More stories

  • in

    Trump is dismantling a key worker safety group. It’s another betrayal of the working class | Devan Hawkins

    As Donald Trump announced his tariffs in the White House Rose Garden last month, he proclaimed: “We’re standing up for the American worker.” While it remains to be seen what impact these tariffs will have on American workers, his words were belied by the fact that just a day before this announcement, hundreds of workers at the National Institute for Occupational Safety and Health (Niosh) – an organization that has stood up for US workers since 1970 – discovered that they had been laid off.Niosh was founded as part of the Occupational Health and Safety Act with the purpose of “developing and establishing recommended occupational safety and health standards”. The organization has been on the frontline of protecting worker health and safety ever since. Its work has focused on understanding the risks faced by millions of workers throughout the country who put their safety on the line every day to perform their jobs. For example, Niosh’s Fire Fighter Fatality Investigation and Prevention Program investigates fatalities to understand their circumstances and make recommendations, ensuring that more of these workers, who risk their lives for others daily, can be safer in the line of duty.Far from being a caricature of a federal body firmly entrenched in the Beltway, Niosh’s work is spread across the country. One of Niosh’s most notable sites is its Morgantown, West Virginia, facility. Located in the heart of coal country for decades, it has focused on studying the health impacts of coalmining – particularly black lung disease – which has seen notable increases in recent years. Nearly 200 workers were fired from the Morgantown location, which will severely hamper this work. (Some were temporarily rehired.)Niosh also supports surveillance programs run out of 23 states. These state-based programs focus on the unique needs of the workforce in those areas. For several years, I was fortunate to have been an epidemiologist with such a program in Massachusetts, where my colleagues and I focused on understanding and preventing health challenges ranging from bloodborne pathogen exposure among healthcare workers, to asthma risk among cleaners, to fatalities in the construction industry.Since its founding, Niosh has been a nimble organization, adapting to and studying new and emerging threats. The World Trade Center Health Program, which is administered by Niosh, was created to study the health impacts of responding to those terrorist attacks – ranging from traumatic injuries and respiratory disease to cancer and mental health – while providing support for those responders.In a similar way to its response to the September 11 attacks, in the grip of the epidemic of opioids and suicides that have cost tens of thousands of lives over the past two decades, Niosh has sought to understand the workplace component of these challenges. These efforts have helped to shed light on the pathway linking occupational injuries to a high risk of drug overdoses among workers in certain occupations, particularly in the construction industry, and contribute to efforts to prevent these deaths.During the Covid-19 pandemic, Niosh studied the risks faced by frontline workers. The pandemic also highlighted one of Niosh’s most essential functions: air filtration ratings. Niosh tests, approves and certifies respirators to ensure that workers are protected from airborne risks ranging from silica dust to lead.Niosh also supports the future of occupational safety and health workers. Niosh traineeship programs across the country provide support to students studying occupational health and safety. I was fortunate to be supported by such a program when I was in graduate school. Throughout the country, hospital employee safety departments, union workplace safety committees, and community occupational health and safety advocacy organizations are staffed by others like myself who received this support.Now is the worst possible time for Niosh to be dismantled. Traditional workplace hazards still remain. In 2023, the last year with available data, there were 5,283 fatal occupational injuries – one every 99 minutes. Violent injuries at work are a growing concern, particularly among healthcare workers. Increasing temperatures caused by climate change place many vulnerable workers at high risk for illness, injury and death, while extreme weather events, such as the wildfires that devastated southern California earlier this year, threaten the health and safety of emergency workers. Emerging technologies such as artificial intelligence are changing the nature of work, presenting new dynamics and hazards.We need Niosh to study these emerging threats and safeguard workers.It remains to be seen what will happen to the remainder of the organization and the programs supported by Niosh throughout the country. Regardless of what occurs, we should support the current and former workers of the organization and carry forward its mission, just as Niosh workers have advocated for the health and safety of workers across this country since the organization’s inception.

    Devan Hawkins is a writer and researcher from Massachusetts. He is the author of the book Worthy and Unworthy: How the Media Reports on Friends and Foes More

  • in

    Emboldened by Trump, the ‘liberal’ UK is giving free rein to its colonial impulses | Kenneth Mohammed

