A Midnight Global Health Massacre
Life-saving programs, including George W. Bush’s cherished global AIDS initiative, were hit in the latest, harshest round of cuts.
Jam-packed one this morning. Let’s get right into it, shall we? Happy Thursday.
Is W. Awake?
by Sam Stein
On Wednesday, reports began dribbling out that Secretary of State Marco Rubio had signed off on eliminating 92 percent of USAID grants, around 4,100 of them, with a savings of $60 billion. On Thursday morning, foreign aid officials woke up to see the details of those cuts. The reaction was justified shock.
Programs that the administration had suggested it believed were worth continuing were now being terminated. That includes efforts to combat the AIDS epidemic—such as George W. Bush’s famed PEPFAR program—that have been a source of bipartisan pride for decades.
One government notice, passed along to The Bulwark, showed that USAID was terminating its contract for the joint U.N. AIDS program, which is the primary mechanism for monitoring the disease globally. An official who works on the program estimated that Rubio had eliminated half of its funding.
That was just a small portion of the carnage.
Two sources familiar with the matter say USAID support for South Africa’s PEPFAR programs were also terminated overnight. The Trump administration had already moved to cut off all aid to the country, citing disagreement with social policies there. But this isn’t about social policies. Bhekisisa, a global health news outlet, reported that PEPFAR-funded organizations “woke up to letters that were sent overnight telling them their grants have been ended—permanently.”
The White House did not respond to a request for comment.
The full extent of the PEPFAR cuts is not entirely clear as of now, though one foreign official told The Bulwark that in addition to any cuts, some USAID employees who work on the program were put on administrative leave.
Even if the USAID spigot was fully cut off, there are other sources of funds into the program, including from the Centers for Disease Control and Prevention and the Department of Defense.
But the sheer magnitude of the damage was breathtaking for those in the field. A coalition of South African groups trying to raise awareness of the PEPFAR funding cuts have hastily organized a zoom call for Thursday. The advisory noted that “though PEPFAR funding support makes up around 17% of South Africa’s HIV budget, the entire programme is at risk, because so many critical projects, such as monitoring and testing, will be weakened.”
And it wasn’t just PEPFAR, of course. A fact sheet sent along by groups trying to undo the cuts noted that one of the contracts terminated was for “a project in the Democratic Republic of Congo that operates the only source of water for 250,000 people in camps for displaced people located in the center of current fighting.”
Adding to the shock was how the cuts transpired. USAID officials were operating under the impression that they remained in the 90-day review period, during which time all foreign aid contracts were to be scrutinized by Trump leadership. The administration is of course not 90 days old. But Rubio and Peter Marocco, the acting deputy administrator of USAID, went ahead anyway.1 It wasn’t lost on those inside the agency that news of the terminations was leaked to the Free Beacon, the conservative outlet that has become a clearinghouse for critical reporting on USAID functions.
As that news broke, much of the pro-USAID contingency was paying attention to a separate but related court matter. Grantees have been pushing the agency to release roughly $2 billion in contracts that Marocco has held up, despite those contracts having been agreed to long ago.
Earlier this week, a federal judge had ordered the Trump administration to resume USAID payments for those contracts no later than last night at midnight. But after the government appealed to the Supreme Court, Chief Justice John Roberts last night paused that deadline via an “administrative stay” giving the court a few days to review the case. Marocco and others had argued (persuasively to Roberts, it appears) that they couldn’t possibly pay all those contracts in such a short time frame.
But at the same time, they were working on terminating tens of billions worth of additional awards. That apparently required no time for thoughtful review.
Agency officials—angered over the cuts, but fearful that they’d be punished for speaking out publicly against them—leaked to The Bulwark a statement encouraging contractors to challenge them in court. It read:
The termination to contracts, grants, and assistance agreements that took place over the last two weeks and the huge bulk last night, were not done according to federal laws, regulations and procedures, and in many cases not done by the cognizant contracting and agreement officer of the awards with authority to do so. These terminations will not uphold under legal scrutiny, the implementing partners who received such termination should explore their outside legal options. The Agency’s internal mechanisms for such protests have been put on administrative leave or fired.
DOGE in a Business Suit
by William Kristol
When I heard yesterday that there was a new, official, seven-page single-spaced joint memorandum from the Office of Management and Budget and the Office of Personnel Management providing “Guidance on Agency RIF and Reorganization Plans,” my little heart went pitter-patter.
