Episode 376: The Humanitarian Aid Landscape One Year After the Dismantling of USAID

For more than six decades, USAID sat at the centre of the global humanitarian and development system. A little over a year ago, USAID became one of the first targets of the Trump administration’s DOGE campaign. Today, the hum and development sector is grappling with profound uncertainty at precisely the moment humanitarian needs are growing, especially with the rise in intrastate conflicts. What has the loss of USAID meant in practice? How are communities responding? And what does the future of international development look like in a world of shrinking aid budgets but rising humanitarian need? 

And joining me to discuss this is Nicholas Enrich. He served as the former top global health official at USAID’s before becoming the acting assistant administrator for Global Health at USAID shortly before Trump’s second presidential inauguration. On March 2 2025 he was placed on administrative leave for exposing the Trump’s administration illegitimate and destructive dismantling of USAID which ended up going viral and his memo has been cited in a Supreme Court case on the legality of USAID’s dissolution. While the public release of his memos were ultimately not enough to save USAID, Enrich was one of the first government officials to publicly blow the whistle on DOGE’s reckless operations and inform other federal agencies of what was to come. Published in April Into the Wood Chipper: A Whistleblower’s Account of How the Trump Administration Shredded USAID.

The International Risk Podcast brings you conversations with global experts, frontline practitioners, and senior decision-makers who are shaping how we understand and respond to international risk. From geopolitical volatility and organised crime, to cybersecurity threats and hybrid warfare, each episode explores the forces transforming our world and what smart leaders must do to navigate them. Whether you’re a board member, policymaker, or risk professional, The International Risk Podcast delivers actionable insights, sharp analysis, and real-world stories that matter.

Dominic Bowen is the host of The International Risk Podcast and Europe’s leading expert on international risk and crisis management. As Head of Strategic Advisory and Partner at one of Europe’s leading risk management consulting firms, Dominic advises CEOs, boards, and senior executives across the continent on how to prepare for uncertainty and act with intent. He has spent decades working in war zones, advising multinational companies, and supporting Europe’s business leaders. 

Transcript

When Doge was coming in, to be honest, I actually was a little bit optimistic about the idea of presenting some ideas of how we could make the agency more effective and more efficient, and had a list that I was looking forward to talking to the Doge team when they got there, but of course I never got that opportunity and they had absolutely no interest in actually making anything more efficient. They came in to destroy. Welcome back to the International Risk Podcast, where we discuss the latest world news and significant events that impact businesses and organisations worldwide.

For more than six decades, USAID has sat at the centre of the global humanitarian and development system. And a little over a year ago, USAID become one of the first targets of the trump administration’s Doge campaign. And today, the humanitarian and development sector is still grappling with a profound uncertainty at precisely the moment that humanitarian needs are growing all around the world, especially in places where there’s intra and interstate conflicts.

So what has the loss of USAID meant in practise? How are communities responding? And what is the future of international development in a world with shrinking aid budgets, but rising humanitarian needs? I’m Dominic Bowen. I’m host of the International Risk Podcast, where we unpack the topics that really matter. And joining me to discuss this Nicholas Enrich.

And he served as the former top global health official at USAID, shortly before Donald Trp’s second presidential inauguration. But on the 2nd of March, 2025, he was placed on administrative leave for exposing the administration’s illegitimate and destructive dismantling of USAID. This ended up going viral, and his memo was being cited in a Supreme Court case about the legality of USAID’s dissolution.

Now, whilst the public release of these memos were ultimately not enough to save USAID, Nicholas was one of the first government officials to publicly blow the whistle on Doge’s reckless operations and inform other federal agencies about what was coming. And in April of this year, he published Into the Woodchipper, a whistleblower’s account of how the trump administration shredded USAID. Nicholas, welcome to the International Risk Podcast.

Thanks so much for having me. Nicholas, whereabouts in the world do we find you today? I am in Washington, DC. Beautiful, a beautiful city.

I understand you’ve now got a new water fountain with blue paint under it. That’s looking impressive. Yeah, I haven’t actually gotten the chance to see it yet, but I have definitely heard something about that as well.

