This list of terminated USAID awards should break your heart. New study finds cuts will cause 14 million deaths by 2030.
Plus six other stories, including a rundown on the healthcare impacts of the tax cut bill passed by the Senate yesterday.
Today’s installment opens with what may be the first public release of a document circulated on Capitol Hill this spring. Then we’ve got a rundown on President Trump’s so-called “beautiful bill,” followed by five shorter stories I want you to know about. Thanks for supporting Inside Medicine!
State Department document sent to members of Congress reveals specific USAID awards terminated by May. New research finds that USAID saved 92 million lives.
So, here’s a list of USAID awards that had been terminated by the Trump administration under DOGE, as of May, by when most of the damage had been done. This document was sent to members of Congress by State Department staffers. Its authenticity was confirmed by Inside Medicine.
I’m not sure this document has ever been posted elsewhere, so this might be its first public airing, but an April analysis by KFF clearly summarized a similar dataset. The file reveals that 85.6% of active USAID awards (5,341 out of 6,239) had been terminated, with cuts totaling $27.7 billion. In the 247-page section of axed awards, a simple command-f search found the word “malaria” to have appeared on 26 pages (covering around 28 grants, by my count); “HIV” appeared on 78 pages; “nutrition” appeared on 65 pages.
But that’s just the tip of the iceberg. I encourage you to peruse the document. Run your eyes over the list of terminated awards (which begins on page 35) to see the amazing work that our nation supported until very recently—awards that saved or improved the lives of millions upon millions of people. Take contract #72036724CA00001, awarded to Helen Keller International: “The purpose of this activity is to improve the nutrition status of women, adolescents, and children in Nepal’s underserved and marginalized communities.” What kind of person would cut such a program without any real justification? That’s a question I’d like to ask Elon Musk or President Trump.
If the impact of these projects is not clear, a stunning new paper out this week in The Lancet sheds light on exactly how large that impact is. That study concludes that USAID funding saved nearly 92 million lives during the 21 years analyzed, including over 30 million children under age 5. The analysis also projects that if the Trump administration’s cuts to USAID are not reversed or otherwise recovered, 14 million preventable deaths—ones that the US was slated to otherwise save—will occur by 2030. (Note: the statistical confidence interval spans from 8 million to 19 million deaths. Regardless of where in that range the real number ends up falling, all of these figures are horrific.)
Earlier this week, former Presidents George W. Bush and Barack Obama appeared at an unofficial closing ceremony for USAID, an agency dismantled by Elon Musk, DOGE, and President Trump. Bush, whose PEPFAR program to fight HIV/AIDS surprised progressives for its ambitiousness when he unveiled it in his 2003 State of the Union address, told the audience, “You’ve shown the great strength of America through your work, and that is our good heart.”
How far we have fallen.
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Senate passes “One Big Beautiful Bill Act,” cuts US healthcare deeply.
The US Senate passed President Trump’s tax cut bill yesterday (i.e. One Big Beautiful Bill Act). The House will now have to pass this version before it becomes law.
The would-be effects on American healthcare are substantial. The bill’s cuts to Medicaid would leave 11.8 million Americans without health insurance by 2034, including millions of children.
Prior to Tuesday, there had been concern that many rural hospitals would close or have to lay off staff if the bill becomes law. It’s unclear how much a last-minute $50 billion boost to these facilities would mitigate the situation, but it’s seen as not enough to plug the hole created by the cuts elsewhere in the legislation.
Long-term care facilities (i.e., nursing homes) will be dramatically harmed by the bill. According to an American Health Care Association survey of nursing home care providers, over a quarter of facilities might have to close if the bill becomes law. (Up to half believe that, at a minimum, cutting staff will be necessary.) A big chunk of that stems from the reduction in Medicaid recipients—who represent a large fraction of nursing home residents. With fewer payers, nursing homes will not be able to remain in business, leaving residents with no safe place to receive round-the-clock care.
But one last minute change may have, to some degree, kicked the can down the road on the nursing home solvency problem. This is where things get nuanced in terms of the greater public good. The Senate’s passed version of the bill delays the enforcing of a Medicare/Medicaid requirement that facilities have adequate nursing staff. On one hand, the requirement is costly, so delaying it may help nursing homes stay solvent. On the other, this requirement has important intentions: better care for long-term care facility residents by mandating safe ratios of qualified staff to residents. The issue is how such a requirement would be paid for (Note to leadership: not by cutting the pool of Medicaid beneficiaries.) So, while it’s good that nursing homes might not have to close as rapidly in the face of other provisions of the bill as a result of this delayed policy, it remains important to improve care in these facilities. Inadequate staffing in nursing homes is clearly linked to preventable deaths.
Additionally, the final version of the bill that the Senate passed cut funding for SNAP (i.e., food stamps), a program that provides nutrition for around 42 million US residents every month, according to the USDA.
Of course, the bill gives a substantial tax break to the rich, and adds tiny tax cuts for some poorer people—the very ones who rely on many of the slashed programs which provide essential healthcare and food.
Open tabs:
“The Senate’s ‘Big, Beautiful Bill’ Will Create a Disaster for Rural Mothers and Babies. Medicaid cuts could endanger maternity services at more than 140 rural hospitals.” Mother Jones.
“Health Provisions in the 2025 Federal Budget Reconciliation Bill.” KFF.
