Surgeon, Writer ("Being Mortal," "Checklist Manifesto"), and formerly led Global Health @USAID. Threads: atul.gawande. Bsky: @agawande.

Joined January 2011
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Starting in early 2025, Elon Musk and the Trump administration began terminating USAID's programs and firing its staff — with Musk himself boasting about "feeding it into the woodchipper." One year ago today, USAID was officially dissolved, its remaining programs haphazardly folded into the State Department. Amid all the lies and misinformation that have followed, some facts about what has actually been lost: • USAID saved more than 3 million lives a year at a cost of less than $10/month per American. That is what was destroyed. On purpose. • According to Boston University's Global Impact Counter — which tracked deaths attributable to the cuts until it stopped operations in February 2026 — an estimated 781,000 people died preventable deaths in the first year, including 518,000 children. • Global child mortality (the number of children who die before their fifth birthday) rose in 2025 for the first time in 35 years — by 200,000 additional deaths. • USAID's 50-country disease surveillance network — the system that cut outbreak response times from 2 weeks to 48 hours — is gone. We are now watching an unprecedented Ebola outbreak unfold in real time — with the highest first-month caseload and death rate in modern history. • Programs reaching 93 million women and children were cut 92%. TB programs cut 56%. Water and sanitation cut 86%. Over 2,000 health facilities permanently closed. • 25 million fewer people received humanitarian assistance in 2025. The overall humanitarian budget was slashed 74% — from $14.1 billion to $3.7 billion. • 363 million people face acute hunger in 2026. The famine early-warning system that would have seen it coming went dark for five months. • $1.7 billion in democracy and governance funding (election monitoring, anti-corruption work, support for independent media and civil society) was terminated. • 360 independent media outlets lost funding. Hundreds of legal clinics closed. • Far from saving money, the Trump administration itself has already said the dismantlement will cost taxpayers at least $19.2 billion in cancellation fees, severance, and penalties. That's more than half of USAID's annual budget — spent on destruction and closeout, not support for vulnerable people. • American farmers, universities, and businesses are among the casualties too. USAID partnered with more than 3,500 U.S. companies and maintained 17 university-based research labs. Its work with U.S.-based contractors and the private sector generated hundreds of thousands of American jobs and multiplied the return on every dollar spent. Those markets and partnerships are gone.
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Independent analyses estimate that your actions to dismantle USAID and drastically reduce lifesaving foreign aid have already killed 700,000 people. Here are some of those people. 🧵x.com/elonmusk/status/206944…
All DOGE required was contact information of the recipients to confirm that funding was not fraudulent. No validated medical funding was stopped. Anything that appeared to be legitimate lifesaving funding continued and is now administered by the State Department. If anyone had actually died as a result of DOGE, their names would be worldwide headline news! On the other hand, USAID did help fund the Wuhan Virology Institute, which caused the deaths of millions, and the revolution that started the Russia-Ukraine war.
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The deaths are massive and real. For health emergencies alone, WHO reports >50 million people lost vital services due to massive aid cuts, including 14 million facing acute starvation. apps.who.int/gb/ebwha/pdf_fi…
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USAID saved 92 million lives since 2000. It cut deaths of kids 32% & overall 15% in partner countries w 0.3% of the US budget. It was arguably the most effective agency in govt. To no surprise, your destroying it and slashing aid is a human catastrophe. thelancet.com/article/S0140-…
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