Excellent. You worked under USAID under four different administrations, which is a great run, and you spent decades building a career in global health. USAID, for anyone that doesn’t know, is the US government’s foreign aid organisation, and an extremely respected one.

Honestly, I’ve worked in the humanitarian sector for decades. And when I look back at the people that have impressed me the most over that time, they were often people that worked for USAID. But I wonder if you can take us back to January 2025.

What changed within USAID after President Trump’s second inauguration? That’s right. For about 13 years, I worked at USAID under four administrations. And so I had been through changes in administration before.

Certainly, the change to the second Trump administration was unprecedented. And it started on the first day. It was an executive order that was issued by Trump that said that we needed to freeze all foreign aid funding around the world.

I remember reading this and thinking, this must be a mistake, because it’s fine for a new administration to try to make sure that the programmes within its agencies are aligned with their priorities. No problem there. But the way that it was worded suggested that they would be talking about interrupting clinical trials, shuttering health clinics, cancelling emergency ambulance services, and things that would actually make people suffer and die in the short term.

And I just couldn’t believe that that’s what they intended. And so I was nervous, but looking forward to hearing some supplemental guidance. But unfortunately, the supplemental guidance that came was a stop work order within three or four days of the start of the administration that confirmed my worst fears and forced our partners to freeze their work.

And can you talk to us about, I mean, just even what it must be in the corridors? I’ve had the blessing of walking around the corridors of OFTA, you know, some of your colleagues and brilliant, brilliant people, just so smart and so knowledgeable and people who genuinely care so much about what’s happening around the world. Can you talk to us about what happened? Because you weren’t actually the top global health official at USAID. How did that come about? And what was what was just the even just the culture and the feeling in the office when this was going on? Sure, things fell apart extremely rapidly.

And the office culture, which, as you said, was usually filled with experts and people who were more committed to a mission than anywhere else I’ve ever worked were replaced by silence and fear. And that was when the changes that were implemented by the Department of Government Efficiency and the political appointees that came in from the trump administration over the first week or so. And at the start of the trump administration, I was actually the director for policy programmes and planning for global health, which basically meant that my job was to make sure that we were as efficiently as possible using our global health resources to achieve our aims in global health.

But within one week, my boss and the 60 most senior career officials at the agency were thrown to administrative leave by the DOJ team, basically decapitating our leadership. In that absence, I was without any warning or notice designated as a replacement to lead the Global Health Bureau. So I came into this, you know, with our programmes frozen, our leadership decapitated, there was a ban on communication.

So we couldn’t talk to the partners whose work was frozen. We couldn’t talk to the World Health Organisation or the governments where we worked or even our own sister agencies at the Centre for Disease Control or the State Department. And this was the context in which I was I was forced to kind of lead our effort to try to restart some of our frozen programmes that for which lives hung in the balance.

And what happens when that occurs? I mean, this was just this was such a huge axe to be swung. I mean, and I know from working in the field, you know, I would usually in a big response Syria or Lebanon or Bangladesh, you know, I’d normally meet with USAID officials, you know, literally a couple of times a week, maybe even more at the start of an emergency. So to hear that you couldn’t communicate, I mean, that sort of goes against exactly what you’re what you’re trying trying to do.

But what are people doing? Are they starting to look for new jobs? Or are they trying to communicate with partners? Or is it just people walking around zombies? what happens when the 60 top officials within an organisation disappear overnight? Yeah, I mean, it was a combination of shock and fear and a slowly dawning understanding that this was not business as usual. This was an administration that did not care about the rules or laws or the consequences of their action in terms of the work of our programmes. I do want to caveat that there was one other good thing actually happened the day that I was designated to lead global health.

And that was Secretary of State Rubio issued this waiver to the freeze on foreign assistance funding that allowed us to restart lifesaving programmes as everything else would stay frozen. And so while we were kind of mired in fear and confusion, we at least did see this one window of opportunity to restart some of our programmes that could start saving lives. So my team and I really just dove into that as our number one priority.

