth tax.” OECD

• Europe’s mixed history reflects high rates and narrow/porous bases; today’s surviving models (e.g., Switzerland, Spain, Norway) show operational feasibility—useful lessons, not templates. Tax Foundation

9) Interactions with Philanthropy & Capital Formation

• Philanthropy: Charitable transfers reduce wealth and thus liability organically—no new deduction needed. To align incentives with the policy’s purpose, Congress may cap a non-refundable credit up to 25% of annual wealth-tax liability for verifiable, arm’s-length contributions to qualified humanitarian organizations; cap prevents wholesale erosion of the base.

• Investment: For founders with illiquid stakes, offer deferral with interest (e.g., AFR+200 bp) secured by liens/escrow; mandatory pre-payment on liquidity events.

10) Implementation Timeline

• Year 0–1 (Setup): Stand-up IRS Wealth Tax Unit; finalize valuation safe harbors; build 1099-W reporting; issue regs and FAQs.

• Year 1 (Assessment): First valuation date at year-end; initial filing due the following Oct. 15 with electronic asset statements.

• Year 2 (Collection): Begin HASF transfers monthly (pro-rated) once collections commence; backstop with a one-time seed transfer from general revenues repayable from first-year receipts.

11) Legislative Outline (Sketch)

1. Definitions & Scope (covered taxpayers; residency; aggregation rules).

2. Tax Imposition & Rate (1% over $1 billion; two-year averaging).

3. Valuation (public mark-to-market; private safe harbors; elections; substantiation).

4. Information Reporting (1099-W; third-party penalties; cross-border exchange).

5. Anti-Avoidance (trust/look-through; related-party rules; GAAR-style catch-all).

6. Expatriation (exit-tax mechanics; security interests).

7. Administration & Enforcement (audits; penalties; interest; appeals).

8. HASF (automatic transfers; reserve mechanics; transparency; no-crowd-out).

9. Sunset/Review Clause (five-year independent evaluation).

12) Risks & Mitigations

• Market volatility: Three-year averaging and HASF reserve smooth revenues.

• Valuation disputes: Safe harbors + third-party reporting + penalty regime.

• Migration/avoidance: Exit tax, look-through rules, FATCA/CRS-style data. Elizabeth Warren's Senate Website

• Litigation: Alternative legal framings (minimum tax / mark-to-market on tradables with deferral charges) offer fallback paths while Moore leaves room for congressional design. Supreme Court

Key Sources (select)

• Billionaires & wealth totals (2025): Forbes; Americans for Tax Fairness analysis of Forbes data (U.S. billionaire wealth >$7 T; ~900 U.S. billionaires). ForbesAmericans For Tax Fairness

• Global revenue scale (2% minimum): Zucman, G20 report (2024). Gabriel Zucman | Professor of economics

• Design/administration: OECD wealth-tax design report. OECD

• Legal landscape: Moore v. United States (2024); Roosevelt Institute constitutional brief; academic commentary. Supreme CourtRoosevelt InstituteGeorgetown Law Scholarship

FINANCING HUMANITARIAN STABILITY: A 1% BILLIONAIRE SURTAX AND THE HUMANITARIAN AID RESERVE FUND. White Paper created with AI.

Executive Summary

This paper proposes a targeted, sustainable financing mechanism to cover the U.S. humanitarian aid shortfall of $9B annually. By combining a 1% surtax on billionaire income with a 1% surtax on billionaire stock gains, revenues would flow into a Humanitarian Aid Reserve Fund (HARF). The fund stabilizes aid flows, guarantees predictable baselines, and creates capacity for extraordinary crisis response.

1. Context and Problem

• Humanitarian aid is underfunded, with a $9B gap in U.S. contributions.

• Volatile appropriations undermine planning and reduce effectiveness.

• Billionaires have seen extraordinary wealth growth: U.S. billionaire wealth totals $5.5T (2024). A small surtax could fill the shortfall without burdening ordinary taxpayers.

2. The Proposed Revenue Mechanism

A. 1% Surtax on Billionaire Income (AGI)

• Applies to taxpayers with net worth > $1B.

• Adds 1% to all taxable income (AGI).

• Revenue: $3–6B/year, based on estimated aggregate billionaire AGI ($300–600B).

B. 1% Surtax on Billionaire Stock Gains

• Public stock: mark-to-market annually using brokerage reporting.

• Private stock: taxed at realization, with interest charge to neutralize deferral.

• Revenue:

• Typical year: ~$4B,

• Boom year: up to $10B,

• Weak year: $0 (covered by reserves).

C. Combined Yield

• Typical year: $7–10B,

• Boom year: $13–16B,

• Weak year: $3–6B.