Five public health/science stories I’m also following.
We need to stay well-rounded in our coverage here. Here are five shorter but important stories I’m following.
A judge has ruled that the arbitrary “Reductions In Force” under RFK Jr. (under Trump, under DOGE) that left 10,000 HHS employees terminated earlier this year were not lawful. The crux of the decision was that “The executive branch does not have the authority to order, organize, or implement wholesale changes to the structure and function of the agencies created by Congress.” See under: impoundment. The ruling requires HHS to update the court on its compliance by July 11. However, Congress is currently considering legal versions of similar cuts in its appropriations package (which is distinct from the tax cuts that the Senate approved yesterday). So, this could all be academic. Still, in the future it would be good to know that sudden, unexplained RIFs affecting federal employees working in agencies under Congressional authority cannot be ordered by random executive branch officials—DOGE or otherwise.
HHS canceled its subscription to Springer Nature journals, a prestigious scientific publisher. (I’d heard the rumor, but hadn’t been able to confirm it.) This means that HHS scientists, including those at the FDA, won’t have access to medical literature that may be important in informing decisions on drug applications, for example. An HHS spokesperson told MedPage Today that the US government does not want to support “junk science.” That’s awkward because some high profile Trump health officials have managed to publish reasonable material in Springer Nature journals in the past—that is, before trading in their credibility for the opportunity to give cover to RFK Jr. as he runs our national vaccine strategy into the ground.
Moderna released Phase 3 data on its flu vaccine in participants ages 50 and up. Their new mRNA vaccine against seasonal influenza was 26.6% more effective than the FDA-licensed flu vaccine it was up against. Technically, we don’t know how good that is, though. For example, if the other vaccine was only 30% effective, a relative efficacy of 26.6% would mean Moderna’s shot was 38% effective—a nice bump, but not a game changer. Of course if the other vaccine was 50% effective, then Moderna’s was 63% effective. We’ll find out more when the full readout is provided. In a related story, RFK Jr.’s HHS canceled a contract with Moderna for the development of an H5N1 influenza vaccine earlier this year. The rapid deployment of a vaccine against H5N1 could help us escape the worst of a bird flu pandemic. Why did RFK Jr. cancel the contract? He just doesn’t like mRNA vaccines, for some reason. Keep in mind that the first Trump administration does indeed get credit for Operation Warp Speed, an effort which led to mRNA vaccines coming to the public well before expected. I continue to find it odd that RFK Jr. has frequently undermined mRNA vaccines, the major achievement of the first Trump administration.
The One Big Beautiful Bill Act does not cover what’s called “discretionary funding”—the mechanism that funds HHS agencies like the CDC. That funding comes from appropriations bills like the one we’ve seen in development this spring (the first draft of which was leaked to the public for the first time right here in Inside Medicine). But all that’s coming soon. At stake will be massive cuts to HHS agencies, including cutting the CDC’s budget in half. An essay in The New York Times entitled “How to Wreck the Nation’s Health, by the Numbers” by Dr. Steven Woolf provides an important summary of the proposed cuts, along with arresting visuals. (Dr. Woolf did a lot of excellent work on excess mortality during the Covid-19 emergency, my area of research interest.) We’ll need to share impactful visuals like these in the coming weeks.
The CDC is being forced to hire Nurse Lyn Redwood, CBS News reported last week. The story coincided with Redwood’s embarrassing presentation (i.e., cited literature that does not exist; cited other literature incorrectly; omitted important literature that contradicted her discredited views on thimerosal in vaccines) to the newly-installed members of the CDC’s Advisory Committee on Immunization Practices. Per CBS, Redwood will work on vaccine safety, despite a long record of misrepresenting data on the topic. In addition, RFK Jr.’s handpicked new ACIP members took to social media after last week’s meeting, posting anti-vaxxer nonsense. (Thanks again, Senator Bill Cassidy, for allowing RFK Jr. to become Secretary of Health and Human Services, thereby letting him pursue his fever dream, pun intended, of dismantling our national vaccine program. This remains your fault, Senator.) Meanwhile, here in my home state of Massachusetts, the town of Newton announced that it will not permit unvaccinated children to return to school this fall. Apparently enforcement had gotten a little loosey-goosey after the pandemic. No more!
That’s all for now. Thanks for reading and supporting science, facts, and the actual American way!
If you have information about any of the unfolding stories we are following, please email me or find me on Signal at InsideMedicine.88.
I am glad that George Bush FINALLY joined the voices of opposition, albeit in a very muted way.
Perhaps we should reframe our arguments regarding the continuation of domestic and foreign safety net programs in a way that will resonate with Republicans and Libertarians.
How about "Support foreign and domestic food and medical aid programs TODAY because dead people can't buy US products or vote TOMORROW"
I downloaded the list but can't bear right now to look at all that has been canceled. Too much... Lots of scary thoughts but a few stand out. BESIDES the harm all this will cause. There is still 3.5 yrs left so look at the damage that can be done in that time on top of this especially with a GOP Congress. Also it will take so long to rebuild from all this both domestic public health/research & global public health. As Dr Fauci recently told some grads he spoke to- it is now in the next generation's hands to deal' with all this & speak truth for science, public health, research, etc. This damage won't be undone in a few months or even a few years. My hope is young people will see the challenges ahead & act on it. Because otherwise it will continue on the downward spiral.