Again, this was the context in which we started to meet the DOJ team members and the political appointees to try to get our programmes restarted. And unfortunately, what we found was not willing and interested partners to understand what the needs of our programmes were and why they were important to save lives around the world. Instead, we found conspiracy theorists, we found truly incompetent and unqualified sycophants who really didn’t know or care what the US government did in foreign aid or in global health and could not be convinced to listen to experts and instead continued a pace of trying to destroy the infrastructure upon which millions of lives depended.

And I think that’s a really important point. And you know, we’ve heard the trump administration talk about money being wasted and money being spent in areas that don’t matter to US citizens. And to talk about how big US foreign assistance was in, in 2024, USAID funded about 47% of the global humanitarian appeal.

And that’s clearly staggering. And I think that’s where some people argue, well, should the US be covering 47% of global humanitarian funding? I mean, not only was the US the largest provider of humanitarian assistance, which brings massive amounts of soft power, you know, it certainly is much more significant than the European Unions, ECHO, probably the third largest, the UK government’s different Department of Foreign Assistance and Development. Was there any argent? Was there any weight or justification for reducing, reviewing, slowing down, limiting the spending of an organisation USAID? I mean, should the US be funding 47% of humanitarian responses globally? Yeah, I think that’s a good question.

And there certainly are argents that, you know, USA was not perfect, and we could have become a lot more efficient. That was actually part of my job was to find ways to improve our efficiency. And the reality is that, at least from my perspective, the purpose of foreign assistance is to end its need for existence.

And so we had a lot more work to do to make sure that we were actually effectively transitioning out of foreign assistance. And we were moving towards that in many ways, but we certainly hadn’t fully achieved that. And I think that that’s where there was a lot of room for discussion and changes and the ability to, to, , take a hard look at our programmes and see, , what more can be done.

I want to be clear, that’s not what happened here. While the trumpadministration justified afterwards, the destruction of USAID as saying that it basically wasn’t functioning, and that it was wasteful, and that it was kind of this covert front for the CIA, and all these justifications, the reality was that it was torn down because the world’s richest man decided that he really didn’t the organisation after listening to some right-wing conspiracy podcast, and wanted to show how he could flex his muscle by destroying an agency that, unfortunately, despite having an outsized impact around the world, within the US public, really kind of flew pretty far below the radar. And because of that, probably became a pretty easy target.

So when Doge was coming in, to be honest, I actually was a little bit optimistic about the idea of presenting some ideas of how we could make the agency more effective and more efficient, and had a list that I was looking forward to talking to the Doge team when they got there. But of course, I never got that opportunity, and they had absolutely no interest in actually making anything more efficient. They came in to destroy.

Yes, I’d be keen to hear that, because I think most of us have read some really startling stories about people being fired, then unfired, then refired again, and put on leave, and off leave, and Doge making just some wild mistakes. We’ve also read some of the bios of some of the people that have been employed by Doge to carry this out, and they appeared completely incompetent, not only way too junior, but had no skillset related to the departments that they were going in. Can you tell us a little bit more about that experience? Who were you dealing with? And what were the sort of conversations you were having with the people from Doge? Yeah, I mean, basically, I divide them into two categories, those who were cruel, and those who were buffoons.

And primarily, the Doge category fell into that second category. As you say, these were not people with a lot of experience. These are not people who are qualified for these roles.

These were not people who understood anything about international development, or certainly about global health, and frankly, didn’t really understand how government works. The first time I was able to explain what our programmes did in global health, it became clear of how little they understood. And so I spent about five minutes giving an overview of what we did in infectious diseases, or how we supported maternal and child health, HIV.

And when I was finished, I was kind of met with this stunned silence, as if they had no idea that that was sort of the work that we did. And the person who was responsible for closing down our agency, actually, a guy by the name of Joel Borkert said, Wow, I had no idea you did all these things. When I thought about what USAID did in global health, I assed it was just abortion, which just kind of is one example of how truly clueless these people were.

