The Trump administration shutdown of the US Agency for International Development (USAID) has already had a severe impact across Africa and threatens a humanitarian catastrophe. The agency’s $44 billion budget is less than 1 percent of the overall $6.75 trillion US federal budget. But even this pittance accounts for a substantial portion of famine relief and disease treatment and prevention in the world’s second most populous continent.

USAID’s stop-work order has immediately halted critical HIV research and closed many treatment clinics. Uganda and Nigeria, among the countries hit hardest by HIV, are sending healthcare workers home and have warned of medication shortages which suppress HIV positive people’s viral load and prevent transmission.

A temporary court order supposedly blocked the White House from immediately placing staffers on paid leave and repatriating the vast majority of USAID employees who are posted abroad. Should Trump and Musk have their way in this wrecking operation, the agency, with more than 10,000 workers worldwide, will shrink to fewer than 300 staff. Only 12 staff would remain in the African bureau and eight in the Asia.    

Despite assurances from Secretary of State Marco Rubio that “life-saving” aid would continue, the abrupt cessation of USAID’s work has already resulted in food aid being stranded in warehouses. When the USAID inspector general reported that food was rotting rather than being delivered to hungry people, Trump simply fired him.

Sub-Saharan Africa, a region that has long depended on USAID for crucial health interventions and humanitarian relief, is set to bear the brunt of these drastic cuts. A region of nearly 50 countries and 1.24 billion people, sub-Saharan Africa is home to some of the world’s most devastating health crises, with HIV/AIDS, malaria, and tuberculosis (TB) continuing to claim millions of lives annually. The average monthly salary translates to under $800. According to the World Bank, 85 percent of Africans live on less than $5.50 per day.

As of 2022, one in every five people in Africa, 264 million people, faced hunger, the worst rate for any region globally. A quarter of the population lacks access to reliable water sources. Ongoing conflicts, droughts, surging food prices, social inequality, and lack of infrastructure are all contributing factors. In sub-Saharan Africa, 40 percent of children under five are stunted due to chronic malnutrition. In 2023, Oxfam reported that over 20 million more people were pushed into severe hunger across the continent, equivalent of the entire population of Botswana, Namibia and Zimbabwe combined.

In 2024, USAID provided approximately $6.6 billion in humanitarian assistance to sub-Saharan Africa, with a substantial portion (73 percent) allocated to health and food security programs. USAID, in collaboration with the US Department of Agriculture, deployed $1 billion in funding for emergency food assistance worldwide, including sub-Saharan Africa.

USAID has been one of the largest contributors to food aid programs in Africa. With its withdrawal, millions face starvation, particularly in conflict-ridden regions such as Sudan and Somalia. “Without USAID’s assistance, famine conditions will become a reality in multiple African nations,” warns Chris Newton, a food security expert at the International Crisis Group.

The role of USAID for American imperialism

Reading the headlines in the bourgeois press and listening to Trump’s vindictive declaration that the agency is “run by a bunch of radical lunatics and we’re getting them out” might give the impression that this is one more attack on social spending by this megalomaniac. This would ignore the history of USAID and its immense importance as a weapon of US imperialism from its foundation in 1961, at the height of the Cold War, to the present. 

From the time that the United States emerged as the dominant imperialist power, on the ashes of World War II, the ruling class has used foreign aid—so-called “soft power”—as a key adjunct of maintaining its world hegemony. The Marshall Plan (1948-1952) was not envisioned by the United States as an act of generosity to rebuild Europe out of the ashes of the war, but as a strategic move to maintain US economic dominance after the war. The post-war reconstruction of Europe laid the foundation for US global dominance by ensuring European capitalist economies were integrated into an American-led global system, and blocking the threat of social revolution in countries like Italy, France and Germany, with the collaboration of the Stalinist parties.

The objectives established by the Marshall Plan were eventually institutionalized in USAID as a tool for global hegemony. President John F. Kennedy’s administration remarked at the time of USAID’s foundation in 1961, “Those who make peaceful revolution impossible will make violent revolution inevitable.” A thoughtful representative of his class, Kennedy never wavered in defense of US imperialism. Whatever the claims he made to the humanitarian prerogatives of USAID, it was an instrument for imposing pro-corporate economic policies, funding pro-US political movements and counterinsurgency efforts, and undermined socialist and nationalist movements across the developing world.

