US aid agency is in upheaval during foreign assistance freeze and staff FORCED departures
MATTHEW LEE and ELLEN KNICKMEYER
Updated Fri, January 31, 2025
WASHINGTON (AP) — Trump administration changes have upended the U.S. agency charged with providing humanitarian aid to countries overseas, with dozens of senior officials put on leave, thousands of contractors laid off, and a sweeping freeze imposed on billions of dollars in foreign assistance.
Democratic senators warned the Trump administration Friday against any effort to eliminate the U.S. Agency for International Development as an independent agency, responding to growing fears among its supporters that such plans may be in the offing.
Sen. Chris Murphy was one of a half-dozen Democrats on the Senate Foreign Relations Committee to argue in statements and on social media that President Donald Trump would have no legal authority to dissolve the agency.
Aid organizations say the funding freeze — and deep confusion over what U.S.-funded programs must stop work as a result — has left them agonizing over whether they could continue operating programs such as those providing round-the-clock nutritional support to extremely malnourished infants and children, knowing that closing the doors means that many of those children would die.
Current and former officials at the State Department and USAID say staffers were invited to submit requests to exempt certain programs from the foreign aid freeze, which Trump imposed Jan. 20 and the State Department detailed how to execute on Jan. 24.
Three days later, at least 56 senior career USAID staffers were abruptly placed on administrative leave.
Three officials said many of those put on leave were lawyers involved in determining what programs might qualify for waivers, helping write proposals and submitting those waiver requests as they believed they had been invited to do.
The officials spoke on condition of anonymity for fear of reprisal. A Trump administration directive that aid organizations interpret as a gag order has left them unwilling to speak publicly for fear of permanently losing U.S. funding.
In an internal memo Monday about the staffing changes, new acting USAID administrator Jason Gray said the agency had identified “several actions within USAID that appear to be designed to circumvent the President’s Executive Orders and the mandate from the American people.”
“As a result, we have placed a number of USAID employees on administrative leave with full pay and benefits until further notice while we complete our analysis of these actions,” Gray wrote.
A former senior USAID official said those put on leave had been helping aid organizations navigate the “confusing process” to seek waivers from the aid pause for specific life-saving projects, such as continuing clean water supplies for displaced people in war zones.
Others were identified as having been involved in diversity, equity and inclusion programming, which the administration has banned.
On Thursday, a USAID human resources official who tried to reverse the action, saying there was no justification for it, was himself placed on leave, according to two of the officials who had viewed internal emails and verified them as authentic. Reporters from ProPublica and Vox first reported the emails on X.
The State Department and White House didn’t respond to messages seeking comment about the staffing changes.
The new leaders at USAID also abruptly laid off contractors who made up about half the workforce in the agency’s humanitarian bureau Tuesday, knocking them out of systems so that some vanished in the middle of videoconferences, the former senior official said. The targeted institutional service contractors do everything from administrative and travel support to grant processing and data analytics.
The staffing changes came three days after the State Department issued guidelines last Friday for implementing Trump’s executive order freezing foreign assistance for 90 days. The department says it's reviewing the money the United States is spending to ensure it adheres to administration policy.
The guidelines initially exempted only military aid to Israel and Egypt and emergency food programs but also said program administrators and implementors could apply for waivers for programs that they believe would meet administration standards.
On Tuesday, new Secretary of State Marco Rubio issued a broader waiver for programs that provide other “life-saving” assistance, including medicine, medical services, food and shelter, and again pointed to the possibility of waivers. Rubio pointed to the broadened exemptions in an interview Thursday with SiriusXM host Megyn Kelly.
“We don’t want to see people die and the like,” he said.
Rubio said there would be a program-by-program review of which projects make “America safer, stronger or more prosperous.”
The step of shutting down U.S.-funded programs during the 90-day review meant the U.S. was “getting a lot more cooperation” from recipients of humanitarian, development and security assistance, Rubio said. “Because otherwise you don’t get your money.”
The State Department said that since the aid freeze went into effect, it has approved dozens of waivers, although many were returned because they did not include enough detail. It said waiver requests for programs costing “billions of dollars” have been received and are being reviewed.
