If you don’t typically engage with politics/government, this is the time to do so. If you are American and/or based in the U.S., reaching out to lawmakers, supporting organizations that are mobilizing on this issue, and helping amplify the urgency of this crisis can make a difference.
Why this matters:
- Millions of lives are at stake
- Decades of progress, and prior investment, in global health and wellbeing are at risk
- Government funding multiplies the impact of philanthropy
Where things stand today (February 27, 2025)
The Trump Administration’s foreign aid freeze has taken a catastrophic turn: rather than complying with a court order to restart paused funding, they have chosen to terminate more than 90% of all USAID grants and contracts. This stunningly reckless decision comes just 30 days into a supposed 90-day review of foreign aid. This will cause a devastating loss of life.
Even beyond the immediate deaths, the long-term consequences are dire. Many of these programs rely on supply chains, health worker training, and community trust that have taken years to build, and which have already been harmed by U.S. actions in recent weeks. Further disruptions will actively unravel decades of health infrastructure development in low-income countries. While some funding may theoretically remain available, the reality is grim: the main USAID payment system remains offline and most staff capable of restarting programs have been laid off.
Many people don’t believe these terminations were carried out legally. But NGOs and implementing partners are on the brink of bankruptcy and insolvency because the government has not paid them for work completed months ago and is withholding funding for ongoing work (including not transferring funds and not giving access to drawdowns of lines of credit, as is typical for some awards).
We are facing a sweeping and permanent shutdown of many of the most cost-effective global health and development programs in existence that save millions of lives every year.
- The waivers never worked. Some waivers were processed, but many groups were still waiting on updates as of a few hours ago. Most of the staff at USAID who could authorize the programs to restart have been laid off, and most groups are still awaiting payment.
- Programs that received waivers are being cut now. Even programs that were granted emergency waivers to resume partial functions, such as those under PEPFAR (the President’s Emergency Plan for AIDS Relief), are being cut.
For EAs, this should raise serious alarm bells. We often focus on identifying the highest-impact, most cost-effective ways to save and improve lives. USAID supports critical initiatives in malaria prevention, vitamin A supplementation, HIV/AIDS treatment, maternal and child health, and more. These programs are among some of the most rigorously evaluated and proven solutions in global health. The elimination of these programs will result in enormous, quantifiable harm, with millions of lives at risk.
Some of the few lifesaving programs that were terminated are:
- Work in Lesotho, Tanzania, and Eswatini to support more than 350,000 people on HIV treatment, including nearly 10,000 children and more than 10,000 women who are pregnant and HIV+ (previously covered under waiver, now terminated)
- The vast majority (likely all) of malaria contracts, including for essential commodities that would have protected 53 million people— nets, diagnostics, treatment, and seasonal malaria chemoprevention (to protect children before the rainy season) were cancelled.
- Contracts with US factories that produce a vital treatment for the most malnourished children in the world.
- Almost all of the Global Health Supply Chain project, which helps deliver billions in lifesaving medical supplies to national governments
- In Nigeria, a nutrition program that supported 77 health facilities across 3 states, putting 60,000 children under 5 at immediate risk of death from preventable causes.
- In Nigeria, training for 10,000 health workers who were set to provide nutrition services to more than 5.6 million children and 1.7 million women
Why this matters for the future of global health & wellbeing
USAID was not perfect by any means, but it has always been an essential partner for improving evidence and cost-effectiveness of foreign aid. This Administration is not taking good faith efforts to improve the effectiveness and accountability of USAID (as shared by Dean Karlan, USAID's first Chief Economist, in an interview with NPR about why he resigned.) USAID should be reformed, not destroyed.
USAID is a vital and irreplaceable player in the global aid ecosystem and provided critical infrastructure that made all other programming work more effectively.
- Science & Building the Evidence Base. Many of the interventions we recognize as cost-effective - like vitamin A supplementation, oral rehydration therapy, and community-based treatment for malnutrition - were developed, tested, refined, and scaled up globally with USAID support.
- Surveys & Reliable Data. The Demographic and Health Surveys (DHS) program is the gold standard of global health surveys. The DHS is primarily funded by USAID and as of today, the data repositories are down. Surveys have been conducted in 90 countries since 1984 and provide nationally representative data to track key health trends, including maternal and child health, HIV/AIDS and malaria. DHS data are increasingly used for scientific research. In 2021 and 2022, more than 1,000 articles included “Demographic and Health Surveys” in the title or abstract - the actual utilization for research is likely much higher.
