USAID’s demise raises fears for millions of lives across the Global South

Taipei, Taiwan – Until recently, Southeast Asia’s Mekong sub-region seemed to be on track to reach its goal of eliminating malaria by 2030.

Named for the 4,900-kilometre (3,000-mile) river that runs from southwest China through Myanmar, Thailand, Cambodia, Laos and Vietnam, the area has long been afflicted by the mosquito-borne illness.

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From 2010 to 2023, the number of cases caused by the most common malaria parasite declined from nearly half a million to fewer than 248,000, according to the Global Fund, a United States government-funded organisation that is the world’s largest financier of programmes to prevent, treat and care for HIV/AIDS, tuberculosis and malaria.

Nearly 229,000 of those cases were reported in a single country, Myanmar, where the illness exploded with the outbreak of a civil war in 2021 and the displacement of millions of people.

As US President Donald Trump’s administration severely scales back foreign aid with the effective dismantling of the US Agency for International Development (USAID), health campaigners now fear that the progress made in the Mekong will be lost after officials targeted Myanmar’s anti-malaria initiative for elimination.

“We were throwing all our resources at [Myanmar], but by stopping this, malaria is going to spill back into Southeast Asia and the Mekong sub-region,” Alexandra Wharton-Smith, who worked on USAID’s Myanmar programme until being laid off by the Trump administration, told Al Jazeera from Thailand.

Myanmar’s government has estimated that cases have risen 300 percent since the start of the civil war, but Wharton-Smith said independent research indicates the real figure is more than double that.

New cases are also emerging in parts of Thailand that had not seen malaria for years as refugees and migrants from Myanmar cross the border, and are likely to rise further following the suspension of programmes to combat the disease, Wharton-Smith said.

The rollback of funding for anti-malaria efforts in the Mekong is just one of many examples of cuts that are raising alarm among humanitarian workers across the Global South, where the collapse of USAID threatens decades of progress against health crises such as tuberculosis, HIV/AIDS, Ebola and malnutrition.

On Wednesday, a top United Nations official for humanitarian affairs said the Trump administration had delivered a “seismic shock” to the global aid sector.

“Many will die because that aid is drying up,” Tom Fletcher, the head of the UN Office for the Coordination of Humanitarian Affairs (OCHA), said at a news conference on Monday.

Once the world’s top source of international aid, USAID is set to slash 5,200 of its some 6,200 programmes – about 83 percent of the total – according to US Secretary of State Marco Rubio.

“The 5200 contracts that are now cancelled spent tens of billions of dollars in ways that did not serve, (and in some cases even harmed), the core national interests of the United States,” Rubio said on X on Monday.

The remaining contracts will be overseen by the US State Department, he said.

The announcement capped six weeks of turmoil for the agency that began on January 20 when Trump issued a 90-day “pause” on US development assistance.

Thousands of USAID employees, contractors and support staff were put on leave or furloughed as projects around the world received a “stop work order” and ground to a halt.

Confusion followed as NGOs scrambled to fill in budget gaps and understand which programmes qualified for an announced waiver for life-saving partners.

The Supreme Court last week ordered the Trump administration to comply with a lower court’s ruling ordering the government to release $2bn in back pay owed to USAID partners and contractors from before the pause.

On Monday, a federal judge again called on the Trump administration to release the “unlawfully” impounded funds, arguing they had already been appropriated by the US Congress for a specific purpose.

US development assistance has been a primary target of the Department of Government Efficiency (DOGE), led by Elon Musk, the world’s richest man and a close adviser to Trump.

Catherine Kyobutungi, executive director of the African Population and Health Research Center in Nairobi, Kenya, said that while she agreed USAID should be reformed, the Trump administration’s gutting of the agency demonstrated a “total lack of understanding in how the world works”.

“We’ve made the case that the USAID funding mechanism was very, very inefficient. There was not too much attention paid to impact, to long-term sustainability and things like that, so it was not a perfect system. The problem is that you don’t upend an imperfect system overnight,” Kyobutungi told Al Jazeera.

“It’s not just that people show up and dispense pills for medical resistance, there’s a whole structure” to humanitarian assistance, Kyobutungi said.

“It’s the total disregard of how things work, how the world works, how projects are run, that is just astounding.”

Politicised aid

While the full impact of the USAID cuts is yet to be seen, a humanitarian worker at a leading nonprofit that works on malnutrition in multiple regions, including Africa and the Middle East, said any delay in funding could be deadly.

Among those most at risk are children being treated in intensive care units at emergency feeding stations for complications such as organ failure and hypoglycaemia, said the humanitarian worker, who spoke on condition of anonymity.

“The global humanitarian community has thousands of stabilisation centres around the world, supported by US government funds,” the person told Al Jazeera, asking not to be named due to fears of repercussions.

“This is crucial because with all the ups and downs of people awaiting waiver requests to resume programmes, the cash flow problems … we can’t allow these centres to close for even a day. Because if the lights go off in these centres, we see children dying.”

“Up until now, this was never a political issue. Feeding starving children was a bipartisan issue, and humanitarian aid was apolitical. Now they’ve politicised it,” the worker added.

It is also unclear how major US projects like the President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative will fare in the future.

Founded by Republican President George W Bush 20 years ago, the projects are credited with saving more than 32 million lives, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS) and archived USAID data.

They are both funded by Congress but implemented through government agencies such as USAID and the US Centres for Disease Control and Prevention, which has also been targeted by DOGE’s cost-cutting measures.

UNAIDS, a major partner of PEPFAR, said last month that it was notified the US government was terminating its relationship effective immediately. The agency said HIV programmes in at least 55 countries had reported cuts in funding.

Grants for UNICEF programmes targeting polio were also terminated, according to the UN, as was funding to the UN Population Fund, which oversees reproductive and sexual health programmes.

USAID has explicitly denied waivers for any programmes linked to family planning or so-called “gender ideology”.

NGOs on the ground in Asia, Africa and elsewhere are now struggling to fill gaps in funding and are facing major disruptions in service since they were issued a “stop work order” during the 90-day USAID “pause”.

Rubio’s most recent pronouncement on USAID has done little to clear up the confusion, while USAID-funded food and essential items remain locked in warehouses, according to two NGO sources.

Back in the Mekong, Wharton-Smith, the former adviser to USAID’s Myanmar programme, said she was concerned that a trickle of malaria cases over the Myanmar border over the last two years could turn into a flood with the withdrawal of USAID.

“We’re going to have more malaria where there hasn’t been malaria before. A lot of people have lost their immunity, so that could mean deaths,” she said.

“What happens when we’ve stopped treating tens of thousands of people for malaria? In a few weeks, rainy season is coming and then summer. It’s going to be a disaster.”