USAID shut down

By Dr. James E. Sulton Jr.

JA International Correspondent

During an appearance on The Joe Rogan Experience podcast in February 2025 Elon Musk said that “the fundamental weakness of Western civilization is empathy.” That same month, Musk posted on X, “We spent the weekend feeding USAID into the woodchipper,” referring to his proudest initiative leading the instantly created Department of Government Efficiency (DOGE). Operating under an executive order freezing all foreign assistance, Musk and his DOGE team locked staff out of networks, cancelled service contracts, and initiated a rapid shutdown of the United States Agency for International Development (USAID).

When the Trump administration froze nearly all foreign assistance through Executive Order 14169 in January 2025, few outside the development community understood how quickly the ground would shift beneath an entire continent. Roughly 83 percent of USAID-funded programs were cancelled or terminated. By July 1, 2025, the agency’s remaining functions were folded into the State Department, ending America’s great humanitarian enterprise after six decades. USAID had channeled roughly 26 percent of all aid flowing into Africa. Its dismantling was not a policy adjustment. It was the removal of a load-bearing wall and one of the most drastic policy moves in the history of international relations. 

Nowhere has the damage been more measurable than in HIV care. Roughly 60 percent of the President’s Executive Program for AIDS Relief (PEPFAR) funding was implemented through USAID. The program supplied antiretroviral therapy for half of all people living with HIV in sub-Saharan Africa and most of the preventive medication used by high-risk populations. In 2025 alone, 2.5 million African users lost access to pre-exposure prophylaxis. Nigeria alone reported an 81 percent decline.

The results that ensued were predictable and cruel: governments underneath great fiscal strain protected patients who were already on treatment. Prevention collapsed altogether. Community monitoring by South Africa’s Treatment Action Campaign found 82 percent of facility managers reporting staffing shortages and 30 percent of surveyed patients were not offered HIV testing when they visited a clinic. One organization dropped from a staff of more than 30 community health workers to four.

The projections are staggering. Modeling published in The Lancet estimates that unmitigated aid reductions combined with discontinued PEPFAR support could produce an additional 4.4 to 10.75 million new HIV infections and 770,000 to 2.93 million HIV-related deaths between 2025 and 2030, with sub-Saharan Africa bearing the disproportionate burden. In June 2026, U.S. officials confirmed a drawdown of remaining PEPFAR support to South Africa – the country with the world’s highest HIV burden – with all funding expected to end by early 2027.

Maternal and child health reveals a parallel story. A study of six vulnerable countries in West and Central Africa – Burkina Faso, Central African Republic, Chad, Mali, Niger, and Nigeria – estimates the cuts could raise maternal deaths by 45 percent among populations in need, roughly 1,000 additional deaths in a single year, with Niger seeing a proportional increase above 90 percent.

Food assistance contracted alongside health. The World Food Program (WFP) experienced a drastic drop in funding in 2025, cutting its budget from $10 billion to $6.4 billion. In Somalia, assistance fell from 2.2 million people to 350,000. In Sudan – where nearly 19.5 million people face acute food insecurity – WFP now reaches 3.5 million people, down from 5 million, against a $646 million funding gap. Humanitarian funding for food sectors fell roughly 39 percent from 2024 levels.

Perhaps the least anticipated consequence was violence. An examination of 870 African subnational regions between March 2024 and November 2025 found  regions historically most dependent on USAID experienced a 12.3 percent increase in total conflict events, a 7.3 percent rise in battles, and a 6.8 percent increase in protests and riots after the shutdown. Those regions showed no divergent conflict trend in the eleven months before the cuts. The aid withdrawal functioned as an economic shock that lowered the opportunity cost of taking up arms.

African governments have not remained passive. Uganda committed an additional $32 million for antiretrovirals. Tanzania disbursed $31.8 million. Kenya directed $134 million to the Global Fund. Ghana lost $154 million annually and President John Mahama responded by repealing a capping law, unlocking roughly $300 million for the National Health Insurance Fund. South Africa earmarked an additional $1.5 billion for health, financed partly through a Value Added Tax increase that fell hardest on the poor.

President Mahama has urged the continent to pursue genuine self-reliance. That ambition is legitimate and perhaps overdue. But there is a difference between planned transition and sudden abandonment. The absence of any adaptive framework – no notice, no handover, no legal safeguards governing donor withdrawal from programs that millions of people depended on – converted a budget decision into a mortality experience. 

The lesson for African policymakers is to protect sovereignty. The lesson for Washington is that credibility, once dismantled, is far more expensive to rebuild than it was to maintain.