The Human Cost of DOGE’s War on U.S.A.I.D.

Listen and subscribe: Apple | Spotify | Wherever You ListenSign up for our daily newsletter to get the best of The New Yorker in your inbox.In 1988, Richard Rhodes, a historian and a journalist who wrote a definitive study of the creation of the atomic bomb, published an article in the Journal of the American Medical Association called “Man-made Death: A Neglected Mortality.” Rhodes argued that demographers and public-health officials ought to take greater care to account for deaths caused by war, neglect, privation, and other effects of policy. His emphasis was on deliberate acts—artificially induced famines, for example, and the willful dismantling of public-health aid and infrastructure.Atul Gawande, who was a leading administrator at U.S.A.I.D. until the Trump Administration’s DOGE initiative, led by Elon Musk, set about defunding and destroying the agency, is a surgeon and a longtime New Yorker contributor. In our latest conversation for The New Yorker Radio Hour, Gawande uses Rhodes’s concept to help describe the colossal human cost that Musk and DOGE have exacted on the world. Gawande, backed up by recent academic studies, says that the decimation of U.S.A.I.D. around the globe has been responsible for some seven hundred thousand deaths, and that number will likely ascend into the seven figures. The policy is not only immeasurably cruel, Gawande argues; it is also stupid, badly undermining what remains of American soft power and prestige, from Africa to Latin America. Our conversation has been edited for clarity and length.Atul, Elon Musk claims there’s no evidence at all that DOGE cuts to U.S.A.I.D. led to even a single death. He tweeted—and I’m quoting here—that “no validated medical funding was stopped,” and that “legitimate life saving funding continued.” You’ve replied saying that the reduction in life-saving aid has already led to no fewer than seven hundred thousand deaths. How did you come to that number?The seven-hundred-plus thousand that have been estimated to have died at the end of a year since the U.S.A.I.D. closure comes from a couple of different sources.

One is a Boston University estimate. A separate one comes from an international study published in The Lancet, looking at the impact U.S.A.I.D. had over the past twenty years—saving ninety-two million lives—and projecting, based on the cuts that have occurred, how many deaths have occurred, and they came up with a very similar number. This is what pissed off Elon Musk. Representative Ro Khanna cited the estimate that 4.5 million children, just children, could die by the end of 2030. The precision of the numbers is a question, but it’s clear that it’s, at minimum, tens of thousands in 2025, and very likely hundreds of thousands.This is an enormous number, so I think it would be worth specifying: people where? People dying of what? Maybe if you could put some more specificity on this, then it ceases to be just a gigantic number.Yeah—this is an example of what Richard Rhodes, the historian, called “public man-made death.” A big part of what U.S.A.I.D. did was humanitarian response: disaster relief for tens of millions of people who are fleeing war or in conflict zones or were driven out by floods, and those kinds of things. W.H.O. estimates that, where eighty million people were reached by emergency-health services in 2024, that number in 2025 dropped by more than fifty million people. That included, for example, fourteen million people who were victims of severe, acute malnutrition. 2.5 million of them were children.Like, a peanut bar that gives you your calories for the day, distributed by community health workers, that the U.S. manufactured, but was cut off—that cut the death rate to less than one per cent. That’s just one category. Another one is childbirth. You know, many of these people who are being forced out of their homes are pregnant. They deliver thousands of babies, and die when they have no services. Another example is Ukraine, which was the biggest single beneficiary of aid—and that was energy infrastructure that kept heat going. It was services for three and a half million children and pregnant women displaced from their homes.I could go into the H.I.V. story.