    As Donald Trump rains chaos down upon the US – dismantling the rule of law trading in rage-fuelled nationalism and bullying the rest of the world – his ideology is now being eagerly imitated not just by the expected rogues of global politics, but by supposed bastions of democracy.These democracies now wear only a mask of civility over that old colonial impulses: control, divide, exploit.Most disturbing is the UK’s quiet complicity, sneaking its own brand of institutional cruelty. Like seasoned illusionists, they use chaos abroad to obscure injustice at home, to legitimise morally indefensible immigration policies.It is as though the UK and the US exchanged a sly nod across the Atlantic, and said: “Let’s see just how far we can go.”The US is now overseeing the deportation of thousands. Not illegal migrants. Legal. Some have lived in the country for decades, built families, contributed to society, paid taxes. As detention centre doors slams, dreams are extinguished in real time.Caribbean nation’s citizenship-by-investment (CBI) programmes, including Antigua & Barbuda, Dominica, Saint Kitts & Nevis, and Saint Lucia, are now under investigation by the US due to perceived security concerns, potentially facing travel restrictions. So, too, Africans are facing bans and visa cancellations.Not to be outdone, the UK has begun tightening visa restrictions on African and Caribbean nations under the thinnest of pretexts. To us, the message is clear: if you are the wrong colour and hail from a former colony, you’re not welcome. Of course, you’re more than welcome if you are Ukrainian or bringing money or minerals.View image in fullscreenA report on the roots of the Windrush scandal posted on the UK government’s website summarises, “major immigration legislation in 1962, 1968 and 1971 was designed to reduce the proportion of people living in the United Kingdom who did not have white skin.” Sixty years later, the UK still engages this socio-political ideology.Take the absurd treatment of Trinidad and Tobago. British authorities last month slapped exorbitant visa fees on Trinidadians, similar to Jamaica and Dominica. The justification? A spike in asylum claims – from an average of 49 a year between 2015 and 2019 to 439 in 2023.In the year ending June 2024, the UK’s net immigration was 728,000, a 20% decrease from 2023’s peak of 906,000. Yet 439 Trinidadians cause a “crisis”? This is political theatre staged for a frothing few with empire nostalgia and immigrant paranoia.But the Trinbagonian government cannot be let off the hook. For over a decade, gang violence triggered by smuggled guns from the US, the drug trade from South America and the influx of gang members from Venezuela has worsened under an impuissant minister of security and a government in paralysis.This new UK immigration policy for Trinidad and Tobago isn’t policy, its punishment. It’s the empire rearing its head again – this time in the guise of “immigration control”. If the UK was truly concerned, it could have picked up the phone and spoken to the high commissioner to the UK or even the Prime Minister to find a proportionate solution – as fellow Commonwealth members. But what does the Commonwealth mean any more? A glorified nostalgia club presided over by a monarch few in the Caribbean have ever seen.The Commonwealth is a relic. An expensive, hollow monument to a colonial past Britain refuses to apologise for and the Caribbean refuses to walk away from. Common means subservience, and wealth flows only one way. For example, the judicial committee of the privy council remains the highest court for many Caribbean nations – a colonial backdoor that ensures British influence remains after the union jack has been lowered.View image in fullscreenWhy does the Caribbean still genuflect before a throne that sees it as a holiday destination at best and an aid burden at worst? Why do African nations tolerate the condescension of aid when their stolen minerals fuel the west’s riches? As Bob Marley demanded, we must “emancipate ourselves from mental slavery”?The truth is: the west cannot function without us. It feeds off our resources, our oil and minerals, our intellect. Yet it treats us like pests at the door: unworthy of entry, let alone equality.Why are we still playing this rigged game? Why are we still begging for visas, pleading for asylum, when our presence build these nations in the first place?It’s time we stopped asking for permission, withdrew our labour, our brilliance, ourselves – and left them to stew in their nostalgia, mistaking walls for strength and xenophobia for sovereignty. We’ll build something better.Trump’s sledgehammer approach to diplomacy has torched relationships with Canada, Panama, Greenland, South Africa and the broader African continent. The Caribbean is not spared, least of all that US favourite: Cuba.This time, he unleashed his bulldog secretary of state, Marco Rubio,on Cuba’s quiet but powerful diplomatic engine: its doctors. For decades, Cuban medical professionals have travelled the world, from rural outposts in Africa to hurricane-ravaged villages in Haiti, treating the sick and delivering babies, with the soft diplomacy the US abandoned around the time it thought regime change was a sustainable foreign policy model.Cuban doctors have long symbolised international solidarity, emerging from a nation routinely vilified – because nothing terrifies Washington more than socialism in brown skin. But rather than acknowledge this medical diplomacy for what it is – a humanitarian gift – Rubio has instead accused Caribbean nations of exploiting these doctors, underpaying them and “trafficking” them. The audacity is breathtaking.Rubio threatened to revoke US visas from government officials and their immediate family members in any Caribbean country that accepts Cuban medical workers. Because America now exports moral lectures it no longer even pretends to live by.But this time, the Caribbean didn’t flinch. Leaders across the region responded with collective eye-rolling and a resounding: “Come take your visa.”These are independent nations, not subsidiaries of the US. Caribbean leaders made it clear: Cuban doctors are paid on a par with local medical professionals, they are not coerced, and are free to leave at any time. They are crucial to the region’s healthcare systems.Rubio’s daring to speak on behalf of doctors who have done more good across the global south than the aid-slashing US state department has in decades, is an insult not just to the Caribbean but to common sense.What we are witnessing here is a petulance from a fading empire that has replaced its moral compass with paranoia, and outsourced its diplomacy to the whisperings of an erratic billionaire, delusional oligarchs and baby-faced thinktanks addicted to colonial cosplayAmerica’s diplomacy had died, been cremated and scattered over Mar-a-Lago.So while Washington plays imperial hardball with nations trying to provide healthcare to their citizens, the rest of us are left wondering, again, why we allow ourselves to be bullied by a country that cannot keep its own citizens out of medical bankruptcy.At some point, the Caribbean – and the wider global south – must draw a red line. Not just rhetorically, but structurally. We need new alliances, new trading currencies, new friends, new models of cooperation rooted not in colonial debt but mutual respect.Because it is increasingly clear that the US is not interested in partnerships – it wants puppets. Preferably black or brown-skinned, desperate and pliable. More