What made that worse was this was the day after they had placed the vast majority of the experts at USAID onto administrative leave. That was before they had any idea what it was that we did. You, on the 2nd of March 2025, you released a memo warning about the consequences of freezing foreign aid, and you were placed on administrative leave.

If I got this correct, within 30 minutes of releasing that memo, that is impressive bureaucracy, that you release a memo and within 30 minutes be placed on administrative leave. What made you, well, what did you write? What did you write in that memo? And what made you decide to speak out, noting that you were basically sinking at least your immediate career that you’d spent decades building? Yeah. Yeah.

So as I said, when I took over this position, global health position at USAID, at the end of January, I spent the next six weeks doing basically anything I could to restart our lifesaving programmes. But I was basically stopped at every turn. And whether it was the elimination of all of our experts, but kicking them out of the agency, or whether it was destroying our payment system and our ability to get funding to our partners, or whether it was the political appointees continuing to limit to the point of absurdity what the definition of lifesaving that they had was basically prevent us from moving forward with any of our activities, and then ultimately terminating all the contracts we needed to do the work.

Within six weeks, there was no part of me that had any remaining hope that we could restart our programmes. And at that point, I decided that my job was not to continue to try to bang my head against the wall to restart these programmes that were never going to be restarted. My job was to bear witness to the destruction.

And so I spent the next few days, along with my team, developing a series of memos that basically showed everything we had tried to do to implement this waiver to restart lifesaving programmes, how we had been stopped at every turn by Doge and the political appointees, and ultimately, what the impact of the interruptions and cuts to USAID programmes would be in terms of loss of life and damage to US national security and international stability around the world. And so, yeah, I sent those out on March 2nd. I was put on administrative leave that exact same day.

And unfortunately, that was the end of my career as a civil servant. Trevor Burrus And you’re glad you did it. Chris I am.

I have no regrets about sending that information out. I mean, sort of as a last straw, I think this February 25th or 26th, Elon Musk was standing in the White House talking about an Ebola outbreak that was happening at the time and saying that, you know, his Doge team had moved quickly and made some changes. And one of the things that they had accidentally cancelled for a minute was Ebola prevention activities, but they had restarted those right away.

And there was no interruption to Ebola. And at this time, I had been for weeks trying to do anything we could to restart our Ebola programme because there was an Ebola outbreak at the time. And we were stopped from doing even the most basic things providing screening at international airports to make sure that passengers getting on international flights did not have symptoms of Ebola.

We weren’t even allowed to do that or to move personal protective equipment or things that. And so to hear Elon Musk lie about this publicly that there was no interruption to our response to Ebola was just infuriating. The day after he said that, his Doge team actually cancelled the last remaining contracts that we would have needed to do an Ebola response.

And that for me was just the last straw because it wasn’t just that the agency was being destroyed. It was that some of the most influential people in the world were lying about this publicly and deceiving the American public in the world about what was actually happening. And to me, there was nothing more important than exposing those lies and sharing what was actually happening within the agency so that hopefully something could be done to correct it.

It’s quite important. I don’t think most people realise how many Ebola outbreaks they’ve actually been over the last decade or so. I mean, we hear about the current Ebola outbreak, 2,000 people have been affected.

It’s travelled across international borders. It’s in a capital city. These are very significant.

But there’s been multiple Ebola outbreaks plus countless other humanitarian crisis that if organisations and donors USA weren’t mobilised, would have been much, much more significant. And even if you don’t care about other countries, the impact potentially on some of these would be brought back to Europe and North America. I mean, your book, Into the Woodchipper, a whistleblower’s account of how the trump administration shredded USAID, as I said before, was published in April, so a few months ago.

What convinced you to write it? And what do you most want readers to learn after reading your book? Yeah, right. So the title of the book, Into the Woodchipper, comes from a tweet that Elon Musk made about two weeks into the trump administration when he said that he had just spent the weekend feeding USAID into the woodchipper. And I wanted to give readers a sense of what it actually felt as a government employee from inside of that woodchipper as our programmes were being destroyed and the impossible decisions that the civil service were faced to deal with while that was happening.