3. The Humanitarian Aid Reserve Fund (HARF)

Structure

• Receives all surtax receipts.

• Pays out $9B annually as a guaranteed baseline for humanitarian programs.

Rules

• Surpluses: 70% to reserves, 30% to extraordinary crises.

• Shortfalls: reserves fill gaps. If reserves fall below 1 year’s need, surtax rises automatically by +0.25% for up to 2 years.

• Investments: U.S. Treasuries only.

• Oversight: Board of Trustees (USAID, State, CDC + 3 NGOs). Public quarterly reports, GAO audits biennially.

Example Flows

• Normal year ($10B revenue): $9B baseline, $0.7B reserves, $0.3B crises.

• Boom year ($15B revenue): $9B baseline, $4.2B reserves, $1.8B crises.

• Weak year ($5B revenue): $9B baseline, $4B from reserves.

4. Advantages

• Predictable: $9B guaranteed each year regardless of market cycles.

• Fair: Contributions come from billionaires, whose wealth has soared.

• Efficient: Uses existing IRS reporting for income and stocks.

• Legal: Structured as an income surtax (avoids direct tax/wealth tax challenges).

• Flexible: Builds capacity for extraordinary crises without new appropriations.

5. Risks and Mitigation

• Revenue volatility: Addressed by reserves + automatic surtax bump.

• Valuation complexity: Limited to public assets for annual mark-to-market; private taxed at realization.

• Political resistance: Framed as humanitarian solidarity, not redistribution.

• Legal challenge: Narrowly framed as income taxation to withstand scrutiny.

6. Conclusion

The U.S. can secure predictable humanitarian aid funding by tapping a fraction of billionaire income and stock gains. A 1% surtax combined with HARF ensures $9B annually, stabilizes U.S. global leadership, and provides flexibility for future crises.

WHAT EUROPE LEARNED FROM WEALTH TAXES — AND WHAT IT COULD MEAN FOR THE U.S. Research and opinion.

DOGE, Elon Musk’s budget assassination team, gutted decades old humanitarian agencies like U.S. A.I.D. and PEPFAR that saved lives across the world. DOGE and Trumps Big Beautiful Atrocity of a Budget Bill further cut important programs that assisted the vulnerable in the United States. We took a look, with the help of AI, how the wealthiest 1% of Americans could pay a fairer share of taxes to help the funding shortfall. Learning from past experiences in Europe, we see that a wealth tax holds promise in the U.S. if the Congress has the courage to hold the richest to help the poorest.

Spain: from patchwork to “solidarity”

Spain has long had a regional wealth tax (Impuesto sobre el Patrimonio), but several regions—most famously Madrid and Andalusia—granted 100% rebates, creating a patchwork where affluent residents could pay little or nothing. In late 2022, Madrid’s central government layered on a national “Solidarity Tax on Large Fortunes” for net wealth above €3 million, designed to harmonize outcomes and backstop revenues where regions zero-rated the regional tax. Rates are progressive (roughly 1.7%–3.5% over the threshold) and the tax sits on top of the regular wealth tax. BOEAgencia TributariaPwC Tax SummariesTax Foundation

What did it raise? In its first year, Spain said the solidarity levy collected €632 million from about 12,010 taxpayers(≈0.1% of filers). In total, taxes on large fortunes (solidarity + regional wealth tax) brought in more than €1.8 billion in 2023. Policymakers then made the solidarity tax permanent to prevent revenue leakage from regional rebates. Reutersinfobae

Takeaway: Spain shows a workable model when sub-national rebates undermine a national base: introduce a uniform top-up with clear thresholds and keep administration simple by mirroring existing wealth-tax rules. BOE

Sweden: a century of wealth tax, then repeal

Sweden introduced a national wealth tax in 1911 and kept some form of it for nearly a century. Over time, concerns grew about valuation complexity, tax avoidance, and capital flight (especially for owners of closely held firms). In 2007, the center-right government abolished the wealth tax. Academic post-mortems point to low revenue relative to administrative and economic costs and the difficulty of valuing private assets consistently. PikettyIFNEconometrics Laboratory

Takeaway: Sweden’s experience underscores that design details matter: if valuation is onerous and the base is porous, the tax can raise little while nudging high-wealth households toward avoidance or emigration. IFN