  • in

    ‘It’s back to drug rationing’: the end of HIV was in sight. Then came the cuts

    This year the world should have been “talking about the virtual elimination of HIV” in the near future. “Within five years,” says Prof Sharon Lewin, a leading researcher in the field. “Now that’s all very uncertain.”Scientific advances had allowed doctors and campaigners to feel optimistic that the end of HIV as a public health threat was just around the corner.Then came the Trump administration’s abrupt cuts to US aid funding. Now the picture is one of a return to the drugs rationing of decades ago, and of rising infections and deaths.But experts are also talking about building a new approach that would make health services, particularly those in sub-Saharan Africa, less vulnerable to the whims of a foreign power.The US has cancelled 83% of its foreign aid contracts and dismantled USAid, the agency responsible for coordinating most of them.Many fell under the President’s Emergency Plan for Aids Relief (Pepfar) programme, which has been the backbone of global efforts to tackle HIV and Aids, investing more than $110bn (£85bn) since it was founded in 2003 and credited with saving 26 million lives and preventing millions more new infections. In some African countries it covered almost all HIV spending.View image in fullscreenThere is a risk, says Lewin, director of Melbourne University’s Institute for Infection and Immunity and past president of the International Aids Society, of “dramatic increases in infections, dramatic increases in death and a real loss of decades of advances”.There is no official public list of which contracts have been cancelled, and which remain. It appears that virtually no HIV-prevention programmes funded by the US are still in operation, save a handful principally providing drugs to stop pregnant women passing on the infection to their babies. Countries report disruption to the most basic measures, such as condom distribution.Some treatment programmes have been spared, but not those whose focus conflicted with the Trump administration’s war on “gender ideology” or diversity, equity and inclusion (DEI), such as those working with transgender communities. Doctors, nurses and other healthcare workers have been laid off, while worried patients are hoarding drugs or stretching supplies, according to UNAids surveillance. UNAids itself has lost more than half of its funding.Even programmes that have survived the cull have faced turmoil since February, with instructions to stop work rescinded but with no certainty that funding will continue.View image in fullscreenIn only one example, the Elizabeth Glaser Paediatric Aids Foundation says it has had to halt HIV treatment for 85,000 people in Eswatini, including more than 2,000 children, and tests for thousands of pregnant women and babies to prevent transmission and begin life-saving medication.Access to drugs represents an “immediate crisis”, Lewin says. “If people with HIV stop the medications, then not only do they get sick themselves, which is tragic, but they also then become infectious to others.”As clinics on the frontline of treating the disease scrabble to secure access to basic drugs, scientists at this month’s Conference on Retroviruses and Opportunistic Infections in San Francisco were hearing that HIV might soon be preventable with a once-a-year injection.The drug lenacapavir was already generating huge excitement in the field, after trial results showed that a six-monthly jab could prevent HIV. New results from the manufacturer Gilead suggest that a tweak to the formula and how it is given could see its protective effects last even longer.Nevertheless, Lewin says, the mood at the meeting, packed with many of the world’s leading HIV specialists, was “dire”.As well as programme cancellations, there are “huge concerns around science and what’s going to happen to the [US] National Institutes of Health, [whose] funding of science has been so significant on every level”, she says.Some scientists in receipt of US funding have been told to remove their names from DEI-linked research, she says, even though DEI is fundamental to the HIV response.View image in fullscreen“I don’t mean that in a sort of touchy-feely way, I mean that’s what we need to do: you need to actually get those treatments to these diverse communities.”In 2022, 55% of all new HIV infections were within “key populations”, such as gay men, other men who have sex with men, sex workers, transgender people, prisoners and people who inject drugs.Prof Linda-Gail Bekker, of South Africa’s Desmond Tutu Health Foundation, has seen US funding for three trials of potential HIV vaccines involving eight countries cancelled and only reinstated after an appeal to the US supreme court.“We’re running around like chickens without heads to at least get one going, because the vaccines are sitting in the fridge and will expire,” she says.She led the lenacapavir trial that showed it offered 100% protection to young women in sub-Saharan Africa, but now worries about HIV/Aids prevention “falling off the radar completely”.The global community had been making headway towards the United Nations’ goal of ending Aids by 2030, she says, with a five-year plan to use “amazing new innovative tools and scale them up”, which would have led to “less dependence on foreign aid and more self-reliance” as new infections fell and attention shifted to maintaining treatment for people with HIV.“All of that is hugely at risk now because, without these funds, our governments will have to step up but they will concentrate on treatment,” she says. “We know they will do that, because that is what we did for the first 30 years.”Efforts to control Aids were entering “the last mile”, which was always likely to be more expensive, she says. “The people who were happy to come into health facilities, they would have come into health facilities.”It would be difficult to rely on government funding to reach the remaining groups, she says, not only because of fewer resources but also because in some countries it means targeting groups whose existence is illegal and unrecognised, such as sex workers or sexual minorities, and young girls may be reluctant to use government clinics if they are not supposed to be sexually active.“I feel like the odds are very stacked against us,” says Bekker, adding: “We’re obviously going to have to re-programme ourselves [and] formulate a different plan.”Pepfar had pledged funding to the Global Fund to Fight Aids, Tuberculosis and Malaria, to deploy 10m doses of lenacapavir in low-income countries. While the Global Fund has promised to maintain its commitment, it might receive fewer than the planned number of doses, Bekker fears.“Six months ago, I was saying the best thing we can do with lenacapavir is offer it to everybody in a choice environment. [Now] I think we’re gonna have to say who needs [injectable] prep,” she says, “and the rest have to do the best they can.“How do we make that decision? And what does that look like? It is back to sort of rationing.“When we started ARVs [antiretroviral drugs] way back in 2000,” Bekker recalls, “you would go, ‘you get treatment; you don’t, you don’t, you don’t’.“It feels terrible … but you have to get over that. You have to say it will be infection-saving for some people. And we’ve got to make it count.”View image in fullscreenFor Beatriz Grinsztejn, president of the International Aids Society, the disruption is critical and threatens many vulnerable people. But, she adds, it could present “an important opportunity for ownership – otherwise we are always left in the hands of others”.She worries about the impact of cuts to funding on younger scientists, with their potential loss from the research field “a major threat for the next generation”. But, she adds, the HIV community is “powerful and very resilient”.There have already been calls for new ways of doing things. It is “time for African leadership”, members of the African-led HIV Control Working Group write in the Lancet Global Health. There are now plans for Nigeria to produce HIV drugs and tests domestically.Christine Stegling, deputy director of UNAids, says it began “a concerted effort” last year to develop plans with countries about how their HIV programmes could become more sustainable domestically “but with a longer timeframe … now we are trying to do some kind of fast-tracking”.Governments are determined, she says, but it will require fiscal changes either in taxation or by restructuring debt.The goal of ending Aids by 2030 is still achievable, Stegling believes. “I think we have a very short window of opportunity now, in the next two, three months, to continue telling people that we can do it.“I keep on reminding people, ‘look, we need to get back to that same energy that we had when people were telling us treatment can’t be available in the global south, right?’ And we didn’t accept it. We made it happen.“We have national governments now who are also very adamant, because they can see what can happen, and they want to make it happen for their own populations.” More

