AILSA CHANG, HOST:
At the request of the Trump administration, the Republicans who control both chambers of Congress are currently attempting to take back government funding that Congress has previously authorized. This is known as a rescission package. The money being clawed back is crucial to NPR. It would eliminate the next two years of federal funding for the Corporation for Public Broadcasting, as you will hear more about elsewhere in the show today.
But the majority of the money in this rescission package - almost $8 billion - would be permanently cut from foreign aid and global health programs after many of these programs were already paused or canceled earlier this year. As the House prepared to vote on this measure, we reached out to Dr. Atul Gawande, previously the assistant administrator of USAID. Welcome.
ATUL GAWANDE: Thank you for having me.
CHANG: So can you just first help us understand what kinds of public health programs around the world this money was set aside for?
GAWANDE: Well, this is money that comes on top of six months of decimation of U.S. foreign assistance capacity - basically, our non-military capacity to do work abroad. We've had 86% of programs in USAID's budget terminated. Half of the funding dollars remained. The agency has been shut down. A handful of staff have been shifted to the State Department. And then this comes on top of that, as further cuts...
CHANG: Right...
GAWANDE: ...That are further made.
CHANG: And is there one particular program that you are the most concerned about here?
GAWANDE: If I were to put my fingers on anything here, I would point to, as an example, our outbreak response programs - whether it's bird flu, Ebola. Those have been largely slashed - not operational. And then this takes what's left and kneecaps it further. But it's only one of many things that these kinds of assistance efforts help us do beyond sending military.
CHANG: So if the U.S. ends up never resuming this funding, what does that mean for countries already struggling with the impacts of funding freezes?
GAWANDE: Let me try to put some context on this. In the last 20 years, recent estimates were made in a rigorous way that demonstrated that the totality of USAID work saved 92 million lives.
CHANG: Ninety two million lives, perhaps, have been saved by these programs. On the flip side of that coin, how many lives do you think could be lost because of these cuts? Do we have any sense, any estimate?
GAWANDE: Well, we know that there are already more than 300,000 lives lost from the existing cuts so far this year, under current estimates. And you add further cuts, all I can say is, you know, it's in the thousands of lives - even more. You know, the indifference to how much life has been harmed and damaged and the longer-term ways we enable a more stable, peaceful and healthier world - that's the thing that hurts the most.
CHANG: If someone were to argue - and we have heard this argument - that, look, disease in Africa or Asia, it's very tragic, but at some point the U.S. just needs to draw a line because the U.S. has poverty and the U.S. has a soaring deficit, how do you respond to that argument?
GAWANDE: There's - in two ways. One is that many of these programs directly protect the United States because we're stopping diseases from abroad. This has been an important part of bringing HIV efforts under control, bringing tuberculosis efforts under control and stopping other conditions that harm the world. The second is that we get influence from this work in the world. You know, we have had six months of decimation of our non-military capacity abroad, and that's ceded ground to others, like China. We are losing our influence and relationships and ability to work together on areas of common interest.
CHANG: Well, here's another argument. The Trump administration has repeatedly pointed to what it describes as waste, fraud or abuse in how these funds were previously used as a primary reason for these cuts. What do you make of that argument?
GAWANDE: Well, I do think there is always space that we have to make improvements. But let me point out, our foreign aid work in global health was less than half of the budget of my hospital system in Boston. Twenty four dollars per person, per year for these programs, and it reached hundreds of millions of lives and saved lives by the millions. It is arguably the most impact per dollar of any agency in the U.S. government. So yes, there are places to make improvements, but this is a demolition and destruction. This is not an effort at addressing improvement in those kinds of situations.
CHANG: Dr. Atul Gawande is a surgeon, public health researcher and a former senior administrator of USAID. Thank you very much.
GAWANDE: Thank you. Transcript provided by NPR, Copyright NPR.
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