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For weeks, some of the federal government’s global health gurus have repeatedly warned about the deaths that will come to Marco Rubio and other leaders if they implement the Trump administration’s plan to end almost every US foreign aid around the world.
Still the clearest accounting, the highest official estimates the casualties. One million children are not treated for severe acute malnutrition. A maximum of 166,000 people will die of malaria. New cases of tuberculosis increase by 30%. Over the next decade, another 2 million children will be paralyzed by polio.
Instead of acting on repeated warnings, Peter Marrocco, the top administrative officer, including the Director of Foreign Aid at the State Department, has hampered the efforts of experts to maintain America’s most important programs.
President Donald Trump’s political appointee, along with billionaire Elon Musk’s government efficiency, pushed a plan to dismantle USAID by ignoring and obstructing staff who disrupt lifesaving projects, despite claiming that the government stayed online.
During the exchange outlined in one of the notes, Doge engineers emailed staff and said they were not permitted to confirm the cancelled program. At another point, then-Treasury Secretary of USAID, Joel Bolkart, told agency staff to take a “radical” approach to approving the exemption.
The explosive notes, including summary of email exchanges and top-level meetings within USAID, as well as research from internal agents, were sent by Nicholas Ensic, assistant administrator at Global Health. Propublica also acquired a detailed breakdown of the department-controlled lifesaving programs, as well as the expected impact of reducing them. Enrich was placed on holiday on Sunday.
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Enrich told The New York Times that he released a memo. The contributions of several other officials, as did thousands of other people at the agency after learning that he was on vacation. The notes were distributed to staff and were obtained by Propublica.
The document hampers the administration’s claims to a careful and deliberative review of USAID programming, identifying several key senior policymakers behind the scenes. The record also expresses the clearest concerns of the government, commemorated by senior officials from within the Trump administration.
The State Department, USAID and Elon Musk did not answer any questions about the story. Rubio and Marrocco did not respond to their interview requests.
Since taking office, Rubio, Musk and Marrocco have taken dramatic steps to neutralize USAID, the world’s largest foreign aid provider, by firing employees and suspending operations. The Global Health Bureau was one of the first parts of the agency targeting large layoffs.
Then last week they suddenly cancelled 10,000 foreign aid projects, which account for 90% of USAID’s humanitarian projects and about half of the State Department. Lifesaving programs, which were still operating around the world, were soon forced to close.
Following a series of lawsuits challenging the constitutional authority to leave thousands of employees and freeze almost all foreign aid, Rubio and Marrocco defended their actions by ensuring that the president has the right to cancel the program and conducts a careful review of the government’s foreign aid programs to align with Trump’s Zenda. The administration says it is eradicating waste and fraud, but Musk has publicly vowed to destroy USAID completely.
However, as Propublica reported on Saturday, government officials say the process is actually rough and coincidence, so the program contractors, the main contact for the aid group, were not sure what was cancelled.
Enrich’s memo provides additional evidence that challenges the administration’s claims in court, predicting the disastrous consequences that unfold both in the US and vulnerable people around the world.
One of the documents said that drastic cuts to foreign aid have pledged to rekindle the outbreak of preventable, deadly diseases. Fuel instability in war-torn regions. And puts the United States at risk of an outbreak of an infectious disease. “This will undoubtedly pose preventable deaths, destabilization and threats to large-scale national security.”
Take tuberculosis. It kills more than 1.25 million people a year, already the deadliest infectious disease on the planet. New infections are expected to increase by 30% as a result of termination, and treatment disruptions will make people develop drug resistance and future treatment options much more difficult and expensive, the memo said.
The US Surge, which is projected by US USAID staff, will inevitably lead to more cases by predicting that there will be around 80 additional cases of additional resistant TB each year due to reduced USAID, the memo added. Even dozens of cases will spend millions of taxes on the US. On average, it costs almost $500,000 to treat people with the most drug-resistant disease, the memo notes.