I got a degree in political science. My main field was political philosophy, but I studied American government a little, too. So as a student I actually read, or at least glanced at, a few memos like this.
Then I came to Washington and worked in the federal government. As chief of staff at the Education Department, I both received memos like this from OMB and signed off on internal memos like this from our own budget office. I sort of like these kinds of memos.
So here’s my report on the Trump administration memo: It isn’t impressive. It may be more organized and sober than DOGE, but it’s just DOGE in a business suit. It’s got timetables and criteria, phases and plans and guidelines. But from its opening denigrating the federal civil service as “bloated” and “corrupt,” to its instruction to agencies to “focus on the maximum elimination of functions that are not statutorily mandated,” it’s simply a crude effort to drastically cut and radically politicize the federal government.
And it wants to do it at breakneck speed, trying as much as possible to foreclose the opportunity for congressional oversight or public debate. Agencies are to develop plans for the next stage of the cuts—the “Agency Reorganization Plans”—by March 13, and plans for “phase 2” by April 14.
But that shouldn’t be a problem for the agencies. Elon Musk assured us all at yesterday’s cabinet meeting that “President Trump has put together the best cabinet ever, literally.” The cabinet secretaries are presumably so good that it shouldn’t be difficult for them to get fully up to speed in a week or two on what works and what doesn’t, what can be cut and what shouldn’t be, in agencies that they’ve mostly never set foot in before.
Of course, as the memo says, those agency heads “should collaborate with their DOGE team leads.” Indeed, later Wednesday, President Trump signed an executive order that further empowered DOGE to withhold payments by the agencies.
Now, it’s true that DOGE has made some mistakes. Musk admitted yesterday that DOGE “accidentally canceled” U.S. government work to prevent the spread of Ebola. But, he claimed, “We restored the Ebola prevention immediately. And there was no interruption.”
Here’s Jeremy Konyndyk, who’s led U.S. government responses to Ebola outbreaks in the past, exposing the lie here:
So—I’ve actually led Ebola outbreak response at USAID. This is bunk from Elon. They have laid off most of the experts, they're bankrupting most of the partner orgs, have withdrawn from WHO, and muzzled CDC. Most experts and operations staff at USAID have been pushed out. USAID’s ops centers have been shut down. USAID’s capacity to deploy response teams is totally broken.
CDC has been hammered by DOGE as well, with huge cuts to the disease detectives that staff frontline responses. CDC leadership also issued guidance barring staff from talking to WHO . . . even as WHO is the lead on [international] support to the Ugandan govt.
WHO is really good at this—in large part because of USG investments in their emergency capacity over the past decade. But Trump has withdrawn the US from WHO and cut off support.
Bottom line: Elon’s vendetta against USAID and the federal workforce is shredding all of the systems that the USG has built up to protect the US homeland against global outbreak risks.
Not to call into question Musk’s veracity, but I’ve got to admit to being alarmed.
Maybe we’ll be lucky with Ebola. And maybe it makes sense to cancel the long-planned annual FDA meeting of vaccine experts to figure out next year’s flu shots. Or maybe not.
It’s striking that neither the OMB memo nor Musk nor Trump ever bother to explain how actual outcomes in real life will be improved by taking a hatchet to federal employees and programs.
But Musk did lay out a clear goal at the cabinet meeting yesterday: “We do need to move quickly if we are to achieve a trillion-dollar deficit reduction in financial year 2026.”
The fact is that we’re not going to get anything close to that kind of deficit reduction from Trump’s spending cuts. But there is one way to get substantial deficit reduction: Congress could refuse to extend some of Trump’s tax cuts for the wealthy. Canceling that giveaway would get us more deficit reduction than the DOGE cuts. And it wouldn’t risk an outbreak of Ebola.
Quick Hits
AN NIH NEWS NUGGET: The National Institutes of Health decided this week to cancel its 2025 summer internship program, according to a person familiar with the matter and internal correspondence reviewed by The Bulwark.
On average, about 1,100 interns usually participate in the NIH’s summer program. They come mostly from colleges, but some are in medical, veterinary, and pharmacy programs. They are spread across all of the agency’s campuses and receive real-world experience at the gold standard of government scientific research institutes.
Because the NIH has been told by Trump officials to freeze hiring, and because it is being compelled to put programs through review, the decision was made to call off the internship program, too. In a letter announcing that decision, an NIH official noted that a small number of summer interns had already accepted their offers. They’d be alerted to the change, the letter said, with hopes that the program would be up and running again in 2026.