  • in

    Trump is tearing up the rights of women. The message from your sisters in the Arab world? Don’t give up: resistance works | Hibaaq Osman

    From outside the US looking in, those of us who have experienced the tumultuous years since the Arab revolutions feel a strange sense of familiarity: the chaos of the Trump-Musk administration, the attacks on minority groups, the elevation of men – a number of whom have been accused of violence against women – to cabinet positions.Trump seems to have started his second term with the same ferocity, callousness, violence and ignominy in which his first term so notoriously ended. Amid the shock of the past few weeks, a sense of panic can be immobilising. But that is exactly what such a strategy is designed to do.For women in the US who now feel under attack like never before, who sense their rights, even their bodily autonomy, slipping through their fingers, I bid a weary but warm welcome to the club. You must know that you do not need to look far for solidarity. There are women in the US who have had to fight every step of the way to have their humanity recognised by a bigoted and over-mighty state. African American women, Indigenous American women, Latin American women – their civil rights struggles have been extraordinary and hugely influential across the world.But if I may, there are many examples to be shared of women in the Arab world who have taken on the laws, institutions and cultures of oppression that mired their daily lives – and won.With some US politicians now looking to bar women from seeking an abortion beyond state lines, you can take inspiration from the women of Libya. Twice now, the Libyan authorities have declared their intention to ban women from independent travel without a male “guardian”. Female activists met these proposals with campaigns that raised global attention and condemnation, exerting political and diplomatic pressure that resulted in the proposals being rescinded.That this is possible in a country in which decades of dictatorship and conflict have prevented the establishment of a democratic culture shows the power of women organising together in grassroots advocacy. Even when the levers of power are not accessible directly, there is still huge power in working together strategically.When women in Jordan and Lebanon started work on addressing colonial-era laws that meant convicted rapists could escape punishment by agreeing to marry their victim, there were not many female parliamentarians they could find to champion their cause in the corridors of power. So they found other means. On social media, they developed hugely creative campaigns. Through this activism, women’s groups built coalitions that put the issue on the political agenda, with the laws abolished in both countries within days of each other.Such laws – which could still be found on the statute book in France as late as the 1990s – are based on an all-too-common belief that it is more shameful to be the victim of rape than it is to be the perpetrator. The work in Jordan and Lebanon then finds a haunting echo in the amazing courage shown last year by Gisèle Pelicot. Her case emphasises that while legal or constitutional changes are vital, the more difficult but fundamental task is to change a culture that allows such violence and discrimination to be conceived and committed at all.It makes me think of the incredible work going on in Egypt led by my colleagues reaching out to religious leaders. Over years, these activists have brought imams to engage with a study on women’s rights, gradually overcoming resistance and demonstrating compatibility with their faith.Some leaders went further, using the study in sermons and advocating for policies such as criminalising early marriage. That work has required incredible patience, persistence and compassion. It takes a lot to understand where people are coming from and to build a platform for respectful conversation, all without ceding ground or your own principles. But it can be done.Such a task of dealing with, and challenging, deeply held beliefs faces women in the US.American women did not suddenly wake up one morning to find sexual abusers in the White House. The path to this point has been long and ignominious. If things are to change for the better, the road ahead is equally long and challenging – but women can lead the way. There will be missteps, there will be failures. But nothing at all will be achieved if those disgusted and enraged by this state of affairs choose to sit back.The triumphs I have witnessed have been the fruit of years of hard work, of determination, of people being prepared to take risks. The stakes in the US show the time for playing it safe is long gone. This is a time to make noise, to find strength in solidarity and being part of a movement.The Trump administration threatens not only the health and rights of women within the US, but the progress that women have made globally. His cuts to American development, humanitarian and medical aid overseas are already having devastating consequences for women and girls facing violence, armed conflict, disaster and disease. And by cosying up to regimes notorious for perpetrating organised gender-based violence, he threatens decades of work to address the impact of conflict on women and girls.In this fight, women across the world are with our US sisters. Our cause is one – it has always been. To stand up against the injustice and inequality you see is an awesome challenge, but it is not one you are facing alone. More