The department did not specify how many waiver requests had been denied but said thus far its actions had stopped more than $1 billion from being spent on programs and projects that are “not aligned with an America First agenda.”
Even with the broadening of exemptions for life-saving care, uncertainty surrounds what U.S.-funded programs legally can continue. Hundreds of thousands of people globally are going without access to medicine and humanitarian supplies and clinics are not getting medicine in time because of the funding freeze, aid organizations warn.
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AP reporter Rebecca Santana in Washington contributed.
The future of USAID remains uncertain amid Trump's funding freeze
Abigail Williams
Sat, February 1, 2025
The front of the U.S. Agency of International Development headquarters building in Washington, D.C.
Just one week after the Trump administration initiated a near-total freeze of U.S. foreign aid, the future of the U.S. Agency for International Development — the agency at the heart of America’s humanitarian assistance operations overseas — remains uncertain.
Trump administration officials are actively discussing placing USAID under the authority of the State Department, according to more than a dozen current and former officials and sources familiar with the discussions, further crippling an agency that has already been brought to its knees.
In the past week, hundreds of USAID employees and contractors have been fired or furloughed, almost 60 senior career leaders at the agency have been sidelined and U.S. foreign missions have been brought to a standstill. Thousands of related jobs are also under threat of furlough or firing in the days ahead.
On Friday, prominent signs in the front lobby of the agency's Washington headquarters appeared to have been removed, leaving those still employed to brace for the possibility of USAID shutting down altogether.
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“It is imperative that we maintain an independent development voice and capability within the U.S. government. USAID is, by statute, an independent establishment outside of the State Department,” Democratic Sens. Jeanne Shaheen of New Hampshire and Brian Schatz of Hawaii and Democratic Reps. Gregory Meeks of New York and Lois Frankel of Florida wrote in a statement late Friday. “Any proposal to modify that structure would require an Act of Congress.”
“A president cannot eliminate an appropriated federal agency by executive order,” Sen. Chris Murphy, D-Conn., warned in a post on X.
Despite a rapid-fire social media storm naming dozens of secretaries, ambassadors, special envoys and senior advisers before taking office, President Donald Trump has yet to nominate a leader for the federal humanitarian aid agency.
According to multiple sources who spoke with NBC News, the downsizing of the agency has largely been directed by Pete Marocco, who was installed by the Trump administration as the head of the State Department’s Office of Bureau of Foreign Assistance. Marocco held several national security positions under the previous Trump administration, including at USAID, where his attempts to consolidate power and slash funding drove officials to write a dissent memo that ultimately pushed him out of office, the sources said.
“What he’s doing now is frighteningly similar to everything he was trying to do at USAID before, but this time he’s destroying it,” said one USAID official familiar with his past actions.
Critics of the Trump administration’s decision to pause U.S. foreign aid and dramatically downsize USAID argue that the cuts under the banner of "America First" ultimately benefit U.S. adversaries.
“Trump’s USAID purge and foreign aid pause is already hurting efforts to deliver aid and growing China’s world standing at our expense,” Sen. Chris Van Hollen, D-Md., said Friday.
“He’s effectively putting the Trump and Rubio foreign policy vision at risk,” another USAID official told NBC News, warning, “If you kill an institution, you are not going to revive it overnight.”
The State Department and USAID did not immediately respond to NBC News’ requests for comment.
Project 2025, the expansive report initiated by the Heritage Foundation and dozens of other Trump-aligned conservative organizations, foreshadowed the actions that Marocco has taken, including the decision to place almost 60 USAID policy-making career civil servants and foreign service officers on administrative leave.
The Project 2025 document said that USAID should “pilot-test” the transformation of those civil servant positions into political appointee roles and outlined a broader effort to consolidate USAID.
NBCNews.com
Democrats slam Trump over reports he’ll merge USAID with State Department
Filip Timotija
Fri, January 31, 2025
THE GUARDIAN
Democrats on Friday slammed President Trump over recent news reports that he is considering merging the U.S. Agency for International Development (USAID) with the State Department.
“It is imperative that we maintain an independent development voice and capability within the U.S. government. USAID is, by statute, an independent establishment outside of the State Department. Any proposal to modify that structure would require an Act of Congress,” four congressional Democrats wrote in a Friday letter to Jason Gray, USAID’s acting administrator.