I could go into the tuberculosis story. I could go into the ways that U.S.A.I.D. was insuring that vaccines were going out in the world. We’re not even beginning to see the vaccine-preventable deaths, the H.I.V. deaths, the TB deaths rise. We know these are only going to grow with time.Atul, there’s a great deal of discussion about the number seven hundred thousand and the mortality data itself. Help me on that.One of the complaints is: these are projections. And therefore the projections are fake. When will we actually know what the child-mortality rates are? It’s going to be a while. The U.S. was the provider of some of the best, highest-quality data in the world—out of U.S.A.I.D., which was dismantled. The inspectors general who would be doing audits and investigations to show what systems were broken—they fired the inspector general at U.S.A.I.D. and have intimidated the I.G.s from doing those kinds of investigations. And so the result is, in the best of circumstances, we will have data over the next two to three years.This is not like deaths of war, where there are mass graves. You have a jump in child mortality from three per cent to four per cent. That’s a one-third jump. And yet, when you’re in a community that has a ninety-seven-per-cent survival rate versus a ninety-six-per-cent survival rate, you don’t feel it, and you don’t see it just from people walking around. We’ve been compiling a tracker. I say “we”—I have put together a team, a group of reporters and journalists that have been compiling all of these reports. And, already, they have documented not only the systems that have gone down but twelve hundred different individually identified people who have directly died from the shutdown of foreign aid.Musk’s defenders have responded saying that the United States shouldn’t be responsible for taking care of people around the world. What do you say to that argument?When J.F.K. argued for U.S.A.I.D., he was arguing that assistance abroad, first and foremost, was also assistance to the United States itself. One of the direct benefits to the United States was eradicating polio in the world, eradicating outbreaks.

We were the driver of eradicating smallpox, interestingly, with the Soviet Union as the instigator of the idea. This was rooted in the Marshall Plan: the idea that, instead of pillaging the world around us as other nations were defeated in war or weakened, we would invest—invest in their liberty, invest in their economic capacity, invest in their survival. And the result was thirteen out of the top fifteen trade partners of the United States received assistance from the United States along the way, whether it was Germany, or South Korea, or India, or then places like Mexico and Latin America, and now we see Africa starting to become middle-income along the way.Total foreign aid from the United States was in the sixty-billion-dollar range, got cut by more than sixty per cent, and then what was left has been sort of turned into “Give me your critical minerals or I won’t give you H.I.V. drugs.” This goes hand in hand with an approach that says, “We don’t coöperate in the world, we try to dominate.” U.S.A.I.D. couldn’t be more opposite in its approach.You mentioned J.F.K. Let me mention R.F.K., Jr. I haven’t heard that much about him in this context. What has he been doing with the C.D.C. and other agencies that fall under Health and Human Services, his agency? What’s he had to say about all this?First of all, he’s reached beyond H.H.S. by stepping in to block foreign assistance—with White House backing—for vaccines around the world. But, within the H.H.S., C.D.C. is hollowed out as an organization capable of acting, abroad or at home, in public health. More than a quarter of their staffing has been removed. Their laboratories have been shuttered, significant parts of them. The vaccine-advisory committees that are needed to approve vaccines are not functioning at this point, and it’s going to take a while to recover that. C.D.C. can recover it, because they still have an institution. They still have budgets that can be restored. It will take a while to build the expertise and infrastructure. U.S.A.I.D. is a shell and will be hard to bring back. It will take time for countries to trust that every election does not become a change in the goals in the first place.

It takes years to eradicate polio, years to build their surveillance for pandemics, years to reduce malnutrition in the world. And if we’re divided about that, and that becomes political fodder, then the institutions can’t function. We won’t be able to make a way forward. So, I’d say, the No. 1 thing to restore capacity is getting back to a place where we believe that these kinds of institutions are what we all want.Atul, you can’t read anybody’s mind, but what was Elon Musk’s motivation when it came to cutting U.S.A.I.D. so severely?The approach of DOGE was like the approach he’s taken with companies like Twitter: take over, slash and burn, and, if anything’s broken, we’ll fix it after. That continues, to this day, to be his argument.So it’s the vanity of an efficiency expert.Only he’s destroying in the name of efficiency, and left no efficiency behind at all. He came in believing you could cut two trillion dollars out of government, and it hit the shoals of U.S.A.I.D.—this obscure agency accounting for less than ten dollars per American taxpayer per month—and, within weeks, suddenly it became apparent that there would be catastrophic loss of life, and it made the enterprise incredibly unpopular. He thought this was going to be, you know, a weekend and we’ll move on, and it didn’t turn out to be the case at all.I wonder if you could give a specific example of a program that went down in flames in this effort, and what the effect of its destruction has been, in concrete terms.The TB program, which dealt with a long-term effort to try to reverse what is still the biggest infectious killer in the world—and there are drug-resistant strains that are now evading our current arsenal of TB drugs. That work involved a project that I was part of that brought chest X-rays that were read by an A.I. reader, for countries that didn’t have a radiologist. You would screen, get a molecular test the same day, and be able to be put on treatment and follow-up, so that you stay on your medicines, because you have to stay on your medicines for a year. Those trials, the innovation was stopped. The programs to roll out the innovations that have been created were stopped.