USAID and the Trump Foreign Aid Doctrine

On President Donald Trump’s first day in office, the administration launched a concerted attack on the U.S. foreign aid framework,^[1] sending shockwaves through the global humanitarian landscape. Under a cloud of misinformation about USAID, this decision has already cost lives, destabilized global security, and left entire regions in need of urgent support. But an even more dangerous and costly trend may yet be emerging. A new ‘Trump doctrine’ is taking shape, where foreign aid is no longer a lifeline but an ultimatum. Even now, aid is frequently leveraged as a bargaining tool, compelling countries to make significant concessions— compromising human rights standards, ceding access to natural resources, or aligning with the political and corporate interests. The conditionality attached to aid will place vulnerable populations at risk, and threaten to destabilize fragile regions by transforming humanitarian assistance into an instrument of political or economic coercion, with far-reaching implications for global security, ethics, and human rights.

Threats to USAID’s funding and very existence had been made before, including in 2023 when far-right conservatives within the U.S. alleged a systemic, “perverse,” and “radical, leftist” ideology, citing programs and policies addressing LGBTI human rights and gender inequalities.^[2] However, few in the agency imagined that USAID, going strong since 1961 with robust bipartisan support,^[3] could be destroyed so quickly. While there are legitimate criticisms regarding USAID and inefficient policies and practices mandated by Congress, the agency has played a significant role in advancing global development and humanitarian objectives. Yet, Elon Musk and Donald Trump, neither of whom have experience in international development or humanitarian aid, justified unravelling USAID using unsubstantiated claims, including an allegation involving a $50 million condom shipment to Hamas.^[4]

USAID played an instrumental role in saving lives (especially those of women and children), improving health outcomes, lifting people out of poverty, and assisting entire nations in transitioning from poverty and insecurity to growth and prosperity. One of the Global Health (GH) offices, Infectious Disease (ID), included the President’s Malaria Initiative (PMI). Created by a Republican president of a different era, George W. Bush, PMI has for two decades led the global fight to reduce malaria deaths and the burden of disease, saving an estimated 11.7 million lives and preventing 2.1 billion malaria cases.^[5] The President’s Emergency Plan for AIDS Relief (PEPFAR), also started by Bush, is likewise credited with saving more than 25 million lives^[6] and preventing millions of HIV infections across 50 countries. Another Global Health (GH) office, Maternal, Newborn, and Child Health and Nutrition (MCHN), could claim over a decade to have enabled 40 million women to give birth in health facilities with skilled birth attendants, to have reached 33 million newborns with post-delivery care, to have trained 14 million health workers in maternal and child health and nutrition, to have provided 115 million treatments to children with diarrhea and pneumonia, to have helped 23 million people gain access to clean water, and to have delivered 327 million prevention treatments to protect women and children from malaria.

Importantly, the decisions made within MCHN about whom to help and where were purely non-political. With limited funds, twenty-five priority countries were decided upon based on a) where maternal mortality figures were highest and b) where interventions could have the most impact, factoring in existing facilities, infrastructure, conflict, and security. The aim was to avoid pouring funds into areas where our programs could not function adequately. This is why Somalia, Chad, and other conflict-affected nations are not on the list, despite very high maternal mortality ratios^[7] (MMR) and dire child health outcomes.^[8] Never in this process would a country’s government, trade status, or any other political factor be considered. The question “Does our government like their government?” was never posed when making these assessments. Case in point: more than $3.7 billion of U.S. aid was delivered to Afghanistan after the Taliban seized power in 2021.^[9] The Taliban were hardly a U.S. ally, but the Afghan people continued to receive life-saving aid, such as food aid, supplies critical for maternal and child health, and vaccines to prevent the spread of Polio.^[10] Yemen was also one of MCHN’s priority countries, receiving aid to support safe and healthy childbirth. In April, 2025, the Trump administration resumed emergency funding to some countries, but excluded Afghanistan and Yemen.^[11]

With similar efforts made by other USAID offices, including the Office of HIV/AIDS (OHA), Office of Health Systems (OHS),^[12] and others, USAID had successfully directed American taxpayer funds toward initiatives that have contributed to improved health outcomes, increased stability, and enhanced safety worldwide. However, with the destruction of USAID, U.S. experts are no longer monitoring the spread of bird flu and other potential pandemics in 49 countries.^[13] All of these services were provided for the very low price of $43 billion,^[14] or roughly 0.7% of the U.S. government’s $6.3 trillion budget, not a third of the federal budget as most Americans believe, according to a Kaiser Family Foundation poll.^[15] The direct benefit to the United States, of course, was that this (and perhaps only this) altruistic act created goodwill, spreading the idea that the Americans were a constructive and reliable actor on the world stage.