The three-page letter responded to multiple outlets‘ reporting that the Trump administration is considering having USAID, which among other things sends aid to communities impacted by conflicts and assists developing countries on many aspects, be placed under the control of the State Department.
Sens. Jeanne Shaheen (N.H.), and Brian Schatz (Hawaii) alongside Reps. Gregory Meeks (N.Y.) and Lois Frankel (D-Fla.) expressed concern over the administration’s decision to place some USAID’s staff on leave, firing contractors and freezing foreign assistance which, they argued, put lives abroad and home at risk.
“The Administration’s decisions to place senior leaders throughout the agency on leave; to terminate ongoing programs without reviewing their efficacy and value simply because of how they were labeled under the previous Administration; and to freeze ongoing foreign assistance without engaging in meaningful consultation and transparency with Congress—including to ensure compliance with the law—have created a maelstrom of problems that have put our nation at risk and undermined American credibility around the globe,” they said in the letter.
Shaheen is the ranking member on the Senate Foreign Relations Committee while Schatz is the top Democrat on the Senate Appropriations Subcommittee on State, Foreign Operations and Related Programs. Meek is the ranking member on the House Foreign Affairs Committee, and Frankel is the top Democrat on the House Appropriations Subcommittee on National Security, Department of State and Related Programs.
Politico first reported that USAID independence is on shaky ground, citing five people close to the administration. The administration is looking at legal pathways that Trump could utilize to sign an executive order that would shutter USAID’s independence, Reuters reported on Friday, citing one source familiar with the matter.
The agency, which has a budget of over $50 billion, was formed in November 1961, and it is housed in the Ronald Reagan Building in Washington.
Since taking office, Trump signed an executive order to freeze foreign assistance for three months and directed officials to conduct a review of all of the programs to ensure they align with his vision of U.S. foreign policy.
A number of Senate Democrats have expressed their opposition to Trump’s reported interest in folding USAID under the umbrella of the State Department.
“Trump’s been purging and intimidating USAID employees,” Senate Minority Leader Chuck Schumer wrote in a Friday post on the social media platform X. “Now there’s a rumor he’ll dissolve USAID as an independent agency. It was created by JFK and established in law to further our national security and spread hope. This’d be illegal and against our national interests.”
The Hill has reached out to USAID and the State Department for comment.
Copyright 2025 Nexstar Media, Inc. All rights reserved.
The Hill.
Inside the Chaos and Heartbreak of Trump's Foreign-Aid Freeze
Belinda Luscombe
Sat, February 1, 2025
Sandra Ramos, 22, plays with her daughter Zoy Yamileth Ramos at an improvised shack she built with the help of the U.S. Agency for the International Development (USAID) on the banks of the Ulua River after the passage of hurricanes Eta and Iota in La Lima, Cortes department, Honduras, on July 15, 2022. Credit - Orlando Sierra—AFP/Getty Images
The dominoes fell really fast. On Monday, Jan. 20, shortly after his inauguration, President Donald Trump signed an Executive Order that called for a 90-day pause on new foreign-aid programs for efficiency and "consistency with U.S. foreign policy." The order got less attention than some of the others he signed that day but may have much more far-reaching effects.
By the evening of Friday, Jan. 24, Secretary of State Marco Rubio had issued a directive that went even further, effectively freezing operations at the United States Agency for International Development (USAID), the U.S. government's lead provider of nonmilitary foreign aid. No new projects were to be started, no contracts were to be extended, and work was to be stopped on most existing programs. By Monday, Jan. 27, at least 56 of USAID's top brass were sent home on paid administrative leave for 90 days, reportedly cut off from their email, and, in case the message was not clear, the photos from the walls of their office were removed.
Chaos and confusion began to spread through the ranks of USAID, both in Washington, D.C, where there are about 15,000 employees and abroad, where there are thousands more. It also spread among the many nongovernmental organizations and religious groups that receive funds from it, and the small businesses the agency contracts to provide services. Some of them had to guess whether their programs had to be paused under the terms of their agreement with the State Department and others received suspension notices and memos from a variety of different channels.