There’s three main reasons that I wanted to get my story out broadly to the world. The first was to really just set a record straight because I’d seen the administration lying about it and I knew that was going to continue. But, you know, it’s really important to recognise that a lot of the people who made these illegal decisions and destructive choices are currently still sitting at very high levels in U.S. government positions.

And I wanted to name names and I wanted to get that story out there so that ultimately maybe there can be some accountability for that level of destruction. But the second reason was really that I was trying to issue a warning. I mean, USAID until very recently had been a congressionally established agency that functioned very effectively for about 60 years with bipartisan support and had accomplished an absolute tonne on a pretty shoestring budget.

And in a matter of six weeks, it was able to be torn apart by a group of, political operatives who had no idea what the agency even did because nobody was willing to stand up and say this not okay. And so I wanted to share that. And ultimately, kind of final reason I wanted to write this book and share the story was sort of as a call to action because what we’re seeing in the United States right now is a lot of Americans are feeling that our democratic institutions are increasingly at risk.

And we’re struggling, many people are struggling with the question of when is the time to speak up and say this no longer okay, this not normal, and to stand up and speak out. And so I’m hoping that my story will just be an example that normal people make important choices every day, and that someday somebody else’s time might come that they need to speak out. And I hope that it’ll give them the courage to stand up and do so.

I mean, it’s critically important that we have trust in our democratic institutions, the rule of law, trust in our politicians and trust in our bureaucrats. We’ve seen for the last 20 years, a consistent and ongoing decline of democracies around the world. And the US is sadly no different.

And part of that democratic decline, I’ve had some great conversations on the podcast recently about gerrymandering in the USA and unpack that in great detail. So I encourage our listeners to go back and look at that. But I wonder, your book, it talks about a callousness, a dishonesty and ineptitude of trump aides.

And I think even if you’re not interested in foreign aid and what happens around the world, you have to be interested in inflation and the price of fuel and the price of eggs. And we’ve seen that with Trump’s war on Iran, and the repeated day after day after day saying that the conflict is over. It looks it might be over.

We’ve got another 60 days of negotiation, but it looks we’re at the closest to peace in the Middle East for a long time. But again, if you were to talk about the conflict against Iran, callousness, dishonesty, ineptitude seem fair words for that. You could say the same again and again for so many different topics.

Is this something that’s broader than just the attack on USAID? Have you seen this? Have you spoken to other government colleagues who’ve worked in other departments? Is this something that you’ve seen replicated over the last 12 months? Yeah, I think that’s a great point. I think that my book is a good example of how it happens, but we’re seeing it not just at USAID, but across the federal government, whether it’s in the Department of Justice or the Department of Education or in other scientific institutions the National Institutes for Health or the Centres for Disease Control and Prevention, and just the list goes on and on. What we’re seeing is a disdain for a nonpartisan bureaucracy of experts to carry out and administer the policies of the administration.

We’re seeing these agencies be hollowed out of their expertise and replaced by unqualified and often uninterested people who don’t know what those agencies even do. And so, yeah, when I see contradictory policies that don’t really make a lot of sense, not necessarily that I personally don’t agree with, but are just really head scratchers, I wonder, you know, how much of this bad policy and how much of this just what happens when you have gotten rid of all the experts who have the experience and expertise to run a government? And I think that’s what we’re seeing is when you get rid of the expertise of a government, it becomes that much harder to run and you start to see mistakes that you’re unable to fix. And right, so my book is filled with examples of what that looks within USAID where when you’re trying to restart a programme, but the experts have been removed and it’s too late when the political appointees start to understand what the implications of that are and are no longer able to fix it.

And my guess is we’re seeing the same thing. And I’m looking forward to reading additional accounts from other branches of the government because I have no doubt that the same thing is happening, repeating itself. And I’ll take this opportunity, Nicholas, to remind our listeners that those of you who prefer to watch your podcast, the International Whiz Podcast is always available on YouTube.

So please go to YouTube and search for the International Whiz Podcast. And if you enjoy the content, please subscribe, and do consider sharing it with a friend. It really is so important for our success.