Despite the documented impact of USAID’s global health and development programs, Elon Musk publicly dismissed these efforts by characterizing the agency as a “bowl of worms.” Reiterating the analogy in a Twitter Spaces chat, Musk claimed that USAID was not “an apple with a worm in it,” but a “bowl of worms.”^[16]

Immediately following the freeze of USAID programs, a list of nonsensical accusations were invented and leveled at USAID. The most famous among them was the claim that USAID was sending $50 million worth of condoms directly to Hamas.^[17] The claim first came from Trump’s Press secretary Karoline Leavitt. The following day, Trump literally doubled down on the claim and baselessly doubled the figure to $100 million.^[18] This, despite the fact that the USAID did not provide or fund any condom purchases for the Middle East region for at least the last 4 years, and the fact that total worldwide USAID condom spending for the entire globe was about $7.1 million in 2023,^[19] mostly to countries in Africa to prevent HIV. Trump-appointed State Department spokesperson Tammy Bruce claimed in writing^[20] that a $102 million line item for condoms was prevented from reaching the International Medical Corps. IMC is a US-based organization that operates two field hospitals in Gaza and distributes zero condoms. Some speculated that the administration might have confused the Gaza strip with a province of Mozambique,^[21] also called Gaza, but Mozambique also received zero condoms from USAID, receiving only $5.4 million in non-condom contraceptives in 2023.^[22] Not to be outdone, Elon Musk claimed on Twitter that USAID used “YOUR [sic] tax dollars” to fund “bioweapon research, including COVID-19, that killed millions of people,”^[23] citing a 2023 New York Post article. Other claims related to a trans musical in Columbia, DEI programs in Ireland, and sex change surgeries in Guatemala, none of which were USAID programs.^[24] Even if these claims were substantiated, they would have amounted to 0.005% of USAID’s budget.

In shutting down USAID, ostensibly to counter waste, fraud, and abuse, Trump and Musk created a massive amount of waste. Food aid, intended to prevent an escalation of deadly famine in Sudan,^[25] for example, was paid for, but not delivered.^[26] The USAID Office of the Inspector General reported, “shipments of in-kind food assistance have been delayed around the world… this uncertainty put more than $489 million of food assistance at ports, in transit, and in warehouses at risk of spoilage, unanticipated storage needs, and diversion.”^[27] USAID staff also reported “the counter-terrorism vetting unit supporting humanitarian assistance programming has in recent days been told not to report to work… and thus cannot conduct any partner vetting. This gap leaves USAID susceptible to inadvertently funding entities or salaries of individuals associated with U.S.-designated terrorist organizations.”^[28] The Trump administration responded to the IG’s report by firing the IG the day after its publication, with no reason given.^[29]

This man-made catastrophe of halting aid represents a fundamental shift in course, away from any action taken solely for the sake of doing good in the world. Altruistic actions – done for no reason but to save lives, improve health outcomes, and make a better world – are antithetical to a zero-sum view of the world, where policies are driven only on a transactional basis. With this world view, soft power is a fiction. Publicly delivering humanitarian aid without getting a financial reward in return doesn’t win the U.S. allies. It means the U.S. has been taken advantage of and made to look weak. This is not exactly a new idea–placing geo-political pragmatism above moral concerns. See, for example, the American Realism movement,^[30] personified in Henry Kissinger and Condoleezza Rice and their immoral and/or illegal foreign policy choices, such as the bombing of Cambodia and Laos and the Iraq war. What we haven’t seen to date is the concept of American Realism taken to this extreme, wherein the globe may suffer great losses for a perceived financial benefit (however small) of the United States.

It is important to note that President Joe Biden’s approach was far from perfect concerning foreign aid. While the USAID’s Bureau for Global Health was free from political pressure, other parts of USAID, focused on democracy, human rights, governance, peace, and security, were not. For example, Ukraine received by far the most aid,^[31] funneled through USAID programs, topping the list of recipients at over $16 billion, with the next highest, Ethiopia, at $1.8 billion.^[32] It was widely acknowledged among staff at another little-known U.S. foreign aid agency, the Millennium Challenge Corporation (MCC),^[33] that large, positive contributions to infrastructure, economic development, and anti-corruption in central America were made largely to deter migrants from leaving Guatemala, Honduras, and El Salvador, and coming to the United States.

The Biden administration and USAID leadership, much like their predecessors, decried the human rights abuses of political foes,^[34] like Russia and the Taliban, while ignoring the human rights abuses of an ally like Israel. Indeed, USAID reported^[35] to Blinken’s office in May 2024 that U.S. food aid was being blocked by Israel in contravention of 620I of the Foreign Assistance Act^[36] which bars military support to countries blocking American aid shipments. Significantly, USAID leadership, under the administration of Samantha Power, acknowledged the famine,^[37] but never acknowledged the cause of the famine publicly. Israel’s blockade was not publicly acknowledged by Blinken or USAID until a leaked letter from Blinken in October 2024 demanded/pleaded that Israel allow more aid trucks into Gaza and acknowledged that Israel was responsible for “denying or impeding 90% of humanitarian movements.”^[38] Both USAID^[39] and the State Department^[40] continued to suppress reports of Israeli human rights violations up to the end of the Biden Administration and on into the Trump administration.