Read More: Federal Webpages Go Dark as Trump Administration Removes Public Data Sets
TIME spoke to several current and former senior officials at USAID and others who head up organizations it supports about the impact of the move on their activity. Almost all requested that TIME not use their names because they didn't want to jeopardize their future funding or employment.
On Tuesday morning one of those aid organizations, which runs dozens of child nutrition clinics in several extremely impoverished countries, had an emergency meeting to try to decide whether to close them. "Those kids have to be fed every three to four hours with therapeutic feeding products in order to reverse the effects of malnutrition, prevent long-term harm, and basically keep them alive," says an official at the NGO. "We had to make a decision: Do we close those centers? Or do we keep them open at the risk of being in violation of our suspension notice or stop-work order?"
Later that day, after the NGO opted to keep the clinic open by repurposing some non-USAID funding, Secretary Rubio released a clarification that "life-saving humanitarian assistance" could proceed. The organization believes, but is not sure, the clinics fall under that heading.
Charitable groups around the world told TIME they were making similar agonizing choices. One had to decide whether to abide by a stop-work order or deliver lunches to schoolchildren in impoverished communities, as it has for years. It decided to obey the order, wasting hundreds of thousands of dollars' worth of perishable food. Another is figuring out whether to close health clinics for pregnant mothers in Haiti, leaving them with scant alternatives for a place to give birth. Yet another was forced to pause a program that helped migrants fleeing Venezuela stay in South American countries (rather than continuing north to the U.S. border), through work training, housing, and support of the host community.
The U.S. plays an outsize role in responding to international crises, providing 40% of the world's humanitarian assistance. Most people in the humanitarian sector acknowledge that Washington has the right to review how the more than $40 billion it spends doing so every year is used. "The government has the prerogative to conduct a review of spending and programs against their priorities," says an executive of a major aid organization. "But the ways in which they're going about it, in my mind, would undermine the likelihood of them actually having an aid sector to work with as they go forward."
Questions emailed to the Department of State went unanswered by press time, but a media note posted online says that a pause is the only way to really "scrutinize and prevent" wasteful spending. (Foreign aid represents about 1% of the federal budget.) "It is impossible to evaluate programs on autopilot because the participants—both inside and outside of government—have little to no incentive to share programmatic-level details so long as the dollars continue to flow," the note said.
Here's what foreign-aid experts are saying about the outsize impact of the temporary pause.
It's Unprecedented
New administrations customarily have a period of review of government-funded programs. Every incoming government wants to save money and be more efficient, and to be seen doing it. But nobody TIME spoke to could recall the agency's funding being almost entirely frozen while such a review is taking place. “The scope of the Trump Administration’s freeze of USAID programs is unprecedented," says Tim Rieser, foreign-policy aide to former Senator Patrick Leahy, who chaired the Appropriations Committee. Many of the programs will cease to be effective if they're not consistent. If a medical clinic closes, infectious diseases can spread quickly. If security guards don't show up at a Syrian refugee camp because they've been told not to, it leaves an opening for local thugs to step in. "We stop work all the time as a result of the ends of contracts or the ends of our grant agreements," says the head of one aid organization. "So there's an orderly way of reinvesting U.S. foreign assistance. It's just not this."
The Agency Was in Need of Reform, But Not Dismantling
Most of the people TIME spoke to about USAID, both from within and outside the agency, agreed that it would benefit from a bit of a shake-up. "There's real reform needed in the sector," says the official at the NGO. "Many of us have been advocating for that." Programs are duplicated. Some initiatives have outlived their usefulness or have led to dependency rather than the development outcomes that were intended. There is waste, and oversight is often difficult. The system tends to favor bigger Western organizations and not smaller, more nimble local agencies. "If there was a process through which all of these programs could be reviewed, I think that everyone would be rolling up their sleeves to have the programs reviewed," says one former senior USAID official. "But there is no such process." Others were more damning. “There are certainly things that could be done to improve USAID," says Rieser, "but these people, who know next to nothing about USAID’s programs or dedicated personnel, are not the ones to do it.”
