Dr. Atul Gawande updates Senators on the destruction of USAID: "They dismantled the US’s largest civilian force advancing global stability, peace, economic growth, and survival."
This past week, Dr. Atul Gawande briefed US Senators on the effects that the destruction of USAID is already having. Here are the facts we need to know.
Over the last couple of months, the Inside Medicine community has been fortunate to hear and learn about USAID directly from Dr. Atul Gawande.
Today, I’m sharing the first public release of Dr. Gawande’s latest update provided to members of the United States Senate, remarks that were delivered in person in Washington, D.C. last week.
This is essential and up-to-date information that we all need to know. When people ask what the human costs of this administration’s brazen actions have been, we must respond with facts. Well, here they are…
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Do you have any idea where things stand with USAID? With everything else going on, I realized that even I needed an update. So, I again reached out to our friend Dr. Atul Gawande, who, until noon on January 20, 2025, ran global health for USAID.
Here’s where things stand: While the Supreme Court ruled last month that the Trump administration still has to pay its bills for work already completed by USAID contractors, that was not exactly a high bar to clear—and even that decision was a narrow 5-4 ruling. Meanwhile, all of the contract terminations and personnel purges have been permitted to go through while the overall issues are litigated. Therefore, the reality is that even if the courts eventually determine that the complete gutting of USAID was not lawful, it will already be a fait accompli—that is, practically impossible to reverse.
So, what of USAID’s crucial work remains, and what has—in Elon Musk’s own words—already been ‘fed to the wood chipper’? In testimony to members of the US Senate this past week, Dr. Gawande summarized what has already been destroyed by callous and brutal DOGE-directed terminations since January. We are only just beginning to be able to estimate the number of deaths these cuts will cause in the coming months and years, but unless something changes, it will surely amount to millions of human lives lost. A particularly depressing aspect is that these are senseless deaths (not to mention other suffering from disease and poverty), without reasonable or accurate justifications, as Dr. Gawande explicitly delineated in his presentation.
I’m grateful that Atul has provided his remarks for publication here in Inside Medicine. Please read his words and share them.
Senate Roundtable on The Dangerous Consequences of Funding Cuts to U.S. Global Health Programs.
Tuesday, April 1 from 2:30-3:30PM. U.S. Senate Visitors’ Center, Room 200/201.
Testimony of Atul Gawande, MD, MPH:
I was the Assistant Administrator for Global Health at USAID during the last administration. It was the best job in medicine most people haven’t heard of. I led 800 health staff in headquarters working alongside more than 1600 staff in 65-plus countries. With less than half the budget of my Boston hospital system – about $9 per US resident – they saved lives by the millions and contained disease threats everywhere.
Before my departure on January 20, I briefed this committee about several major opportunities ahead for the next few years. Among them were three breakthroughs. The journal Science had just declared one of them the scientific breakthrough of 2024. American scientists had developed a drug called Lenacapavir that could prevent or treat HIV with a single injection that lasted six months and perhaps even a year. Deploying this game-changer in high-risk communities through PEPFAR could finally bring an end to HIV as a devastating public health threat.
Similarly, USAID launched a trial of a four-dose pill that could prevent tuberculosis in exposed individuals and dramatically reduce cases – while three TB vaccines complete testing.
And USAID was just about to scale up a novel, inexpensive package of existing drugs and treatments that was found to reduce severe hemorrhage after childbirth – the leading cause of maternal death – by 60%.
American companies, nonprofits, and scientists played key roles in these breakthroughs, and they were poised to transform global health over the next five to ten years. The next administration had no reason not to pursue these objectives. Congress had already funded them. There was nothing partisan about them at all.
But instead of saving millions of lives, we got surgery with a chainsaw. The new administration not only shuttered this work, they fired the staff of the entire agency, terminated 86% of its programs, and kneecapped the rest – all against Congressional directives. They dismantled the US’s largest civilian force advancing global stability, peace, economic growth, and survival. And they have done it in a way maximized loss of life and mismanagement of taxpayer dollars.
Here are few specific examples of the global health damage:
● Our 50-country network for stronger surveillance to deadly diseases from bird flu to swine fever – gone.
● Our emergency response system that cut response times to global outbreaks from >2 weeks to <48 hours – gone.
● AIDS programs to prevent new cases of HIV in high-risk populations – gone.
● Programs for preventing child and maternal deaths that reached 93 million women and children under 5 in 2023 and added 6 years of life on average – cut 92%.
● Lifesaving tuberculosis programs – cut 56%.
● Lifesaving water and sanitation programs – cut 86%.
● Funding for Gavi, the global vaccine alliance, which was set to vaccinate half a billion children — terminated and, if not restored, will cost 500,000 lives a year and drive higher exposure to measles in the US.
The damage is already devastating. And it is all part of a larger dismantling of America’s world-leading capacity for scientific discovery, health care delivery, and public health that goes well beyond USAID. They are using the same playbook to purge staff and destroy programs in across our entire domestic infrastructure in government, universities, and medical center. And they are inserting political controls on NIH science research, FDA approvals, and CDC guidance.
For the sake of power, they are destroying an enterprise that added more than 30 years to US life expectancy and made America the world leader in medical technology and innovation. We need you in Congress to stop this process. USAID cannot be restored to what it was. But we must salvage what we can of our health, science, and development infrastructure and stop the destruction.
Thank you, Dr. Gawande!
That’s all for now! If you have information about any of the unfolding stories we are following, please email me or find me on Signal at InsideMedicine.88.
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I sign petitions and write to congress people, but I'm 89 years old and not in great health. What else can I do? Tell me please.
Heartbreaking and so wrong.