For decades, under both Democratic and Republican administrations, political choices, including insufficient localization,^[41] awards channeled through large American contractors,^[42] and strict Congressional earmarks^[43] have made USAID, the world’s largest aid agency, extremely inefficient. One of the most famous examples is the decades-long, congressionally mandated practice of procuring U.S. food aid from American farmers.^[44] This preference for in-kind aid has long been criticized for its inefficiency, as cash transfers and support for local agriculture would be far more practical, cost-effective, and sustainable.^[45]

The new Trump doctrine, however, goes far beyond inefficiencies and poor political choices. Since much of this aid is life-saving, withholding aid is less a bargaining chip and more accurately a deadly weapon or at the very least a threat to kill and harm people. If the targets of this tactic don’t comply with Trump’s or Musk’s wishes, they face the threat of mass death, sickness, and catastrophic economic shocks. One of the early victims of this weaponization was South Africa. Trump announced aid to South Africa would be completely cut off completely, in part due to the country’s ICJ case against Israel,^[46] and in part due to Trump’s claim of discriminatory policies against white Afrikaners. South Africa was the largest recipient of U.S. PEPFAR funds to prevent and respond to AIDS, along with many other global health programs.^[47] Cutting off all funding has meant a sudden drop in the availability of antiretroviral medication and corresponding spikes in illness, transmission through sex, and mother-to-child transmission. The head of UNAIDS, Christine Stegling, stated unequivocally^[48] that without these funds she expects a 400% increase in AIDS deaths, amounting to 6.3 million people.

Similar weaponization tactics were deployed against Egypt and Jordan when both countries refused to take in Palestinian refugees forcibly-displaced by the U.S. and Israel. Their refusal to participate in ethnic cleansing elicited a direct threat from Trump,^[49] who insisted they will take in Palestinians or be cut off from all U.S. foreign aid. If these threats materialize, they may have a massive destabilizing effect on Egypt and Jordan domestically, blocking $1.5 billion^[50] and $1.7 billion^[51] in aid, respectively, and could disrupt the 45-year-long peace agreement between Egypt and Israel. Though the 1979 Camp David Accords did not explicitly include a pledge by the U.S. to deliver aid to both Egypt and Israel, the U.S. did make a strategic commitment to provide substantial aid to both countries as part of the ongoing peace process.^[52] While some claimed^[53] the threat to cut aid and ethnically cleanse Gaza was a pressure tactic to force Gulf states to come up with a long-term solution, the threat remains. As of this writing, Israel’s onslaught on Gaza has resumed, and the path to a resolution that doesn’t involve mass ethnic cleansing appears less and less clear.^[54]

The new Trump doctrine did not come without warnings. In early 2018, during Trump’s first term, the administration cut a scheduled payment of vital, life-saving aid to UNRWA (the UN Relief and Works Agency) from $130m to $65m.^[55] This cut was intended as a threat, accompanied by a demand that the agency make unspecified reforms and that the Palestinians renew peace talks. The consensus among Palestinian leaders was that they were being asked to unilaterally erase the right of return from peace negotiations and from UNRWA’s mandate.^[56] In the clearest terms, life-saving aid was being withheld as a bargaining chip to try to get Palestinians to give up some of their human rights. The Palestinians’ right to return to their homes is enshrined in UN resolutions, and not a right that UNRWA or a Palestinian government can remove, but the Trump administration was determined to remove that right de facto, if not de jure, wielding life-saving humanitarian aid as a threat and a deadly weapon.

The Trump doctrine is at work in the deportation of individuals to El Salvador, which  receives approximately $6 million annually in U.S. aid and in return has received thousands of alleged gang members, despite federal judges issuing orders to halt the flights.^[57] Many individuals were deported based on flimsy evidence, such as tattoos that are often common cultural symbols and not necessarily gang-related. In exchange for taking these individuals, often in harsh conditions in overcrowded prisons with inadequate nutrition, unsanitary environments, and widespread abuse and torture.^[58] The money from the US goes to housing the deportees and helping to support the country’s prison system, including the infamous Terrorism Confinement Center (CECOT).^[59] The prison’s conditions are notoriously inhumane, and human rights organizations have documented numerous abuses, including severe overcrowding and lack of access to basic necessities. In return for accepting these detainees, El Salvador strengthens its international standing as a tough opponent of crime, which further cements its relationship with the U.S. government.