It's Chaotic
It's unclear from the government's directives which programs are affected by the freeze on funding and which are exempt. And it's difficult to ascertain whom to ask about it. Initiatives that advance diversity, equity, and inclusion are obviously disfavored, and collaboration with the World Health Organization is a no-go area. Emergency food programs and "core life-saving medicine, medical services, food, shelter, and subsistence assistance" are supposed to be exempt, but it is unclear what programs fall under that description. School lunches are sometimes the only food a child reliably gets in a day, but are they "core lifesaving food," for example?
Individual programs have to apply for a waiver to the pause, and thousands have, which according to TIME's sources, has caused a backlog, exacerbated by the absence of executives with the most knowledge of the programs. The media note from the State Department says, "The process was used successfully dozens of times in the first several days; however, many requests failed to provide the level of detail necessary to allow a thorough evaluation."
Because of the method by which USAID funds are disbursed, the only way to pause all of the funding was to issue a legion of individual stop-work orders, which came from various sources, some of which were foggy as to the degree or type of work that had to be paused. "I wish [current USAID leadership] would either make a more blanket statement, or that they empower their teams to interpret this, so that, say, a project in Nepal gets to hear from the mission in Nepal that this is what you should do and this is what you can't do," says the aid-organization head.
It's Provoking Fear
It's unclear what the USAID leaders did to provoke the ire of officials who enforced a sudden ejection. The stated reason from USAID acting director Jason Gray was that he had "identified several actions within USAID that appear to be designed to circumvent the president’s executive orders and the mandate from the American people,” but former USAID officials say none of the departees knows what action any of them took that would fall under that category. USAID's labor-relations director said he found no evidence of misconduct and was withdrawing this decision, but then he was put on leave himself hours later, a series of developments previously reported by the Washington Post and ProPublica.
Their unceremonious removal and the arrival of new unknown personnel in leadership has unnerved the employees who remain while at the same time increasing their workload. "People are scared, and whenever people are scared, they are on the side of being conservative, keeping their head down," says a former USAID executive. After the freeze one current employee reported receiving just one email in an entire workday. "People are going to work and they're just sitting there," says the same executive. "People are afraid to write emails, because all the work is stopped. And the U.S. taxpayer is paying for all this."
It's Wasteful
Leaders of organizations that have received USAID funding in the past have to guess whether their budgets will be affected long term and plan accordingly, so they are axing employees and closing programs just in case. "The kind of catch-22 that all organizations are in is if we advance the work by trying to understand and interpret what is meant, then we could be facing the risk of financial outlay of millions of dollars that wouldn't be reimbursed," said an NGO chief. "If we don't advance the work, then we potentially have perishable lifesaving support that is stranded and wasted. And so it's an impossible kind of paralysis that we face."
It's Against American Interests
Foreign aid is often said to be the third leg of the national-security stool, alongside defense and diplomacy. When people in difficult situations can be given assistance, it makes them less likely to want to leave, or destabilize a government, or try to use force to gain resources. "Foreign aid is one of the tools in your toolkit, and by destroying that toolkit, you're making America less safe, and you're also not achieving the goal of peace," says Susan Reichle, a former senior executive at USAID. Others point to the perils of removing a stable source of relief in an increasingly destabilized world. Among them was Sen. Chris Coons (D-Conn.) who told the Senate on Thursday, Jan. 30, just shy of a week after Secretary Rubio's first memo was released, that the real beneficiary of the move was China. "Our biggest global competitor and adversary is delighted that we’ve handed them an opportunity to say to communities and countries around the world that we are not a reliable partner," he said. "The administration may be claiming that this pause is temporary, but its effects will not be."
USAID website goes offline in Trump administration's 2-week-old freeze on foreign aid worldwide
ELLEN KNICKMEYER
Updated Sat, February 1,2025
A man walks past boxes of USAID humanitarian aid at a warehouse at the Tienditas International Bridge on the outskirts of Cucuta, Colombia, Feb. 21, 2019, on the border with Venezuela. (AP Photo/Fernando Vergara)
WASHINGTON (AP) — The website of the U.S. Agency for International Development went offline without explanation Saturday as thousands of furloughs, layoffs and program shutdowns continued in President Donald Trump's freeze on U.S.-funded foreign aid and development worldwide.
Congressional Democrats battled the Trump administration increasingly openly, expressing concern that Trump may be headed toward ending USAID as an independent agency and absorbing it into the State Department. Democrats say Trump has no legal authority to eliminate a congressionally funded independent agency, and that the work of USAID is vital to national security.