It would be useful to briefly sample the thorough account made by William Blum, an American journalist and a sharp critic of US foreign policy, in his book Killing Hope, on the crimes and murders committed in the name of US imperialism by USAID, directly and indirectly: 

• In Guatemala, from 1962 to the 1980s, USAID’s Office of Public Safety (OPS) trained more than 30,000 Guatemalan police, many who were engaged in counterinsurgency operations against leftist groups. Tens of thousands of civilian deaths have been documented. Between 1970 and 71, more than 7,000 people were “disappeared” or killed. 
• The Phoenix Program (1968-1971) in Vietnam was a USAID-backed operation aimed at eliminating the National Liberation Front’s political infrastructure through mass arrests, torture and extrajudicial killings. CIA official William Colby, who directed the operations, is on record that 20,587 alleged Viet Cong soldiers were killed during this operation.
• In the mid-1970s in Zaire (now Democratic Republic of the Congo), USAID was involved in providing dictator Mobutu Sese Seko military aid to suppress rebel movements over concerns for American mining interests while enriching the would-be dictator. The CIA funneled money through USAID-backed programs ensuring continued US influence. The country was home to one of the largest CIA stations in Africa in pursuit of its Cold War operations in containing Soviet influence while securing resources for US mining interests.
• From 1980 to 1994, USAID contributed to the massive military expansion in El Salvador, backing the ruling military junta. The aid provided through USAID went to promote counterinsurgency efforts propping up the military government who were responsible for death squad activities and mass civilian killings. In the same period in Nicaragua, the USAID-funded Contra war resulted in tens of thousands of deaths.

USAID’s numerous operations throughout the globe across the decades involved counterinsurgency and regime change operations in Latin America, support for African dictators and extraction of resources in the interest of American corporations, implementing economic liberalization policies after the collapse of the Soviet Union and ensuring US corporate access, as well as funding of opposition movements in the Ukraine and Eastern Europe, and the restructuring of the Middle East in the aftermath of the Iraq wars. For the past three years, the largest recipient of USAID funding has been Ukraine, where the agency supports the US-NATO war against Russia, the central foreign policy objective of the Biden administration.

Donald Trump is not targeting USAID because of this bloody record. On the contrary, as his language about “radical lunatics” suggests, he scorns the practitioners of “soft power” only because he believes that military force alone—plus direct bribery of foreign governments and corporations—are the necessary instruments of his foreign policy. Moreover, he regards the most impoverished countries, where much of USAID’s activities take place, as irrelevant, “shithole” countries, as he once described them, whose people should be allowed to starve, sicken and die without the wealthy countries lifting a finger to prevent catastrophe.

Globally, the COVID pandemic has claimed 30 million lives in the last five years. As of 2023, 733 million people, or one in 11 are facing hunger, especially on the continent of Africa. While the world produces enough food to feed everyone, estimates place nearly 3 billion who cannot afford a healthy diet. There are at least 9 million hunger-related deaths caused each year, most involving children under five. And the recent genocide in Gaza is but a case study for the plight of the working class. In other words, the maladies of Africa and every other region of the world are a byproduct of capitalist rule in its current terminal stage. 

The attack on USAID thus signifies the exhaustion of democratic bourgeois rule and the open turn by the ruling elite to the most barbaric methods to assure its political and economic dominance over the globe. The most immediate consequences of this policy shift will be felt in the poorest regions, particularly in Africa.

A catastrophe for those with HIV/AIDS

Approximately 25.6 million people in sub-Saharan Africa live with HIV, making up more than two-thirds of the global total. Despite major progress, the epidemic remains severe, particularly among women and young girls, who are three times more likely to contract HIV than their male counterparts. USAID has been instrumental in providing access to antiretroviral therapy (ART), education programs on prevention, and support for those affected by the disease. According to Dr. Kenneth Ngure, president-elect of the International AIDS Society, “The withdrawal of USAID funding means that the fragile progress we’ve made in preventing new infections will be reversed, and millions of people may be left without lifesaving treatment.” 

The consequences of the US aid cutoff are far-reaching and potentially catastrophic. Over 2 million Nigerians rely on USAID-supported clinics for antiretroviral therapy. Many of these clinics have already closed, leaving patients at risk of viral rebound and increased transmission rates. “People will go untreated, leading to more infections, and ultimately, a worsening of the epidemic,” warns Dr. Rachel Baggaley, an HIV specialist and former team-lead for the World Health Organization’s HIV programs. 

The cessation of the US support for these global HIV/AIDS programs, in particular the President’s Emergency Plan for AIDS Relief (PEPFAR), would potentially see the number of HIV infections increase six-fold by 2029. This would also mean a 10-fold jump in AIDS-related deaths (6.3 million) and an additional 3.4 million orphaned children, according to UNAIDS Executive Director Winnie Byanyima. To appreciate the enormity of this figure, it took nearly 30 years to see cases decline 60 percent to a low of 1.3 million new cases in 2023. 

Malaria and tuberculosis

In 2023, there were an estimated 241 million cases of malaria worldwide, with close to 600,000 deaths. Over 90 percent of malaria cases occurred in Africa. The disease remains one of the leading causes of child mortality, claiming the lives of around 450,000 children under the age of five each year. USAID has played a vital role in malaria prevention through its distribution of insecticide-treated bed nets, indoor spraying programs, and the rollout of the first-ever RTS,S malaria vaccine. More than 6.6 million African children were expected to receive it by 2025. Dr. Salim Abdool Karim, an award-winning epidemiologist, warns, “Ending USAID’s malaria programs could lead to a resurgence of infections and set back our fight against this disease by decades.”