- Early Warning Systems & Coordination. USAID doesn’t just fund direct interventions - it also supports critical infrastructure for global health and crisis response, like the Famine Early Warning Systems Network (FEWS NET) which was created in 1985 after more than 1 million people died in Horn of Africa famine. FEWS NET used to provide data to predict food shortages and prevent famine before it begins. But it’s been offline for weeks. Losing early warning systems like FEWS NET is a devastating blow.
Your action and engagement is needed NOW
This is a moment where political advocacy is not just an adjacent concern—it is a fundamental necessity. If we care about maximizing impact, we cannot afford to ignore the role of government in shaping the global health landscape. Even the most cost-effective interventions cannot function without political will and funding.
A few actions I recommend:
- Contact Congressional Representatives
- The good news is that members of Congress from both parties are alarmed. But concern is not enough. They must act. You can find tools for contacting members of Congress on websites like RESULTS (disclaimer, I work there), Oxfam US, and 5 Calls.
- Stay Informed and Mobilize
- Groups are working to keep the public informed of recent actions - and harm to global communities through initiatives like USAID Stop Work. You can also get connected to advocacy teams in your state through them.
- I've found Devex and the New York Times to have the most up to date reporting following this crisis and the Center for Global Development is doing timely analysis as well.
- Support organizations working to mitigate harm
- Advocacy groups: Definitely support with your time and voice. I think there could be a strong argument to re-aligning some financial donations to advocacy, but I'm not sure. The US government spent billions on global health last year. Even a slightly higher chance of reinstating programs or influencing priorities toward global health could have an outsized impact and affect hundreds of millions of dollars of funding. I would love to hear thoughts in the comments.
- Implementing groups: There was a forum post recently about bridge funds which could be good to donate to - but your voice as an American/person living in the US can make a HUGE difference. Many smaller NGOs will not be able to work as effectively without the infrastructure USAID provides globally.
While many EAs tend to focus on private philanthropy, this crisis highlights why government action is indispensable. The global health community is rallying to push back against these terminations. The effective altruism community should join them. Lives are at stake, and the cost of inaction is simply too high.
You write: "While many EAs tend to focus on private philanthropy, this crisis highlights why government action is indispensable."
I think this is totally right. Over the last few days, I think that EAs have over-focussed on "how can we donate directly to the programmes that are being cut", rather than "how can we influence governments, now and in the future, to maximise the amount of aid that goes to effective programmes". It's good that you are thinking politically about this. The leverage from influencing government policy is so high. The lessons of the last few days/weeks should be "more EAs need to think and act politically about global health and development, as that is where the real leverage is", rather than "how can we directly make up the shortfall on the ground". (Though of course I understand the very admirable instinct to do the latter...)
I think EA has been taken in too far by "mistake theory", with the idea that surely everyone values saving lives, they just disagree with each other on how to do it, and if we just explain that PEPFAR saves lives to the right people, they'll change their minds.
But like... look at the ridiculously hostile replies to this tweet by Scott Alexander. There is an influential section of the Right that is ideologically against any tax money going to help save non-american lives, and this section appears to be currently in charge of the US government. These people cannot be reasoned out of their positions: instead the only path is to rip them away from power and influence. These anti-human policies must be hung over the head of the Republican party, and they must bleed politically for them: so that future politicians are warned away from such cruelty.
What section do you put Marco Rubio in?
Not sure hostile tweets are compelling evidence here. Social media participation seems very self-selected. Generally I think hostile tweets represent tails of a bell curve. (Also, most of the replies I'm reading don't seem overly hostile.)
Search for "Life Effects" in Scott's survey results. Many readers say they donate more to charity as a result of his blog. His reasonable approach appears to work.
Even if we grant that some people are unpersuadable -- If your goal is for Republican poll numbers to go down as a result of the USAID situation, the best advocacy strategy isn't obvious. For all we know, fire-and-brimstone rhetoric will polarize more people against foreign aid.
Vegans have taken a super-aggressive approach to advocacy for years. My sense is that it works on about 5% of the population, and turns off the remaining 95%.
Progressive activists only make up 8% of the population in the US (they're just very vocal): https://hiddentribes.us/
"You're anti-human because you bought yourself a birthday cake instead of donating to malaria nets!" Even EAs don't use this kind of language with each other. If it doesn't work for us, why would we expect it to work on the general population?
The side that defied a court order to eliminate 90% of USAID programs this week including all the lifesaving programs described above, with the name Marco Rubio referenced as being the decision-making authority in the termination letters.
I'm not sure the number of statements he's made in favour of some of these programs being lifesaving before termination letters were sent out in his name is a mitigating factor. And if he's not actually making the decisions it's a moot point: appealing to Rubio's better nature doesn't seem to be a way forward.