Trump and congressional Republicans say much of foreign aid and development programs is wasteful. They single out programs they say advance liberal social agendas.
The fear of even tougher administration action against USAID comes two weeks into the administration's shutdown of billions of dollars of the United States' humanitarian, development and security assistance.
The U.S. is the world's largest donor of humanitarian aid by far. It spends less than 1% of its budget on foreign assistance, a smaller share overall than some other countries.
Administration officials had no comment Saturday when asked about concerns expressed by lawmakers and others that Trump may be planning to end USAID's separate status..
President John F. Kennedy created the organization at the height of the Cold War to counter Soviet influence. USAID today is at the center of U.S. challenges to the growing influence of China, which has a successful “Belt and Road” foreign aid program of its own.
Congress passed the Foreign Assistance Act in 1961, and Kennedy signed that law and an executive order establishing USAID as an independent agency.
USAID staffers spent Friday and Saturday in chat groups monitoring its fate, giving updates on whether the agency's flag and signs were still up outside agency headquarters in Washington. As of late Saturday afternoon, they were.
In a post on X, Democratic Sen. Chris Murphy said presidents cannot eliminate congressionally appropriated federal agencies by executive order, and said Trump was poised to “double down on a constitutional crisis.”
“That’s what a despot — who wants to steal the taxpayers’ money to enrich his billionaire cabal — does,” Murphy said.
Billionaire Elon Musk, advising Trump in a campaign to whittle down the federal government in the name of efficiency, endorsed posts on his X site calling for dissolving USAID.
“Live by executive order, die by executive order,” Musk tweeted in reference to USAID.
Trump placed an unprecedented 90-day freeze on foreign assistance on his first day in office Jan. 20. The order, a tougher-than-expected interpretation of Trump’s freeze order on Jan. 24 drafted by Peter Marocco, a returning political appointee from Trump’s first term, shut down thousands of programs around the world and forced the furloughs or layoffs of many thousands.
Secretary of State Marco Rubio has since moved to keep more kinds of strictly life-saving emergency programs going during the freeze. Aid groups say confusion surrounding what programs are still allowed to operate is contributing to paralysis in global aid organizations.
Rubio, in his first public comments on the matter, said Thursday that USAID’s programs were being reviewed to eliminate any that are not in the U.S. national interest, but he said nothing about eliminating it as an agency.
The shutdown of U.S.-funded programs during the 90-day review meant the U.S. was “getting a lot more cooperation” from recipients of humanitarian, development and security assistance, Rubio said.
Republicans and Democrats long have fought over the agency, arguing whether humanitarian and development aid protects the U.S. by helping stabilize partner countries and economies or is a waste of money. Republicans typically push to give State more control of USAID’s policy and funds. Democrats typically build USAID autonomy and authority.
A version of that battle played out in Trump’s first term, when Trump tried to cut the budget for foreign operations by a third.
When Congress refused, the Trump administration used freezes and other tactics to cut the flow of funds already appropriated by Congress for foreign programs. The General Accounting Office later ruled that it violated a law known as the Impoundment Control Act.
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AP photographer Carolyn Kaster contributed to this report.
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Trump aid freeze disrupts global HIV/AIDS fight
Nathaniel Weixel
Fri, January 31, 2025
A legacy bipartisan initiative to combat HIV and AIDS in Africa is collateral damage from President Trump’s directive to halt all U.S. foreign assistance, despite efforts to exempt humanitarian assistance and lifesaving medication from being caught up in the three-month funding freeze.
The State Department issued a memo implementing the pause for new and obligated State and U.S. Agency for International Development (USAID) funding following Trump’s executive order calling for a 90-day pause on new foreign aid to allow the government to determine if programming aligns with Trump’s foreign policy.
The pause in global health funding has frozen activities at health clinics across Africa that rely on the President’s Emergency Plan for AIDS Relief (PEPFAR), raising immediate fears of a rapid spread of HIV around the continent.
It’s not unusual for a new administration to order a review of existing programs or even to pause new spending, and PEPFAR shouldn’t be immune from that, said Jirair Ratevosian, a fellow at Duke University’s Global Health Institute who formerly worked as a chief of staff for the PEPFAR program.