Now, Nicholas, not all of our listeners fully understand the impact of USAID and we’ve touched on a little bit of that. But I also wonder when you hear people describe it as foreign aid in the same way that I’ve referred to it as foreign aid on several occasions, what are we missing? What are we not considering when we consider not just global health, but also development, but also global economics and even national security? And this something that I’ve often used when engaging with embassies in the midst of sudden onset humanitarian disasters, that even if you put aside the humanitarian concerns, there is quite often very important national security or economic concerns that is a very, very valid and justifiable and even moral reason as to why countries should be providing humanitarian assistance. Can you talk to us about the broader impacts of what foreign aid and foreign assistance actually does? Yeah, absolutely.

Right. I think you’re exactly right that to the extent that Americans think of foreign aid and the impacts of USAID, they’re , can see this enormous impact. And we have seen that, right? Recent estimates have showed that USAID programmes have resulted in saving 92 million lives over the last 20 years alone.

It’s an incredible impact. But again, it is not a charity. It is an investment in global economic development and American national security that Americans and the rest of the world have benefited from over the last six decades enormously.

And so from a global health perspective, some of the national security is achieved by addressing potential global pandemic threats and infectious diseases before they reach our borders. And the investments that we’ve made in early detection systems so that we can stem threats before they become international epidemics have had enormous impact. And that’s something that we have invested enormously in since the COVID pandemic and when we’re already starting to see the erosion of those investments.

But it goes a lot beyond health. I mean, just the investment in stability that’s based on a foundation of American generosity and goodwill has allowed us to benefit from stable systems and interconnected partnerships around the world that have created a stable world order that Americans and the rest of the world has prospered from enormously over the last several decades. And I think that’s one of the things that I’m worried that we’re giving up.

You don’t have to take my word for it. Secretary Rubio, when he was in the Senate, was one of the biggest advocates for the work of USAID as a tool of soft power and national security. I think he said that you should travel to countries where, and I’m paraphrasing here, where people’s lives have been saved from HIV because of American investment.

And you’ll find that it’s very hard to radicalise the people whose children’s lives have been saved by American dollars. And I found that a very compelling case. And so I kind of wonder why he has since switched course and destroyed the agency that he recognised as such an important tool for stability.

And I think that’s an important point. I mean, whether you Marco Rubio’s politics or not, he’s clearly a very intelligent man and he’s clearly a very effective operator. And I believe he understands the impact of foreign assistance of USAID and that achieving diplomatic efforts is not just a stick.

There’s going to be multiple lines of operation of which humanitarian assistance development programmes are one element of that. Why do you think he got behind this? Yeah, I mean, that’s a great question. all the history of his public statements and his support for funding bills, et cetera, speak to the opposite.

But, you know, I think that to some degree he was put in this position by a very strong push from Elon Musk and Doge to get rid of the agency. He issued this waiver, but I think what he didn’t understand was that he had allowed the degradation of our infrastructure, our operations and our expertise. And the appointees that he had replaced them with were so unknowledgeable about what U.S. did in foreign assistance and international development that I think he was actually just really frustrated and confused that there was no implementation of his waiver for lifesaving assistance because he had torn out the things that were needed to do those.

He sort of lashed out at the career staff at that time and said, well, what’s happened? This must be insubordination or incompetence. If I’ve said you can restart lifesaving programmes, why aren’t you? But he wasn’t looking beneath the surface to see how Doge and the political appointees were actually completely undermining the ability to actually restart any foreign assistance programme. So I think by the time he started paying attention to what was really happening, it was already too late and the damage and destruction had already been done.

And you and I were discussing this a little bit before we started recording, but I’ve read estimates that up to 95 million people could lose access. You and I were discussing this before we started recording, but I’ve read estimates that up to 95 million people could lose access to basic health care, that millions of children will lose access to education, that about 9.4 million additional deaths may occur over the next four or five years due to these cuts. Has there been any taking stock, any visible aspects or assessments or measures done to try and identify how much the impact has been so far as a result of these USAID cuts? Yeah, I think I’ll start by saying that these numbers are almost impossible to wrap your head around the scale of them.