I'm inclined to agree that EAs should think more politically in general.
But the value of specific actions depends on both scale/leverage and the probability of success.
Influencing governments in the short-term has a low probability of success, unless you're already in a position of power or it's an issue that is relatively uncontroversial (e.g. with limited trade-offs).
Because of the scale of government spending, it could still be worth trying - but the main value might be in learning lessons on how to get better at influencing in the future, rather than having any immediate impact.
From the perspective of the long term, helping humans to improve how they govern themselves, might be the necessary condition for any other causes. Without it, even miracle scientific breakthrough will not produce positive outcomes.
Notably, we have zero sway in the current administration. Arguably, most Republicans have zero sway too. Even Marco Rubio is acting like someone else, apparently to avoid being fired. I'm reminded of Prof. Gerdes, a conservative YouTuber whom I follow simply because he ends every video by saying "thank you for being the kind of person who cares about Ukraine" - which is just not something a 2025 Republican would say. Indeed, he eventually mentioned that he "just couldn't" vote for Trump a second time. I wish I could be politically powerful, but I don't even have a single EA friend. So, political donations don't seem in the cards this year.
I've got really mixed feelings here and I don't know which way to swing. I'm still extremely uncertain about how much we can influence aid policy especially amidst the current messy global political situation.
Sure leverage can be high, but the question is how on earth do we get that leverage? What do you suggest?
I would love to see some great posts on the forum about how we counterfactually could have spent our money or time to prevent this current mess? That might convince me that future work could be valuable too.
To state the obvious Politics is super hard to influence for many reasons including
1) huge money and effort already poured into influencing politics from many angles, so achieving acting in that environment is really difficult.
2) so much unpredictability and change over time.
CE literally started an org which was trying to do something like this, which soon shut down because they didn't feel it was working
https://forum.effectivealtruism.org/posts/emBSDADvCnSwtL2kS/center-for-effective-aid-policy-has-shut-down
I think it's easy to say that leverage is "high" for political action but there still needs to be a meaningful pathway to make that happen. Right now in the wake of trump, AID policy might be a harder needle to shift than ever before. A recently elected left wing government in the UK even just slashed aid by 40 percent - wild stuff.
There could even be a counter argument that in a world where governments are backing away from international aid and are harder to leverage, increasing EA donations and covering gaps could be more important than a few years ago.
I know EA aligned people put a lot of successful effort into helping USAID funding be more evidence based, which bore great fruits for a while but now it's unfortunately in the dust at least for now
I'm all for political leverage and putting funding into it, but we need concrete fundable ideas different from those we have tried which didn't work already.
Also Making up the shortfall on the ground is a great thing to do, and like your said in no way mutually exclusive from political work.
Appreciate this thoughtful comment Nick! I'm also unsure where I fall on how EAs should respond/ where the balance between funding policy advocacy and cost-effective interventions on the ground should be. I think within the advocacy piece - my argument would be that EAs should diversify influence strategies and the types of organizations they fund in order to build power from multiple angles. And even to build the evidence base needed for these kind of calculations, because I think everyone is kind of shooting blind. Influencing aid policy is difficult but it's possible with the right strategy…which I think could be more diversified than it is now.
EAs have so much experience evaluating programs and identifying what to move forward, so I think a big challenge for this community will be figuring out how to move forward. I think increased investment in grassroots advocacy strategies could be most useful in the short term, especially in a culture currently leaning anti-intellectual and anti-science.
Thanks Dorothy those are good points.
I'm a huge fan of grassroots organising although its so hard to quantify the benefits of I'm not sure it falls in the realm of what effective altruism can easily get behind. Also grassroots organisation shouldn't need very much money - I've been involved in the past and we didn't need much!
I'm only a fan of leveraging existing orgs if they can really show they are achieving wat they say they are. How do we know current advocates are effective? I can't see a reason reason for me why EA orgs shouldn't be able to start up and work on this over time - I would take a few EA orgs failing at advocacy as some signal that it might not be a super cost effective approach.
I'm skeptical of the idea that there are magical orgs out there doing things that new orgs couldn't replicate at all. Could you suggest some existing orgs that you think are very good that EA could support?
EA does support some too. One example that EA does support with stacks of cash in this space is the Center for Global Development. I've had one terrible interaction with them that lowered my confidence in whether they really are a good faith org and also their general competency, but that doesn't mean they aren't doing impactful stuff.
Great points Nick. Can I message you/are you open to moving this offline? I want to keep the conversation going and have a lot of thoughts but some I'm not comfortable sharing publicly yet (not 100% convinced of my position) and I need to be sensitive given my job and relationships with other orgs in the space.