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Of all the actions Musk and President Trump set in motion, nothing will hurt more people around the world than their dismantling of the U.S. Agency for International Development (USAID).
Elon Musk is leaving the White House — and leaving a trail of destruction in his wake. But of all the actions Musk and President Trump set in motion, nothing will hurt more people around the world than their dismantling of the U.S. Agency for International Development (USAID).
By making disease-stemming drugs, clean water, and food available to millions, USAID has probably saved more lives worldwide than any entity in history.
Since 2000, USAID’s programs have prevented the deaths of 58 million people from tuberculosis, 25 million from HIV/AIDS, and over 11 million from malaria. It’s given 70 million people access to safe drinking water and, working in concert with global vaccine initiatives, helped to nearly eradicate polio.
As the main funder of global health interventions, USAID served as a bulwark against diseases that don’t halt at national borders. Its programs identified emerging epidemics and minimized the spread of drug-resistant diseases that threaten Americans as well.
Although it’s commonly assumed to be much higher, foreign aid is just 1 percent of federal spending, so cutting it won’t begin to balance the budget. So instead Trump and Musk attacked USAID by slandering it, calling it a “criminal agency” (Musk) that’s “run by a bunch of radical lunatics” (Trump).
This, of course, was a lie. USAID was known for having rigorous oversight, with 275 investigators and auditors in its watchdog office.
Most USAID funding in low-income countries targets disease prevention, economic growth, and disaster relief. But DOGE and Trump made staggering false claims, like Trump’s that USAID was sending “$50 million to Gaza to buy condoms for Hamas.”
As a result, USAID was the first casualty in the Trump administration’s struggle to make the federal government subservient not to the Constitution but to one man. And Musk — the world’s richest man, whose income last year exceeded USAID’s entire budget — and his fellow billionaire President Trump withdrew medicines and food from millions of the world’s most vulnerable people. Afterward, Musk gleefully announced that they’d fed “USAID into the wood chipper.”
I’ve followed USAID since seeing its economic and agricultural programs in the African Sahel in the 1980s, and I’ve spent 40 years heading nonprofits working to provide clean drinking water internationally.
No organization I’ve led has received USAID funding, but over the years I’ve known scores of USAID staff who were hard working and conscientious about spending U.S. tax dollars. Trump owes an apology to USAID’s employees, now indiscriminately fired or coerced into early retirement.
Every federal agency can stand being streamlined. But what happened to USAID wasn’t reform — it was destruction. “They didn’t know what they were doing or care to find out, but I came to realize that cruelty is their purpose,” one senator told me in April. “Cruelty is how they think they demonstrate power.”
It’s fair to say American voters didn’t ask for this. USAID went unmentioned during the 2024 presidential campaign — and bipartisan majorities continue to say they oppose gutting the agency.
American entities which partnered with USAID — including corporations, faith-based organizations, foundations, universities, and civic groups like Rotary International — will continue to raise their own private funds. But by themselves they can’t replace USAID’s leadership abroad.
Now that Trump and Musk have eviscerated the agency, millions will suffer. The Center for Global Development estimates that U.S. foreign assistance has been saving 3 million lives annually. The journal Nature calculates that the loss of U.S. global health funding alone could result in 25 million additional deaths over the next 15 years.
For Americans — including Trump voters — feeling queasy over what’s been carried out in their name, it’s not too late to convey to Congress your support for life-saving foreign assistance.
Regardless of how they voted, Americans should be proud of how their foreign aid has reduced worldwide poverty, sickness, hunger, and thirst — all for 1 percent of the federal budget. The future cost to the United States, if it abandons its leadership in global health and development, will prove incalculable.
Defense against dangerous epidemic outbreaks requires constant vigilance. With Robert F. Kennedy Jr. and Donald Trump headed to Washington, D.C., we are entering very troubling territory.
Elvis Presley hardly seems a likely candidate for the pantheon of public health heroes. But in October 1956 the ascending rock idol lent his considerable stardom to helping save lives.
His little remembered role is a cautionary tale as incoming President Trump advances a series of farright and unqualified appointees to major public agencies. The most dangerous is likely to be conspiracy theorist Robert Kennedy Jr. as Secretary of Health and Human Services, augmented by like-minded, perilous public health heads of the Centers for Disease Control and Prevention (CDC), Centers for Medicare and Medicaid Services (CMS), National Institutes of Health (NIH), Federal Drug Administration (FDA), and his choice for Surgeon General.