  • in

    The Long Wave: Why Trump’s USAid freeze endangers millions

    Hello and welcome to The Long Wave. I have been following Donald Trump’s suspension of the US Agency for International Development. USAid is the world’s single biggest aid donor, and the decision to halt its work has sent shockwaves around the world. This week, I trace the effects of its potential demise on the Black diaspora. But first, the weekly roundup.Weekly roundupView image in fullscreenFresh calls for DRC ceasefire | A summit of leaders from across Africa, including Rwanda and the Democratic Republic of the Congo, has called for an immediate and unconditional ceasefire in DRC. The Rwanda-backed M23 rebel group has seized swathes of territory in eastern DRC, leaving thousands dead or displaced.Altadena seeks justice for LA fire victims | A memorial service at the First African Methodist Episcopal church in Pasadena, led by the Rev Al Sharpton, has highlighted the Eaton wildfire’s disproportionate impact on Altadena’s Black residents in a rally for justice and equality.Liverpool waterfront’s role in slavery | Canning Dock in Liverpool, England, where ships trafficking enslaved Africans to the Caribbean were fitted out and repaired, is opening to the public so lesser-told aspects of its history can be explored. This project, alongside other redevelopment programmes, aims to shed light on the waterfront’s role in the transatlantic slave trade.Overtourism fears for Bo-Kaap | Residents of the picturesque, candy-coloured Bo-Kaap district in Cape Town, South Africa, are grappling with the impacts of tourism. Many have expressed frustration about road traffic, crowds blocking streets for photos and rising gentrification.Black hair animation makes waves | Researchers at Yale University and the University of California, Santa Cruz, have developed algorithms to capture the true form of afro-textured hair in animation and computer graphics. The development marks a huge step for the portrayal of Black characters in animated films, cartoons and video games.In depth: What is USAid and why has it been suspended?View image in fullscreenThe significance and reach of USAid’s operations came very close to home when I realised that even in the war-stricken cities of my birthplace, Sudan, USAid was providing support to soup kitchens crucial to the survival of cut-off civilian populations. The freezing of USAid’s work has severely compromised these life-saving efforts, as well as that of US-funded facilities caring for malnourished babies. In the capital, Khartoum, two-thirds of Sudan’s soup kitchens closed in the first week after the aid suspension.On Donald Trump’s first day in office, he announced a 90-day pause in the organisation’s operations because they were part of a “foreign aid industry and bureaucracy … not aligned with American interests”. USAid was established by John F Kennedy in 1961 as an independent agency of the US government. It grew to have a large remit, providing everything from humanitarian assistance to disaster relief. But it also plays a role in education, promoting democratic participation and governance, and supporting the health ministries of the countries it operates in. The range of its programmes and the number of locations in which it is active is staggering.The USAid budget was more than $40bn in the 2023 fiscal year. The suspension, which looks like a permanent dismantling, is embroiled in legal disputes. A federal judge has blocked the decision to put thousands of USAid workers on administrative leave, on the grounds that the Trump administration does not have the authority to abolish an agency established by congressional legislation. As the process unfolds, the work of the agency has been halted overnight, with severe repercussions.Sub-Saharan AfricaView image in fullscreenCountries in sub-Saharan Africa account for more than a third of US foreign assistance spending. In addition to famine relief and medical and humanitarian support in conflict areas such as Sudan, USAid assists health ministries and, most urgently, a large sexual health and HIV prevention programme. Approximately 40,000 healthcare workers in Kenya partly financed by USAid are likely to lose their jobs. The impacts on treatment available to patients, pregnant women and disease treatment are almost too vast to estimate.What is unfolding in South Africa – where patients have showed up for treatment and medication to find that clinics were closed – offers a small insight into what could happen next to people at the sharpest end of medical emergencies. The country is in the grip of one of the world’s largest HIV/Aids epidemics, constituting a quarter of cases worldwide.Latin AmericaView image in fullscreenUSAid’s work focuses on the challenges most prominent in any given location. In Latin America, support for those displaced by guerrilla violence, integration of migrants and the prevention of sexual exploitation have relied heavily on US foreign assistance. Almost 8 million Venezuelans have left the country in the past decade, fleeing economic crises and settling in neighbouring countries. About 3 million of them are in Colombia, the largest recipient of US foreign aid in South America. Last year, USAid funded the feeding and nutrition of a large number of refugees in Colombia, partnering with the UN World Food Programme and extending almost $50m in relief. Abandoning such vulnerable populations not only deprives them of food, but leaves them prone to exploitation and abuse by the sort of criminal gangs that prey on the displaced and hungry.skip past newsletter promotionafter newsletter promotionThe ramifications of the suspension extend to the preservation of precious and fragile ecosystems. In Brazil, USAid forged the Partnership for the Conservation of Amazon Biodiversity, an agreement that supports Indigenous people and rural communities, and in doing so protects the Amazon and helps combat the climate emergency. The loss of that support affects not just these communities and those employed by such foreign assistance programmes, but the environmental health of the planet.The CaribbeanView image in fullscreenIn the Caribbean, USAid projects are diverse and embedded in civil society, environmental protection and future proofing younger generations. In Jamaica, among the programmes that have halted is the Youth Empower Activity, which is targeted at the most at-risk people. It helps them access education, professional training and improve job prospects, with a view to increasing household income and promoting national development. Thousands of Jamaicans are enrolled in the scheme – but now a total of $54m of US funding is under threat in the country, according to government estimates.The suspension could also interrupt a USAid-funded, Caribbean-wide project to bolster food security by increasing fruit and vegetable farming, scholarships for degrees in agriculture and support for small farmers. The shutdown came days after the launch of a programme to reduce the risks to marine and coastal biodiversity – an attempt to ameliorate an environmental crisis affecting the region’s coral reefs and biodiversity. Beyond the impact on individuals, small business owners, and the environment, there is, as with all such stoppages, the loss of livelihoods of people employed by these schemes.Soft power lostView image in fullscreenDespite the large sums deployed, USAid, and US foreign assistance in general, is perceived to also benefit the United States. Although it cannot be quantified in exact numbers, supporters say such assistance contributes to the US’s soft power abroad. That soft power is twofold: the first is in a sort of preventive measure, whereby aid helps to stabilise poorer countries and pre-empt deepening crises that could compromise the US’s global security agenda. The second is that aid is seen as a bulwark to the influence of countries such as Russia and China, both of which are particularly active in Africa, for example. In maintaining a presence on the ground across the world, and strong alliances with governments and civil society organisations, the US promotes a foreign policy that aims to curtail the ability of its adversaries to create their own alliances and political footholds.Aid model under scrutinyView image in fullscreenThe speed of the suspension, and how it has plunged so many around the world into hunger and uncertainty, raises questions about the wisdom of depending so profoundly on a country that has proven to be so unreliable. Ken Opalo, a specialist in development and the author of An Africanist Perspective on Substack, wrote: “The cuts are a painful reminder that aid dependence isn’t a viable development strategy.” If the USAid suspension remains, that viable development strategy, or the stepping in of alternative funders, will not materialise overnight. In the meantime, millions of people wait to learn if their sudden change in circumstances will become permanent, subject to a huge constitutional battle thousands of miles away.