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“But, you know, there’s a distinction between reviewing a program, asking questions about a program, and completely freezing its lifesaving mission,” Ratevosian said. “What’s transpired over the last [few days] is something completely different, which is chaos, confusion and potential reversal of one of America’s greatest accomplishments.”
The $6.5 billion PEPFAR is considered to be one of America’s most consequential programs in Africa. It is credited with saving 25 million lives and with scaling back the AIDS epidemic.
Experts and aid organizations are sounding the alarm over the sudden halt. The stop-work orders came without warning, sowing immediate chaos and confusion.
PEPFAR employs more than 270,000 health workers. They have been told to stop serving patients and not go to work.
Clinics shut their doors and turned patients away. The administration even told them to stop dispensing antiretroviral HIV medication that they had in stock because it was supplied with PEPFAR funds.
Some entities have private funding and other stopgap measures to fall back on, but for others the situation is more difficult.
“There are programs all over the continent providing treatment and prevention that are now not delivering what they normally do,” said Mitchell Warren, executive director of AVAC, an international nonprofit focused on HIV prevention. “There will be people, beginning this week, who come back into the clinic, or thought they had an appointment to come back to clinic to get more medication, and won’t be able to get it.”
Just as suddenly as the stop-work memo was released, the State Department appeared to somewhat reverse course, announcing Tuesday that lifesaving treatments and medications were not subject to the freeze. But the waiver provided no specific guidance on what services qualified for exemption, deepening the confusion on the ground.
Warren said the waiver appears to allow clinics to resume dispensing HIV medication, but it’s not entirely clear. Without clarification, he said clinics are continuing to withhold medication.
“If you said lifesaving medication, I would tell you that anyone on antiretroviral therapy or anyone getting antiretroviral prevention, it’s lifesaving. But it’s open to interpretation,” Warren said.
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“And we do not yet have any official notification from PEPFAR or from USAID or from [the Centers for Disease Control and Prevention] which programs qualify for that waiver,” he added.
If a person with HIV stops taking the medication, the virus is no longer suppressed and can multiply, leading to weakened immune systems, illness and then potential spread to others.
The foreign aid freeze comes at a precarious time for the PEPFAR program, as some of its authorizations expire in March. PEPFAR has traditionally been reauthorized for five-year periods, but the March 2024 omnibus funding bill only extended it for a year.
“Historically, PEPFAR has had tremendous bipartisan support that allowed it to kind of sit outside of regular politics,” said Jen Kates, a senior vice president and director of the Global Health & HIV Policy Program at KFF. “That is no longer the case.”
Republicans have put the aid program in their crosshairs in recent weeks following the State Department notifying Congress last month it discovered that nurses working in PEPFAR-funded clinics in Mozambique had carried out nearly a dozen abortions.
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While abortion is legal in Mozambique, U.S. law bars any PEPFAR aid recipients from providing abortion services.
Rep. Brian Mast (R-Fla.), the chair of the House Foreign Affairs Committee, has called for an investigation.
Mast entered the chair position promising to scrutinize U.S. foreign assistance abroad alongside Trump’s “America First” foreign policy push.
And Sen. Jim Risch (R-Idaho), chair of the Senate Foreign Relations Committee, said earlier this month that PEPFAR “is certainly in jeopardy.”
Yet Sen. Chris Coons (D-Del.), a member and former chair of the Senate Appropriations subcommittee that funds the State Department, said there are still Republican colleagues who support the program.
“Some very much so. I’ve spoken with a number of my colleagues who respect and recognize the decades-long impact PEPFAR has had on saving literally millions of lives across several administrations back to President George W. Bush, who launched it,” he told The Hill.
He said he hoped “decisions that are being made yesterday, today, going forward, do not hamstring the program from being able to continue to carry out its critical lifesaving mission.”
Sen. John Cornyn (R-Texas) spoke in support of the program during Robert F. Kennedy Jr.’s confirmation hearing on Wednesday before the Senate Finance Committee, and asked the Health and Human Services nominee if he supported PEPFAR.
Kennedy said he’d “absolutely” support the program and seek to strengthen it.
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