For a century, polio epidemics made it one of the world’s most terrifying diseases. A 1916 outbreak in New York City killed over 2,000 people; another in the U.S. in 1952 claimed over 3,000. Children were especially targeted, over 60,000 infected yearly, facing lifelong severe spinal injuries requiring braces, crutches, and wheelchairs, and the dreaded iron lung, an artificial respirator, or premature death.
Wealth and status proved no barrier, as evidenced by President Franklin Roosevelt who was diagnosed at age 39 in 1921 with polio and endured it the rest of his life. What was a safeguard was the first vaccine, developed by virologist/medical researcher Jonas Salk. The announcement on April 12, 1955 by University of Michigan School of Public Health scientist Thomas Francis, Jr., who declared it “safe, effective, and potent,” was greeted as a national celebration, spread rapidly over radio, television, and wire services.
Parents lined up to vaccinate their young children, plenty did not. Teen immunization levels stagnated at just 0.6 percent. Enter Elvis. He agreed to go on the popular Ed Sullivan TV show, not to sing, but to get publicly vaccinated, viewed by millions. Vaccination rates among American youth soared to 80 percent in just six months. Overall annual cases of polio plummeted within a year from 58,000 to 5,600. By 1961, only 161 cases remained. After an oral vaccine followed, polio disappeared in the U.S. completely.
Yet polio never vanished globally, especially in underdeveloped nations, as in Africa, and in war zones, including in Gaza today—driven by Israel’s decimation of public health protections during its catastrophic and ongoing assault. In 2022, the first U.S. case in decades was reported by the New York State Department of Health.
Defense against dangerous epidemic outbreaks requires constant vigilance, and public support for full embrace of public health safety measures, including vaccinations. The experience of Trump’s first tenure is far from reassuring, especially his abominable failure in the face of Covid-19, the worst global pandemic in a century which ultimately cost the lives of over 1.2 million Americans.
Initial skepticism over the polio vaccine has a long antecedent in the U.S., described early in the Covid pandemic by what Los Angeles Times writer Carolina Miranda aptly termed “toxic individualism” and rugged individualism. It is traceable to a virulent brew of misguided notions of individual liberty that undermine and sabotage the public good, or a commons of national and community interest. Much of its roots are linked to structural racism, as in the resistance to Civil Rights Movement measures, and continuing today in white opposition to reforms such as expansion of health care and other public programs, immigration rights, and other societal benefits.
That history provides context for the eruption of the anti-vax, anti-public health measures that exacerbated and prolonged Covid suffering and death and seeded the ground for opposition to other essential vaccines. It’s true, as medical ethicist Arthur Caplan writes, that much of “the damage to getting Americans to vaccinate has already been done… There are almost no serious state mandates for childhood vaccines. Parents who want to opt out are easily doing so, as can be seen by the resurgence in measles and whooping cough. Nearly 40% of teenagers are not up to date on the HPV vaccine even as Australia and Scotland are on the verge of eliminating cervical cancer thanks to serious immunization campaigns.”
Further, he adds “Democrats avoided vaccination as an issue this election year because they knew that, post Covid, vaccination has become something of a political third rail. Could Kennedy and [CMS nominee Dr. Mehmet] Oz make things worse—absolutely. But are matters already bad—sadly, yes.”
The Kennedy-Trump threat
Yet Kennedy and his coterie of other department heads can make matters much worse. With the imprimatur of a President-elect already lionized by an often-fawning base will likely discourage more resistance to vaccines that can turn schools into major disease vectors and hasten the spread of new epidemics sure to come.
Even in the wake of Covid, Kennedy, with his power as HHS Secretary has said he would pause NIH’s drug development and infectious disease research and shift its focus to chronic diseases that do need attention but not at the expense of combating global epidemics.
Kennedy has also indicated a desire to shutter “entire” FDA departments, which oversee safety and effectiveness of prescription drugs and vaccines. And he has threatened to purge FDA staff for “aggressive suppression” of unsafe products and therapies, such as raw milk, and discredited COVID treatments, including hydroxychloroquine.
There’s his lurid, scientifically refuted linkage of vaccines to autism and other conspiracies, such as his claim that Covid was bioengineered to exempt Chinese people, already targeted by Trump rhetoric that fueled hate crimes, and Ashkenazi Jews of Eastern Europe origin, reinforcing right-wing antisemitic bigotry.