    To receive the complete version of The Long Wave in your inbox every Wednesday, please subscribe here. More

  • in

    RFK Jr could have disastrous global impact on public health, experts fear

    The appointment of a US health secretary with anti-vaccine views could cause deaths and have profound consequences around the world, global health experts fear.Robert F Kennedy Jr, Donald Trump’s pick for the position, has a history of spreading misinformation on vaccines and questioning the science of HIV and Aids.His nomination has been greeted with bemusement and alarm. One global health activist, speaking on background, said the move was akin to making the disgraced doctor Andrew Wakefield, who falsely claimed that the MMR vaccine caused autism, the UK’s health secretary.Prof Sir Simon Wessely, a regius professor of psychiatry at King’s College London, said of the move: “That sound that you just heard was my jaw dropping, hitting the floor and rolling out of the door.”Prof Sir Andrew Pollard, the director of the Oxford Vaccine Group, said there was real concern that Kennedy might use the platform “to pursue the same anti-science positions on life-saving public health interventions that he has advanced previously”.He added: “If this makes families hesitate to immunise against the deadly diseases that threaten children, the consequence will be fatal for some.”Prof Beate Kampmann, of the London School of Hygiene & Tropical Medicine, said the measles vaccine had averted more than 60m deaths worldwide in the last 25 years.“Progress will be rapidly lost in societies where vaccine hesitancy is promoted – as I fear will be the case in the US if Kennedy is appointed,” she said. Beyond US shores, the influence “could swing either way”, she said. “My worry is that polarisation on the topic will further increase.”The US is a huge force in global health as the largest funder and the home to many big pharmaceutical companies and leading health research institutes. The decisions of its regulators, such as the Food and Drug Administration, are closely watched by their equivalents elsewhere.Some of those institutions are likely to be disrupted by Kennedy’s pledge to “clear out corruption” at US health agencies and potentially eliminate entire departments. But the impact of a Trump administration on global health will be broader than any policies pursued by Kennedy alone. Trump could reinstate plans to withdraw from the World Health Organization and is almost certain to cut funding to UNFPA, the United Nations sexual and reproductive health agency that works in many poorer countries.As under all Republican presidents since Ronald Reagan, NGOs expect there to be a “global gag rule” banning recipients of US health funding from performing or promoting abortions anywhere in the world, which will potentially expand to cover even recipients of humanitarian aid.Kennedy’s stance on vaccination is being watched warily. Globally, routine vaccination coverage has yet to return to pre-pandemic levels. Lower immunisation rates led to a 20% annual increase in measles cases in 2023.Kennedy has previously made common cause with anti-vaccine groups overseas. In June 2019 he visited Samoa, where the measles vaccine was being blamed for the deaths of two babies a year earlier. It later emerged that the deaths had been caused by incorrect preparation of the vaccine mixture.Immunisation rates halved to 31% and not long after his visit a measles outbreak ended up infecting more than 57,000 people and killed 83, including children. Even as the outbreak raged, Kennedy wrote to the Samoan prime minister suggesting it might have been caused “by a defective vaccine” rather than inadequate coverage. Kennedy said previously he bore no responsibility for the outcome.His nomination was greeted with cautious civility in Berlin, where Kennedy made a name for himself as a coronavirus sceptic during the pandemic. The health minister, Karl Lauterbach, a qualified doctor, offered his congratulations but couched it in language that made his scepticism clear. “Here’s to a constructive collaboration. Will certainly not be just easy. But the choice of the voters is to be respected,” he wrote on X.Kennedy managed to enter Germany in 2020 despite tight travel restrictions in order to address coronavirus sceptics at a rally in the capital. He became a hero of the so-called Querdenker anti-coronavirus conspiracy theorist group, speaking to a demonstration attended by about 18,000 people.Kennedy drew parallels between his presence in Berlin, as a “fighter against totalitarianism”, and his uncle John F Kennedy’s appearance there in June 1963 during the cold war when he said the city had previously been a front against totalitarianism.On Friday, individuals and groups linked to the Querdenker movement welcomed the appointment, with some claiming Kennedy would “save the rest of the world”.The Hartmannbund association of German doctors voiced its concern about the overall effect a Trump presidency could have on Germany’s healthcare system. Its chair, Klaus Reinhardt, warned of the potential impact of any trade war between the US and Europe on the supply of medicines, saying issues over tariffs could greatly increase health costs and the individual contributions currently required by Germany’s health insurers.Scientific leaders say another pandemic is inevitable and that while during the Covid-19 pandemic Trump’s Operation Warp Speed aided the development, approval and mass manufacture of vaccines in record times, similar US leadership under Kennedy appears less likely.On other issues, experts are waiting for more detail on Kennedy’s plans. He has pledged to tackle chronic diseases and address the issue of overly processed foods. Leadership in those areas could be welcome in a world where diabetes rates have doubled in the past three decades.Many global health activists said they would agree with Kennedy that big pharma has questions to answer, but that companies should not be falsely accused of making vaccines that harm people; rather, they should be asked why so much of the world does not have access to affordable medicines. More