The Enrich Bureau also warned that cutting foreign aid would destabilize the entire world region. In the Democratic Republic of the Congo, with the withdrawal of US aid, health services have collapsed as an ongoing conflict flare, the memo says. They said more than 400 MPOX patients are stuck and more than 1 million people face a serious food and water shortage. Malnutrition, cholera and measles are also expected to increase.
Malaria season is approaching across the Sahel, a transitional zone between Africa’s northern desert and the southern savanna. According to multiple people with first-hand knowledge of the program, the US has already purchased mosquito nets, diagnostic tests and treatments that cannot provide treatment. Cancelled programs there and elsewhere are expected to cause 12-18 million malaria infections next year.
And these infections can be even more deadly. Malaria spread through mosquitoes is particularly fatal for children under the age of 5. The US was paying to help deploy drugs that were very effective in preventing children from getting sick or dying. These programs have been cancelled.
According to documents and interviews, the possibility of spreading deaths and illnesses is nothing new to Rubio and his top aides who ordered the massive termination of almost all foreign aid programs.
USAID staff repeatedly lobbyed to continue running the most important programs, sharing details about patients served in individual programs and the potential harms that could be reduced with political appointees at times on multiple occasions. In response, according to Edrich’s memo, political leadership was “fully blocked” by staff who “completely prevented” Rubio’s promise to continue life-saving assistance.
In a public statement and court application, Rubio and Marrocco say a waiver exemption process is in place to keep the lifesaving program funded online.
But behind the scenes, a small number of employees who remained at USAID struggled to get basic information, including how to file a waivers with Marrocco for approval. And when the organization received the approved exemption, they were unable to resume work as the administration had not yet paid. (The Trump administration has refused to refund nearly $2 billion to foreign aid contractors for work already completed.)
Agent staff had no way of sending payments to the organization because access to the financial system had been cut off.
On February 8th, Global Health staff learned that Rubio is planning to cancel many programs the department has identified as lifesaving. The people at the department sued Volkart and Mark Lloyd, assistant managers of the agency, to maintain those businesses. (Borkert and Lloyd did not answer any questions about this story.)
Lloyd wanted more information. However, that same day, the station staff also received a response from Doge. Doge adviser Jeremy Lewin has heard that Global Health is conducting a supplementary review of the awards scheduled to be terminated by Rubio Secretary and Deputy Assistant Administrator Marrocco, according to one of Redich’s notes. “This is to delay the timely processing of these termination notices and is unacceptable. …The Bureau should not implement its own policy and program review before acting on these termination instructions.” (Lewin did not answer the question in this story.)
Ensic also said he received written instructions to suspend the approval waiver of life-saving humanitarian assistance. This is an order he handed over to other stations where he worked to identify the programs he needed most.
In a subsequent exchange, spelled out in one note that frequently contradictory guidance, Ensic said two political appointees, Tim Mace Berger and Rayken Rapier, shouted at him along with Bokart. (Meisburger and Rapier did not answer any questions about this story.)
At a meeting on February 24, Meisburger and Lloyd told people at the bureau not to plague exemptions from programs including infectious diseases such as Mpox, Polio and Ebola, according to Redich.
The Trump administration said these aid programs saved lives. I canceled them anyway.
Then two days later, the administration suddenly ended about 10,000 programs across the State Department and USAID. The agency staff responsible for maintaining these contracts said they were not consulted prior to the move. Enrich would soon reach out to Volkart and others to warn him that “it will have a significant impact on life-saving activities,” he said in a memo.
Borkert responds, indicating that many of the programs ended incorrectly. “Some of them have approvals that could have been sent by mistake, and we have the ability to withdraw,” Volkert wrote to enrich. “We need to identify what they are.”
Recently, government officials and aid groups told Propovica it appears the administration is trying to reverse its most drastic action to figure out which emergency operations have been cancelled. Staff are told to report information about the termination agreement to the agency leader. It is not clear which programs will be restored.
“It’s an incompetent mess,” one official said.
Propublica plans to continue its results from termination of USAID, the State Department and US foreign aid. We want to hear from you. Contact reporter Brett Murphy and Anna Maria Barry Jester at 408-504-8131 via signal.