And that’s not including his attack on fluoride in drinking waterwhich promotes oral health, as cited in a letter by 77Nobel Prize winners opposing Kennedy, or his speculated doubt that HIV causes AIDS and the effectiveness of AZT therapy.
Anti-vax consequences
Still, it is his fanaticism on vaccines that prompts the most alarm.
During the COVID-19 epidemic, Children’s Health Defense, a group Kennedy founded and led, petitioned the FDA to halt the use of all COVID vaccines. In a 2023 podcast, Kennedy proclaimed there is “no vaccine that is safe and effective,” and disputed CDC’s guidelines about if and when kids should get vaccinated.
The implications are alone enough for a mass movement to escalate pressure to block confirmation of Kennedy, and Trump’s nominees to lead the CDC, CMS, FDA, NIH and Surgeon General who mostly share his chilling views on vaccine safety. Multiple studies document what is at stake.
The World Health Organization estimates vaccines have protected 150 million lives over the past 50 years, and that 100 million were infants. About 4 million deaths worldwide are prevented by childhood vaccination every year. More than 50 million deaths can be prevented through immunization between 2021 and 2030. By 2030, it is estimated that measles vaccination alone can save nearly 19 million lives.
In November 2013, University of Pittsburgh researchers issued a similar study. It documented that about 103 million cases of disease had been prevented by vaccination since 1924. The disease with the most cases prevented was diphtheria, 40 million cases. Second was measles, 35 million cases.
Globally, reported Scientific American, measles vaccines, preserved 94 million lives over the past 50 years. It cited a 2024 Lancet study published in October that vaccines against 14 common pathogens protected 154 million people over the past five decades—that's a rate of six lives every minute. They have cut infant mortality by 40 percent globally and by more than 50 percent in Africa. Throughout history vaccines secured more lives than almost any other intervention.
Lancet found that each life defended through immunization contributed to 66 years of full health, without long-term linked to disease.Vaccines impact nearly every measurement of health equity, from improving access to care, to reducing disability and long-term morbidity, to preventing loss of labor and the death of caretakers.
Writing in Forbes, hardly a left-wing Trump critic, earlier this year, ER doctor/health researcher Arthur Kellerman also cited the Pittsburgh study, as well as Johns Hopkins data of nearly 88 million cases of illness. In 1900, he wrote, 30 percent of deaths in the U.S. occurred in children under 5 years of age. In 1999, they accounted for only 1.4 percent. "Vaccines," he concluded, "played a vital role in this progress.”
Measles, a highly contagious childhood disease that can lead to pneumonia and fatal brain swelling, declined rapidly after the first measles vaccine was introduced in 1963. But, the CDC cites 16 measles outbreaks in 2024. Kennedy’s alleged role in promoting vaccine misinformation during a deadly measles outbreak in American Samoa in 2019, which he denies, has also been widely reported. Unvaccinated families, writes Kellerman, “tend to cluster in communities defined by faith, culture or political ideology. When a highly contagious disease gets into such a community, an outbreak can occur. We’ve already seen localized outbreaks of measles, rubella, mumps, and pertussis.”
In 2022, Kennedy’s attorney and close advisor Aaron Siri petitioned the FDA to revoke approval of the polio vaccine for further study despite its long history of success.
Republican Senate Majority Leader Mitch McConnell, who endured polio as a child, has denounced the push “to undermine public confidence in proven cures” like the polio vaccine. Only a “miraculous combination of modern medicine and a mother’s love” saved him from paralysis he said in a statement. “The polio vaccine has saved millions of lives and held out the promise of eradicating a terrible disease. Efforts to undermine public confidence in proven cures are not just uninformed—they’re dangerous,” McConnell said.
Yet McConnell, and similar Republican critics have yet to publicly oppose Kennedy and his similar malefactors of health (to borrow FDR’s “malefactors of wealth” frame).
We can no longer count on Elvis to protect our children, families and communities. It is up to the rest of us.
"So if you're wondering if Donald Trump is trying to kill your kids, yes, yes he is," said one critic.
Public health advocates, federal lawmakers, and other critics responded with alarm to The New York Timesreporting on Friday that an attorney helping Robert F. Kennedy Jr. select officials for the next Trump administration tried to get the U.S. regulators to revoke approval of the polio vaccine in 2022.