Norway: the durable model

Norway still levies a net wealth tax—one of Europe’s oldest (tracing to 1892). The combined municipal + national rate is about 1.1% on wealth above NOK 20 million (≈$1.8–1.9 million), with valuation discounts for certain assets (e.g., closely held shares) and coordinated state/municipal sharing. OECD and independent trackers note that Norway reliably collects meaningful, if modest, revenue from its wealth tax (on the order of ~1% of total tax revenue in recent years). After rate tweaks in 2022–23, Norwegian media reported a spike in wealthy out-migration, highlighting the importance of calibration—but the tax remains in force. Tax Foundation+1Skatteetaten

Takeaway: Norway suggests a pragmatic, durable design: moderate rates, clear valuation rules, and discounts to ease liquidity/valuation frictions for private businesses—all while keeping the base broad enough to matter. Skatteetaten

Lessons across the three

1. Base clarity beats ambition. Spain’s top-up mirrors the existing wealth-tax base; Norway codifies discounts and annual valuation methods; Sweden’s complexity/avoidance sank the policy. BOESkatteetatenIFN

2. Moderate rates + tight administration work better than high rates on a leaky base. Norway’s ~1.1% top rate is politically and administratively durable. Tax Foundation

3. Sub-national coordination matters. Spain’s solidarity levy overcame regional rebates; a U.S. analog would need federal-state coordination. infobae

The U.S. angle: closing aid gaps and shoring up human needs

Right now, U.S. humanitarian funding is under pressure. In August 2025, President Trump blocked $4.9 billion in already-approved foreign aid via a rarely used rescission maneuver, and broader proposals to pare back foreign assistance have circulated—raising near-term risks for global health, food security, and refugee support. Federal News NetworkThe White HouseThe Washington PostThe Wall Street Journal

A U.S. wealth-tax option—built to Norway/Spain specifications—could help:

• Who pays? Top 1% by net wealth (or a narrower “UHNW” tier).

• Rate & base (illustrative): 1% on net wealth above $50 million, with public assets marked to market each year and private assets taxed at realization with an interest charge (a “deferral charge”)—the same liquidity/valuation playbook seen in Norway’s discounts and Spain’s mirroring approach. SkatteetatenBOE

• Administration: Expanded third-party reporting for brokers and custodians; safe-harbor valuation for closely held firms; elective installment plans for illiquid cases—again, echoing Norway’s practicality. Skatteetaten

How much could it raise? The U.S. now has a record ~902 billionaires (Forbes, March 2025). Even a narrow billionaire-only levy at ~1% of net wealth could generate tens of billions per year; broadening the base to the top 1%would raise more. (For context, Spain’s wealth/solidarity taxes together raised ~€1.8 billion in 2023 from a far smaller high-wealth population.) ForbesReuters

Where it would go

Create a federal Humanitarian & Community Resilience Fund to channel receipts into:

• International humanitarian aid: stabilize a recurring $9 billion floor for food aid, health, and refugee response—insulated from rescissions. Federal News Network

• Domestic “humanitarian” programs: targeted grants for K-12 in low-income districts, nutrition (WIC/SNAP complements), and community health clinics, with transparent, formula-based allocations and independent audits.

Why this version is more likely to work

• Design learns from Europe: adopt moderate rates, clear valuation, and liquidity relief, avoiding Sweden’s pitfalls. IFN

• Stability by statute: dedicate funds to a trust-style account so short-term politics can’t raid them—an answer to the 2025 aid freeze episode. Federal News Network

Bottom line

Spain shows how to harmonize and backstop wealth-tax revenue; Norway shows how to keep it durable; Sweden shows what happens when complexity and leakage overwhelm the base. A U.S. version that borrows the Norway/Spainplaybook—moderate rate, clear valuation, liquidity protections, and earmarked uses—could reliably backfill humanitarian aid cutbacks and supplement domestic education, food, and health programs without leaning on annual budget brinkmanship. Tax FoundationBOEFederal News Network

THE MAN WHO SAW THE FUTURE OF AFRICA. Essay by Howard French in NY Times

Not long after John F. Kennedy was inaugurated as president, he received his first visit from a foreign leader. He had chosen Kwame Nkrumah, Ghana’s first president. By today’s standards, in which Africa seems to sit on the far margins of world affairs, the selection is practically unimaginable.

But even as a senator, Mr. Kennedy had begun to see Africa — with its enormous landmass, newly independent countries and young population — as a continent full of promise. By one count, during his presidential campaign speeches in 1960 he mentioned Africa 479 times. As president, he was keen to compete for influence there with the Soviet Union and even side with anticolonialism, courting tension with America’s European allies.

Until Mr. Kennedy’s assassination, Mr. Nkrumah remained the American president’s most important African interlocutor, a fact that reflects both the Ghanaian leader’s charisma and the tremendous prestige he had earned on the continent by peacefully leading his country to independence from colonial rule in 1957. Driven by his belief in Pan-Africanism, Mr. Nkrumah worked tirelessly to overcome the Balkanizing impact of colonial rule across Africa.