  • in

    Is circular migration a solution to the crisis at the US border? Guatemala provides a clue

    Arnoldo Chile, 33, drives his old Toyota pickup truck through the orchards that stretch across the slopes of the mountains surrounding the Guatemalan community of El Rejón in Sumpango, about 45 minutes from Antigua Guatemala, one of the country’s leading tourist destinations. People in this small village in the Sacatepéquez department rely almost entirely on agriculture as their primary source of income.View image in fullscreenHowever, most struggle to make a living, leading to poverty and social exclusion. Facing these challenges, several of Chile’s neighbours have emigrated illegally to the US, hoping to make enough money to support their families.His case, however, is different. Thanks to the circular migration programme by the Cuarto Pinos agricultural co-operative and the Juan Francisco García Foundation, he obtained an H-2A visa that allows him to work in agriculture in the US for several months each year.“At first, I was a bit sceptical that this project could work; I thought it might be a scam like others that have happened in Guatemala before. But since my first time in 2016, I’ve been to the US several times under this programme,” says Chile.He harvested broccoli, cabbage and lettuce in the early years, eventually being promoted to row boss, assisting the supervisor. “I earned $19 (£14.50) an hour and made about $3,500 (£2,700) a month, while here in Guatemala, I could only earn about $450 (£340) a month,” he says.Using his earnings, Chile bought a small plot of land near his village, El Rejón, and now provides work for several family members, primarily in blackberry production.View image in fullscreenAs migration across the US-Mexico border hit its lowest level in three years in the first few months of 2024, driven by the Joe Biden administration’s strict enforcement policy, the humanitarian costs of crossing are mounting. People arriving from South and Central America stranded in Mexico are facing increasing dangers, and reports of deaths at the border are on the rise.In this context, Guatemala’s circular migration offers legal, safer pathways for workers to make a living in the US and support their home communities – surely a better alternative to the migration crisis in the Americas.An estimated 2.9 million Guatemalans live outside their country, mainly in the US. According to Úrsula Roldán, who has a PhD in geography and is the director of the Institute of Socio-Humanistic Sciences at Rafael Landívar University, they usually migrate to escape low incomes, poverty and the risk of social exclusion in a country where the state often fails to meet their needs for education, health and other basic public services.Another reason, she says, is chain migration, when individuals already established in the US call for their relatives to join them. “With the climate crisis, the country has been facing floods and droughts that further worsen this situation. This results in crop failures, leaving rural families in even more dire conditions in Guatemala,” Roldán adds.The results of circular immigration leave scholars such as Roldán in little doubt about its efficiency. The immediate families of regular migrants who participate in these programmes receive better education and healthcare access, which is crucial in avoiding social exclusion.View image in fullscreen“This project was created in response to a combination of economic, social and environmental factors affecting rural families in our country,” says Vanessa García, the head of social responsibility at Cuatro Pinos. “Many families seek better job opportunities, and remittances sent by migrants have become a crucial source of income, motivating many to migrate irregularly.”Different studies suggest that over the years, gender roles tend to shift within families with regular migrants, showing a greater focus on gender equity and a gradual empowerment of women, those who migrated and those who remained in the home country managing the family income.“The communities have seen improvements in development as migrants have bought more land and increased their vegetable production for export, providing jobs for women and men in their communities,” says García.View image in fullscreen“There have also been improvements in housing, education, and the nutrition of their children, which is essential. Some families have also started businesses within the community,” she adds.skip past newsletter promotionafter newsletter promotionElsewhere in El Rejón, Juan Francisco Yucute, 32, reviews the accounts of the small store he managed to open with his wife, thanks to the money he made working in the US under the circular migration programme, where he earned about $12 (£9) an hour. He participated in the scheme on four occasions, and was away for four to five months each time.View image in fullscreenHe is has left the programme, as the company he worked for in Arizona no longer needed him. However, the money he saved allowed him to start his small business and build two adjacent premises he now rents to neighbours.