And I do believe that when the dust settles on the trump administration, that the policy decision to eliminate USAID and foreign assistance will be his legacy. I mean, the scale of the destruction is on a nearly unprecedented scale. Conservative estimates show that 750,000 people have already lost their lives in the first year since USAID was eliminated.

Again, it’s just the destruction is massive. Now, I will say that those are estimates. And so far, what we’ve always been able to see is estimates and based on modelling and analysis.

And the reason is that we haven’t actually seen the official data. And part of it is because the State Department, where the small remnants of what is left of foreign assistance has been moved, has been sitting on congressionally required data reporting and has not provided that information publicly. So we just don’t know the extent of the destruction.

And the other piece is that the very contracts and programmes that were working to collect data in countries has been ripped away by the destruction of the agency that have made it that much harder to get accurate data to show the extent of the destruction. So unfortunately, we’re stuck with really, really heart-wrenching anecdotal examples and estimates and modelling. But I do hope that somebody can convince the State Department to start releasing some of the data to show actually happening on a global scale.

And talk to us about how decisions are being made. Now, I’ve responded to humanitarian disasters in Kashmir, in Lebanon, in Sudan, in Somalia, all over the world. And it’s always a matter of prioritisation.

You never have enough money. Even in Yemen, we had $180 million just from USAID. We had several millions of dollars from ECHO, the European Union and from the British and countless other donors.

And we still didn’t have enough because the needs are just so gigantic. So in the humanitarian sector, we’re used to prioritising. And when it comes to public health and global health, it’s actually quite a structured process.

And you know, public health experts and education experts are quite good at prioritising the programmes that are going to have the most impact, as we would say quite crudely, where we’re going to get the most bang for our buck, where we’re going to get the most impact for the money that we can secure from donors. But we’re living in a period of just such immense humanitarian need. We’ve got conflicts in Sudan, Ukraine has huge humanitarian needs.

It’s not just bombing from Russia. I mean, the Russians are deliberately targeting energy infrastructure, hospitals, schools, places of worship. I mean, the humanitarian needs, the farmland that’s been lost in Ukraine, that’s over and above what we’re seeing in Palestine, in Gaza, in the West Bank, in the Democratic Republic of Congo.

I mentioned Lebanon before. I mean, the list goes on and on and on. Now that USAID is missing from this huge, huge need, how are global health experts and humanitarian organisations NRC, Medicine Sans Frontieres, how are they making decisions in the current crisis? Yeah, I mean, difficult.

There are gaps. There’s no question about the fact that there are gaps. I think as we discussed earlier, there is a conversation to be had about transition and for the governments of the countries where USAID used to work to start taking financial responsibility for these programmes.

But that’s not something where you just pull the rug out from under them and expect that to happen overnight. And so there is this kind of desperate scramble for trying to fill the gaps that have been left. And unfortunately, it’s not just USAID that has pulled back.

We’re seeing a similar pattern among many other donor agencies and countries that have at the same time been reducing their donor contributions to foreign assistance. And that’s compounded these gaps and problems. And we’re seeing that on a daily basis, whether it’s the kind of anecdotal reports of reduced HIV testing or the few countries where we have received data where we’re seeing diagnosis of tuberculosis just plummeting, meaning that the disease continues to spread undetected.

And similarly, in some of the infectious disease outbreaks that we’ve seen recently, the Ebola outbreak currently in the Democratic Republic of the Congo, we’re seeing that when the those those gaps continue go on unfulfilled, our ability initially detect and be prepared for potential infectious disease outbreaks is no longer is no longer at the level that it used to be. And the problem with that is that once you start behind the game in terms of trying to respond, you need even more resources than you would have if you had had been funding the community health workers who would be the first ones to say, hey, it looks we’ve got a potential outbreak of a viral hemorrhagic fever here. Let’s get a response here before waiting several months to realize that it is Ebola and it’s actually spread across international borders, for example. So the gaps compound on one another because we’re now always in a delayed response mode, which is the most expensive way deal with a global health, rather than, you know, we’ve we’ve heard the expression that an ounce of prevention is worth a pound of cure, and we’ve gotten rid of prevention because thats it’s the first thing to go with with the cuts.

