President Donald Trump, Secretary of State Marco Rubio and richest-man-in-the-world Elon Musk have not personally killed anyone, but their actions are unquestionably causing the unnecessary deaths of millions of innocent people — including 4.5 million children — who have been cut off from the lifesaving aid the U.S. was once proud to provide.

One of the president's first executive orders on Jan. 20, 2025, was a 90-day pause on all foreign assistance. It wasn't really a pause; it was the beginning of the end for the U.S. Agency for International Development, which has been saving and improving lives around the world for more than half a century.

The effects of Trump's order were felt immediately. Shipments of antiretroviral HIV medications, malaria nets and oxygen tubes for newborn infants expired in warehouses or never arrived in sub-Saharan Africa. In Haiti and Sudan, the funding "pause" halted programs for clean water, maternal health and refugee food rations. And, inevitably, people began to die.

It's been a tragic end for an agency that was founded in 1961, the brainchild of President Kennedy, who saw the exercise of soft power as a way to counter Soviet influence abroad. Later, of course, it was Chinese economic influence that USAID programs sought to neutralize.

By far, USAID's greatest triumph was its global health program, which included President George W. Bush's massively successful 2003 HIV-AIDS initiative, PEPFAR. In the last 23 years, more than 26 million lives have been saved, and millions more new HIV infections have been prevented.

"To many people around the world," President Obama said in a June 2025 message of gratitude to the thousands who lost their jobs, "USAID is the United States." Fittingly, its logo was a drawing of two hands clasping with the slogan "From the American people."

At the beginning of Trump's second term, USAID operated in 100 countries and employed 10,000 people. Working with host countries, it funded infrastructure projects, made loans and provided money, food and technical expertise to boost growth and education in developing nations.

When Trump decided to kill it as an independent agency and fold its remains into the State Department, USAID was working all over Sub-Saharan Africa and Asia to combat not just health crises like HIV-AIDS, but also malaria and tuberculosis, and outbreaks of the deadly viruses Ebola and Marburg.

Musk, who foolishly promised Trump he could shave $2 trillion from the federal budget with his White House advisory team, which he calls the Department of Government Efficiency, or DOGE, developed a bizarre hatred for USAID after hearing a wacky critic of the agency on Joe Rogan's podcast. In social media posts, Musk called it a "criminal organization," "a radical-left political psy op" and a "crazy waste of money." (USAID's $40-billion annual appropriation totaled only about 0.7% of the federal budget. Less than $2 billion went to administrative costs.)

Like an army of child soldiers, Musk's DOGE team of callow computer nerds — remember "Big Balls"? — were soon unleashed. "We spent the weekend feeding USAID into the wood chipper," Musk tweeted on Feb. 3, 2025. "Could gone [sic] to some great parties. Did that instead."

His lack of moral clarity is stunning.

As Bill Gates so poignantly put it in a May 2025 Financial Times interview, "The picture of the world's richest man killing the world's poorest children is not a pretty one."

If you want a window onto the fecklessness of DOGE and the Trump political appointees put in place to wreck the agency, I recommend "Into the Wood Chipper: A Whistleblower's Account of How the Trump Administration Shredded USAID," by Nicholas Enrich, formerly USAID's acting administrator for global health.

In headshaking detail, Enrich chronicles the administration's six-week assault on USAID.

You may recall the outrage when DOGE found a program that seemed like a gift from the gods to Trump.

"We identified and stopped $50 million being sent to Gaza to buy condoms for Hamas," Trump announced on Jan. 29, 2025. "And do you know what's happened to them? They've used them as a method of making bombs." This was a fantasy. The program, focused on reproductive health and HIV prevention, served a region of Mozambique called Gaza, a continent away from the Hamas stronghold.

Likewise, the parade of political appointees Trump put in charge either knew little about the agency, or had axes to grind. After Enrich delivered a presentation on the agency's work to his new Trump-appointed bosses, one of them said, "I had no idea you did all this. As a Republican, when I think of what USAID does in global health, I assumed it was just — you know — abortions." (It's common knowledge, or should be, that American tax dollars are prohibited from funding abortion care.)

One political appointee told Enrich that Ebola, which had recently broken out in Uganda, was "a scam."

During the chaotic interlude before Enrich was fired (after being told on the same day he was an essential employee and was being laid off), he and his colleagues desperately tried to save some of the agency's most critical programs. They believed — wrongly as it turned out — that Rubio was being truthful when he announced that programs responsible for saving lives would be exempt from Trump's pause on foreign aid.

"No children are dying on my watch," Rubio confidently (but incorrectly) asserted to the House Foreign Affairs Committee.

According to an impact counter developed by Boston University's Brooke Nichols, an associate professor in the School of Public Health and an infectious disease mathematical modeler, in the first year after USAID was abruptly ended, nearly 263,000 adults and 518,428 children died unnecessarily. House Foreign Affairs Chairman Brian Mast, a Florida Republican, accused Nichols of "dangerous hysteria" and of spreading misinformation.

But journalists at ProPublica, NPR, the Washington Post and the New York Times, among others, have traveled the world to document the preventable deaths and illness caused by the abrupt defunding of USAID.

A study in the Lancet concluded that by 2030, as many as 14 million people could die due to the defunding, including 4.5 million children under age 5.

Not that you will ever admit it, Secretary Rubio, but children are still dying on your watch.

Heckuva job, as someone once said.

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