As the world’s powers turn away from the continent, it’s a vision that may hold the key to realizing Africa’s potential today.

The United States did not withdraw from Africa after Mr. Kennedy’s death, but the continent was sharply downgraded in the hierarchy of Washington’s interests. America’s involvement quickly narrowed to a policy of near-zero-sum competition with Moscow, in which each superpower forged alliances with the aim of restraining the influence of the other. Most of these involved military relationships and limited financial support to dictatorships of one kind or another, with little regard for democracy, governance or long-term economic development.

Since the end of the Cold War and the dissolution of the Soviet empire, American engagement with Africa has declined sharply and become largely limited to humanitarian assistance. Under President Trump, even this is now in doubt, with the virtual elimination of the United States Agency for International Development and apparent plans to end support for PEPFAR, a program created by George W. Bush that has had remarkable success in combating H.I.V. in Africa.

This summer, a new nadir was reached when news outlets reportedthat the White House was considering restricting entry to the United States from 25 African countries, in addition to the seven that were covered in a ban announced in June. And even as Washington raises barriers to immigration from Africa, it has begun to explore ways of using the continent as a dumping ground not only for Africans deported from the United States but also for people from other continents.

It is tempting to see the United States as a complete outlier, but its withdrawal from Africa reflects broader developments in the world. Europe’s involvement with the continent has also declined. This is attested to by France’s retreat from a large swath of West Africa in the Sahel, after years of failed efforts to defeat a variety of Islamic insurgencies. Today the biggest African concern of the former colonizing powers — as well as of the European Union generally — is preventing growing migration from the continent.

Even China, after more than two decades of a determined push to expand political and economic ties to Africa, has put on the brakes and started to focus elsewhere. After expanding rapidly from a tiny base, Chinese economic involvement with Africa has plateaued, as Beijing has quietly reassessed the difficulties of realizing profits on the continent. Chinese lending to Africa peaked in 2016, with its investment there now relatively flat.

In light of trends like these, Mr. Nkrumah’s logic about how Africa should engage the outside world appears remarkably sound. His determined nonalignment was based on more than the principled belief that African countries should be free to pursue their interests with whichever partners they wished. He was leery of the proposition that any foreign partner — even a United States led by Mr. Kennedy — would commit to Africa’s development in the long term. He believed that this was, above all, the duty of Africans.

At the time, Mr. Nkrumah was opposed and derided by some fellow African leaders for what they saw as his unrealistic dream of merging dozens of newly formed countries to form a continental government, perhaps with him at the helm. His ideas were more subtle, though, and his tactical vision more patient than he was given credit for in his day.

As long as the continent was composed of its legacy jigsaw countries, most of them small in size and population — and many of them landlocked, condemning them to additional poverty and instability — they would remain underdeveloped. The small size of their markets would make it all but impossible to industrialize or to sustain engagement with the outside world on favorable terms. This implies more than the kind of naked extraction of fossil fuels and minerals that is commonplace now and a shift to local transformation of the continent’s resources and commodities.

The Ghanaian leader saw this move toward larger units, both economically and politically, as a matter of successive voluntary steps — with states joining to integrate their markets and road and rail networks, then perhaps merging at the subregional level before any eventual attempt to form a nation that would encompass, say, all of West, East or Southern Africa. If it were ever to come about, a continental union lay in a distant future.

One surprising source for this vision was the Federalist Papers. While he was a college and graduate school student in Pennsylvania in the 1930s and ’40s, Mr. Nkrumah became deeply familiar with the history of how a group of small colonies bound themselves together to forge an independent, federal country that became much richer and stronger than the sum of its parts. This was the future he saw for his continent, as he explained to his peers at the founding summit of the Organization of African Unity, held in Addis Ababa, Ethiopia, in 1963.

Mr. Nkrumah’s fellow leaders rejected his idea. But the continent’s subsequent history — six decades of deprivation, poverty and corruption — has laid bare the costs of having a plethora of small countries that largely turn their backs to one another. In the absence of collaboration, they remain poor and condemned to engage as weaklings with the outside world.

In demographic terms, Mr. Kennedy was right that Africa is the continent of the future. Its population will more than double before 2070 and by the end of this century could be larger than India’s and China’s combined. It is up to Africans to unlock their economic future, matching that population growth with development.

With no one in the world serving up favors to the continent, Mr. Nkrumah’s insight about the gains to be had through federation is as salient as ever. What is lacking is sufficient action. The time has come for a continent cut loose in the world to take the next step.

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.