"The United States has been a leader in the global fight to eradicate polio, which is poised to become only the second disease in history to be eliminated from the face of the earth after smallpox," said Liza Barrie, Public Citizen's campaign director for global vaccines access. "Undermining polio vaccination efforts now risks reversing decades of progress and unraveling one of the greatest public health achievements of all time."
Public Citizen is among various organizations that have criticized President-elect Donald Trump's choice of Kennedy to lead the Department of Health and Human Services, with the watchdog's co-president, Robert Weissman, saying that "he shouldn't be allowed in the building... let alone be placed in charge of the nation's public health agency."
Although Kennedy's nomination requires Senate confirmation, he is already speaking with candidates for top health positions, with help from Aaron Siri, an attorney who represented RFK Jr. during his own presidential campaign, the Times reported. Siri also represents the Informed Consent Action Network (ICAN) in petitions asking the Food and Drug Administration (FDA) "to withdraw or suspend approval of vaccines not only for polio, but also for hepatitis B."
According to the newspaper:
Mr. Siri is also representing ICAN in petitioning the FDA to "pause distribution" of 13 other vaccines, including combination products that cover tetanus, diphtheria, polio, and hepatitis A, until their makers disclose details about aluminum, an ingredient researchers have associated with a small increase in asthma cases.
Mr. Siri declined to be interviewed, but said all of his petitions were filed on behalf of clients. Katie Miller, a spokeswoman for Mr. Kennedy, said Mr. Siri has been advising Mr. Kennedy but has not discussed his petitions with any of the health nominees. She added, "Mr. Kennedy has long said that he wants transparency in vaccines and to give people choice."
After the article was published, Siri called it a "typical NYT hit piece plainly written by those lacking basic reading and thinking skills," and posted a series of responses on social media. He wrote in part that "ICAN's petition to the FDA seeks to revoke a particular polio vaccine, IPOL, and only for infants and children and only until a proper trial is conducted, because IPOL was licensed in 1990 by Sanofi based on pediatric trials that, according to FDA, reviewed safety for only three days after injection."
The Times pointed out that experts consider placebo-controlled trials that would deny some children polio shots unethical, because "you're substituting a theoretical risk for a real risk," as Dr. Paul A. Offit, a vaccine expert at the Children's Hospital of Philadelphia, explained. "The real risks are the diseases."
Ayman Chit, head of vaccines for North America at Sanofi, told the newspaper that development of the vaccine began in 1977, over 280 million people worldwide have received it, and there have been more than 300 studies, some with up to six months of follow-up.
Trump, who is less than six weeks out from returning to office, has sent mixed messages on vaccines in recent interviews.
Asked about RFK Jr.'s anti-vaccine record during a Time "Person of the Year" interview published Thursday, the president-elect said that "we're going to be able to do very serious testing" and certain vaccines could be made unavailable "if I think it's dangerous."
Trump toldNBC News last weekend: "Hey, look, I'm not against vaccines. The polio vaccine is the greatest thing. If somebody told me to get rid of the polio vaccine, they're going to have to work real hard to convince me. I think vaccines are—certain vaccines—are incredible. But maybe some aren't. And if they aren't, we have to find out."
Both comments generated concern—like the Friday reporting in the Times, which University of Alabama law professor and MSNBC columnist Joyce White Vance called "absolutely terrifying."
She was far from alone. HuffPost senior front page editor Philip Lewis said that "this is just so dangerous and ridiculous" while Zeteo founder Mehdi Hasan declared, "We are so—and I use this word advisedly—fucked."
Ryan Cooper, managing editor at The American Prospect, warned that "they want your kids dead."
Author and musician Mikel Jollett similarly said, "So if you're wondering if Donald Trump is trying to kill your kids, yes, yes he is."
Multiple critics altered Trump's campaign slogan to "Make Polio Great Again."
U.S. Sen. Elizabeth Warren (D-Mass.) responded with a video on social media:
Without naming anyone, Senate Minority Leader Mitch McConnell (R-Ky.), a polio survivor, put out a lengthy statement on Friday.
"The polio vaccine has saved millions of lives and held out the promise of eradicating a terrible disease. Efforts to undermine public confidence in proven cures are not just uninformed—they're dangerous," he said in part. "Anyone seeking the Senate's consent to serve in the incoming administration would do well to steer clear of even the appearance of association with such efforts."