The Trump doctrine is also currently present in trade negotiations, conditioning deals with requirements that foreign governments erode the human rights protections for their own citizens. In April 2025, the Trump administration communicated to the UK Prime Minister, Keir Starmer, that a better trade deal would be contingent on the UK repealing hate speech laws.^[60] The White House framed these repeals as advocacy for “free speech,”^[61] though in effect the change would erode legal protections for LGBT+ groups and other minorities. The changes could mean the repeal of the Public Order Act 1986,^[62] the Racial and Religious Hatred Act 2006,^[63] and the Online Safety Act 2023, which would hold social media companies accountable for failing to curb hate speech.^[64]

The new Trump doctrine extends to vital military aid as well. The administration has conditioned continued military support to Ukraine on significant concessions, particularly access to Ukraine’s vast mineral wealth.^[65] The proposed minerals and natural resources agreement was presented as a prerequisite for ongoing U.S. military aid. For Ukrainian soldiers on the front lines, this agreement, which grants the U.S. the right to exploit Ukraine’s natural resources, could be a matter of life or death. Similarly, Elon Musk temporarily suspended, and threatened to permanently end, his critical Starlink satellite services unless Ukraine agreed to his political demands.^[66] In this case, Ukraine was pressured to sacrifice its territorial integrity and cede land to Russia because Musk preferred to withhold Starlink funding.

The new Trump doctrine has already inflicted enormous damage, even as the second Trump administration is only a few months old. Over the next four years the doctrine may expand, evolve, and change in predictable or unpredictable ways. For example, life-saving aid to developing countries could be conditioned on buying weapons and other products produced by Musk and other Trump-affiliated mega-donors.^[67] The Ukraine example might be expanded to all countries, requiring widespread exploitation of natural resources in exchange for essential medicines and vital medical supplies. Given the administration’s animosity toward the International Criminal Court^[68] and the United Nations,^[69] countries may be eligible for foreign aid only if they withdraw from the Rome Statute or vote in line with the U.S. in the General Assembly. For example, a vote in favor of Palestinian statehood in the General Assembly could make a country ineligible for aid. Much like the administration’s effective threat to defund Columbia University,^[70] countries receiving aid may be required to outlaw and crush leftist/populist political movements, protests, and other forms of dissent. Aid has never been explicitly conditioned this way before, but the world learned long ago: Trump has no problem breaking norms and crossing lines defined by morality, or by law in some cases.

Once firmly established, the new Trump doctrine may become the norm in Republican circles going forward. This slide to the right has taken shape in many other policy areas, for example with immigration, healthcare, and gun control. Support for unconditional humanitarian aid, USAID as an agency, and the use of “soft power” around the globe used to enjoy bipartisan support, with few far-right exceptions. This Republican shift is most evident in the case of Secretary of State Marco Rubio, who has a long history of praising USAID as an agency that “furthers our national interests” during his time as a Senator.^[71] Even recently, Rubio had defended USAID against attacks, highlighting its enormous benefits USAID offers for less than 1% of the U.S. budget.^[72] In 2022, Rubio wrote a letter to Biden proposing an increase to USAID funding “to send a clear message that the United States has a comprehensive strategy to counter the Chinese Communist Party’s (CCP) expanding global influence…”^[73] Rubio today, however, claims “USAID systems and processes are not well synthesized, integrated, or coordinated, and often result in discord in the foreign policy and foreign relations of the United States,” and “undermines the president’s ability to carry out foreign relations.”^[74]

Over the next few decades, GOP attacks on USAID and the concept of unconditional aid may become a regular occurrence. This policy of vacillation—switching aid off and on—has been imposed on specific services in the past. Funding to UNFPA has been periodically cut,^[75] and the “global gag rule” banned funding to NGOs that provide legal abortion services, even if US funds were not used for abortion.^[76] These funds were switched on under the Clinton, Obama, and Biden administrations, and switched off under the Bush and Trump administrations. For the foreseeable future, more than 40 billion in foreign aid funds might similarly ebb and flow depending on the policy direction of the sitting president. As thousands of experienced USAID staff are subject to ongoing cycles of hiring and turnover, additional challenges and inefficiencies in aid delivery are likely to arise.

One inherent flaw in the roll-out of the Trump doctrine might lead to its own downfall. Having already preemptively abolished aid and forced countries to find new donors and set up emergency funding by other means, the threat of denying aid is no longer a bargaining chip. Meanwhile, Trump may succeed in alienating allies and foes alike and erasing 60 years of good trade relations and humanitarian good will. One day the U.S. may one day find itself truly isolated, needing the rest of the world more than the rest of the world needs the U.S. For their own wellbeing and security, developing countries will need to learn to live without the U.S. as a reliable partner.