Compared to the tens of thousands of federal workers finding themselves unemployed—or soon-to-be unemployed—these past few weeks, this may be small potatoes. But it still matters—not just to the people inside the NIH, who cared about the program, but for the additional harm it does to America’s scientific future. The brain drain caused by the Trump administration is here, brought about by decisions big (like putting a cap on the billions of dollars the NIH sends to universities for administrative costs) and small (like shuttering a summer program for up-and-coming scientists).
BOW BEFORE YOUR DOGE: In the last week, we’ve seen a remarkable amount of quiet discord within the top ranks of the Trump administration, with a heap of cabinet secretaries quietly pushing back as Elon Musk’s DOGE outfit tries to elbow past them to cancel contracts and fire employees. But Donald Trump wants you to know that this discord is fake news.
“ALL CABINET MEMBERS ARE EXTREMELY HAPPY WITH ELON,” the president wrote on Truth Social yesterday morning. “The Media will see that at the Cabinet Meeting this morning!!!”
Sure enough, there was Musk at the cabinet meeting, clad in a “tech support” tee shirt and MAGA hat2, giving yet another stemwinder about DOGE while the cabinet listened politely. And sure enough, Trump gave them a chance to weigh in: “Hey Elon, let the cabinet speak just for a second. Is anybody unhappy with Elon? If you are, we’ll throw him out of here.”
The cabinet laughed, some more comfortably than others. Commerce Secretary Howard Lutnick started clapping, so the cabinet applauded, some more enthusiastically than others. Secretary of State Marco Rubio, whose authority DOGE has reportedly been treating with particular disdain, managed a single clap.
The scene’s meaning was unmistakable. Trump’s loyalty can be fickle. As of now, however, there’s no question that Musk still enjoys the blessing of the king. It’s up to the cabinet to accommodate themselves to his wishes, not the other way around.
WHAT COULD GO WRONG: Don’t look now, but it sure looks like the flu vaccine might not be coming out on time next year.
Ordinarily, the Food and Drug Administration’s vaccine advisory commission meets early in the year to examine the flu strains that are currently circulating around the world. At that meeting, they make a crucial, highly educated guess: aiming to predict which strains will be most prevalent half a year from now as the U.S. enters its next flu season. That gives vaccine manufacturers a blueprint for which strains to begin the lengthy process of mass-manufacturing product against.
Except, well, the Department of Health and Human Services—now helmed by the ragingly anti-vaccine Robert F. Kennedy Jr.—just canceled that meeting, per the New York Times:
A panel of scientific experts that advises the Food and Drug Administration on vaccine policy — and that has been the target of criticism from Health Secretary Robert F. Kennedy Jr. — learned on Wednesday that its upcoming meeting to discuss next year’s flu vaccines had been canceled.
The F.D.A. sent an email to members of the panel, the Vaccines and Related Biological Products Advisory Committee, on Monday afternoon informing them of the cancellation, according to a senior official familiar with the decision. There was no reason given. The panel was to meet on March 13.
We haven’t covered it much yet given [gestures around wildly] all this, but it’s reasonable to assume that HHS will be the site of particularly drastic cutting in the months ahead. After all, DOGE has an enthusiastic arsonist for a partner in Kennedy, who views not just vaccines but the whole modern medical-research apparatus with deep suspicion.
Cheap Shots
Correction, February 27, 2025, 11:23 a.m.: An earlier version of this newsletter incorrectly identified Peter Marocco as the acting administrator of USAID. Secretary of State Marco Rubio remains the acting administrator of USAID, and Marocco is the acting deputy administrator.
A pretty open-and-shut violation of the Hatch Act, which restrains executive-branch employees from political activities on federal premises, for any of us total dorks who might still happen to care.
This is usually when I point out that the great and good American people voted for this.
However, today's a good day to point out there are moral monsters within the Trump administration. Rubio certainly knows what the consequences of these USAID cuts will be. I'm pretty sure that someone like Vought knows, too. People are going to die, so we can reasonably conclude that Rubio and Vought want people to die.
I don't see how the United States ever recovers from this act of international arson. Whatever goodwill we had has been squandered in only one month.
And speaking of monsters, RFK Jr. is doing what we all knew he would, and never, ever forget that the senate GOP confirmed this man.
Perhaps past presidents might want to SAY SOMETHING OR SAY ANYTHING???