The halting of USAID’s Malaria Vaccine Development Program (MVDP) means the progress toward second-generation malaria vaccines has stalled, potentially reversing years of progress. “We were on the brink of a breakthrough,” says Professor Kelly Chibale from the University of Cape Town. “Now, the future of these promising vaccines is uncertain.”

Tuberculosis remains a significant public health threat, with sub-Saharan Africa accounting for nearly a quarter of the world’s cases. In countries such as South Africa, Nigeria, and Kenya, the burden of TB is compounded by high HIV co-infection rates, which complicate treatment and increase mortality. USAID has been a key partner in developing new TB treatments and ensuring medication access for patients. “Without continued support from USAID, we risk a dramatic increase in drug-resistant TB cases, which are much harder and more expensive to treat,” states Dr. Sharon Hillier, a professor of reproductive infectious diseases at the University of Pittsburgh. 

TB treatment requires sustained medication over months. With funding cuts, diminishing stockpiles will soon run out, leading to a resurgence of drug-resistant TB. “Interruptions in TB treatment will inevitably lead to more cases of multidrug-resistant TB, which is harder and costlier to treat,” says Dr. Timothy Mastro, an epidemiologist at the University of North Carolina at Chapel Hill. 

The impact of USAID’s dismantling extends beyond direct aid and healthcare services; it has also brought critical medical research to a grinding halt. One immediate consequence has been the suspension of the malaria vaccine research program. Thousands of people in HIV prevention trials have suddenly lost access to treatment irrespective of the ethical concerns raised by abandoning these trial participants. Not only is South Africa’s HIV drug production initiative placed at risk, health experts fear the spread of drug-resistant HIV strains. 

For instance, the BRILLIANT Consortium HIV Vaccine Trials, a consortium of researchers across eight African nations was established to advance HIV vaccine research by designing and implementing early-stage clinical trials. In 2023, the consortium received a grant for more than $45 million from USAID for their initiatives. However, these important projects have now been placed on hold. “This setback could mean years of lost research that we may never recover from,” said Dr. Glenda Gray, chief scientific officer at the South African Medical Research Council. (Science, 2025)

Research on novel TB treatments, particularly for children, has been abandoned, leaving thousands of patients without innovative, life-saving care. “Cutting this research mid-stream is ethically and scientifically indefensible,” states Dr. Leila Mansoor from the Centre for the AIDS Programme of Research in South Africa.

According to the New York Times, more than 30 studies have been suspended that included trials in malaria treatment for children in Mozambique, treatment of cholera in Bangladesh, cervical cancer screening in Malawi, TB treatments for children and teenagers in Peru and South Africa, nutritional support for Ethiopian children, and mRNA vaccine technology for HIV in South Africa, to name a few.

Conclusion

The effective end of the fig leaf of US foreign humanitarian aid is not merely the work of Trump and Musk, the billionaire sadists who regard feeding the starving in Africa as a waste of money, just as they resent all social spending within the United States. There is a historical process involved, symbolized by Trump’s selection of Robert F Kennedy Jr. to head the Department of Health and Human Services.

President John F. Kennedy established USAID (along with the Peace Corps and similar efforts) to provide a democratic and humanitarian cover for the defense of imperialist interests around the world. Sixty years later, his nephew is a high-level aide to a president who is dismantling all such pretenses of social reform, both at home and abroad, because American imperialism is bankrupt and can no longer afford them. The ruling elite will rely on brutal violence to defend its interests against the working class, in both foreign and domestic spheres.

And the inaction on the part of the Democrats only largely confirms they know well that the reformist charade is over. They are far more afraid of the mounting class antagonisms within the United States than of anything Trump may do. 

There is no doubt that the shutdown of the very limited aid provided by USAID will have devastating consequences for sub-Saharan Africa and other regions of the world reliant on the organization. The loss of funding will not only reverse decades of progress in fighting infectious diseases but will also leave millions without access to critical healthcare, food, and clean water. Without immediate intervention or alternative sources of support, the region faces an impending crisis that could claim countless lives. “The long-term effects of this decision are difficult to quantify, but they will undoubtedly be devastating,” concludes Dr. Hillier. “This is not just a funding issue; it’s a matter of life and death for millions of people.” 

But this tragedy cannot be overcome through appeals to American imperialism and the Democratic Party to somehow reverse Trump’s actions. If mankind stands on the brink of disaster, it is because of the world capitalist system, and any struggle against hunger, poverty, disease, climate disaster and war must begin by recognizing this.

The means to eradicate these social evils exist in abundance. The goal of providing a decent life for all human beings is achievable and sustainable. But this requires a new, socialist and internationalist perspective for the working class, to put an end to production for private profit and the nation-state system dominated by a handful of imperialist powers. The struggle of humanity against age-old evils, so apparent in Africa but lurking just beneath the surface even in the wealthiest countries, can only go forward through the initiative of the working class, the only truly international class, in a revolutionary struggle against the profit system.