and I think that was measured best. I think there was a flood in Mozambique probably about 20 years ago, and the government didn’t have the funds to enact preparedness measures. They tried raising a million dollars from foreign donors and couldn’t raise anything. The floods came, but then once the floods came, there was no problem in raising $42 million dollars in response efforts, which really just highlights the absurdity that they couldn’t raise a million dollars to do preparedness efforts, but there was no problems to raise $42 million in response efforts. And I think that that illustrates that point really well.

But I’m wondering, are we seeing any of these gaps filled? Are we seeing new stakeholders or old stakeholders step up fill in the void left by governments? US and European governments that are now prioritising other spending priorities, ye know multilateral institutions, philanthropic organisations, the private sector, maybe local organisations. Are we seeing any of the gaps filled?

Not on on a sufficient scale, I wouldn’t say. But what we are seeing is, and one thing that’s very encouraging is many groups are trying step up thinking about how they can fill that. Because it’s not, I said, this not a an overnight fix. there There is no overnight fix to the kind of disillusionment of the leading provider of foreign assistance around the world. It’s going to take time. But you’re seeing… philanthropic institutions and multilateral organizations around the world starting to think about how they’re going to fit into this kind of new international development landscape. Most encouraging, we’re seeing the governments where where we’ve worked trying to step up and take responsibility for these programs, recognizing that that help isn’t there. But I think we’re also continuing to see countries turn some of our adversaries for support where, you know, ye countries Russia and China that had have a development model that that we had been helping steer countries away from because it could just kind of mires them in continued debt And doesn’t actually solve long-term development objectives. But at this point, governments are turning wherever they can get support to to, again, fill the gaps that that came from the U.S. just turning its back on the world.

And Nicholas, I wonder, you’re a global health expert. When you look around the world, one question we ask all the guests on the Internationalist podcast is, what are the international risks that concern you the most?

Well, the short term is the ones that catch the headlines, which are the infectious diseases, the Ebola outbreak. I mean, I’m not, the Ebola outbreak is is a catastrophe. i don’t think it’s not the kind of disease that’s to spread turn into the next COVID or a global pandemic threat, fortunately. But what we’re seeing in the delayed kind of muddled response of the international community is how far how much ground we’ve lost in terms of pandemic preparedness. Similarly, in the Hantavirus response, these are a couple examples within the last month or so of how much ground we’ve lost in the last year in terms of pandemic preparedness. And that does create, that that that that gives me trouble sleeping at night to know that potentially the next you know respiratory pathogen that might be the risk of a pandemic, we won’t be able to prepare for it and respond to it as quickly. But longer term, I think it’s kind of the next generation of what’s happening due to these cuts. I mean, we’ve lost our global immunization program that provided millions of immunizations to kids for some of the most deadly diseases for for children under five. where seeing HIV rates among babies being born at at relatively high rates in clinics where just a year ago, those rates were near zero. So, you know, to me, from a from from from a global health perspective, i’m I’m worried about what how these cuts will affect the next generation and how much ground will will have lost on the investments of USAID and other international development donors our partners over the last 20 years, how far back are we going to be set on some on on some of these health issues?

Yeah, thanks so much for raising that. And I appreciate your insights on that, Nicholas. And thank you very much for coming on the show today.

Yeah, thanks so much for having me. a Great conversation.

Well, that was a great conversation with Nicholas Enrich. And I really enjoyed hearing his insights on USAID, on the DOGE activities, reduced funding to the humanitarian development programs around the world. And of course, his new book, Into the Wood Chipper, a whistleblower’s account of how the trump administration shredded USAID.

Today’s podcast was produced and coordinated by Anna Kummelstedt. I’m Dominic Bowen, your host. Thanks very much for listening. We will speak again soon. That was great, Nicholas. Thank you very much for your insights.