“My wife and I used to work in the fields before I went to the US, just like most people in our community,” says Yucute, who thought about going to the US illegally until he heard about the circular migration scheme. “My idea of opening the store was so that she and my daughters could have a less strenuous job than agriculture, where you have to spend hours under the sun and rain, and in a village where the roads to the fields are dangerous.”According to a report, the expenses for circular migration typically range between $500 (£382) and $1,000 (£765), covering administrative costs, travel and other fees. This is significantly less than the $12,000 (£9,200) to $15,000 (£11,500) demanded by smugglers for irregular entry into the US, a method that does not always guarantee success.“For migrants, using coyotes [people smugglers] is an alternative route to reach the US. We know that US anti-immigration policies have tightened border controls, which has increased the risks posed by drug trafficking and organised crime along the migration route, making circular migration a viable option,” says Roldán.View image in fullscreenThe process to obtain a temporary work visa in the US is complex. It can take up to 120 days, as the Department of Labor requests certification to justify hiring foreign workers where there is no local workforce. If no local candidates are found for the position, the employer can apply for a visa for foreign workers and often starts international recruitment with the help of specialised agencies.Despite increasing numbers of Guatemalans seeking H-2A and H-2B visas to take part in circular migration programmes, irregular migration continues to prevail. In 2022, it was estimated that about 11,000 temporary workers from Guatemala arrived in the US under circular migration programmes.However, these numbers are significantly lower compared with the 55,302 Guatemalans deported by air from the US or the 222,085 encounters with law enforcement while attempting to cross the US border illegally in 2023.View image in fullscreenBlanca Paola Canel, 25, is well acquainted with this situation as her husband emigrated to the US irregularly. She choose to stay in their village of San José Yalú, near Sumpango, where she now runs the bakery they started together two years ago. Since then, her business has thrived. Not only has she succeeded, but she has also employed some of her relatives and several local young people.“I know many people from here who went to the US illegally. As for me, I never wanted to leave because I have this business that I need to oversee and manage,” says Canel. “I’ve been able to sustain and expand the business and offer employment to five or six people. I hope we can continue to create jobs in Guatemala.” More

  • in

    What is the Pepfar fight and what does it mean for Africa?

    What is Pepfar and why is it in the news?Pepfar is an acronym for the US “president’s emergency plan for Aids relief”. It was set up two decades ago by George W Bush to address the HIV epidemic.It’s the biggest government-run fund of its kind. Since 2003, the project has donated about $110bn (£90.5bn) to governments, universities and nonprofits in 50 countries, either directly or through agencies such as USAid.Until now Pepfar has been funded in five-year cycles. In the past the programme has had virtually unanimous support from Republicans and Democrats. But the next funding cycle (from 2023 to 2028) became ensnared in US abortion politics and the fallout contributed to Congress missing the 30 September deadline to allow another five-year funding cycle for the initiative.What’s the link between Pepfar and abortion?US laws already prevent Pepfar (or any state agencies) from paying for abortion services, according to the California-based policy research group, Kaiser Family Foundation (KFF). But in May, a coalition of conservative thinktanks and lawmakers began to make waves with arguments that Joe Biden’s administration has “hijacked” Pepfar to promote abortion instead of treating and preventing HIV.That’s where the risk to Pepfar’s five-year budget emerged – because the Republican lawmakers then refused to sign off on a spending bill for Pepfar if there weren’t stricter rules in place to stop Pepfar funds from overlapping with abortion services in any way.According to Brian Honermann, deputy director of public policy at the US-based Foundation for Aids Research, the allegations that Pepfar has been usurped to push a “radical social agenda” overseas are “baseless” and “stitched together from unrelated policy speeches, documents and assertions about how those apply to Pepfar”.What will happen to Pepfar now?The multibillion-dollar health programme is a permanent part of US law. That means Pepfar funding will continue, but it will lose its favoured position of receiving five years of funding at a time.The failure to reauthorise Pepfar will mean some of its built-in rules will expire, including a guideline that requires 10% of Pepfar money to go to orphans and children in need.Will organisations and governments lose their Pepfar grants?The fund has enough money to pay governments and civil society organisations until September 2024 (about $6.8bn), but a state department spokesperson warns that Pepfar won’t escape unscathed in the long term.Moreover, getting funding for only one year at a time will make it harder for Pepfar to plan ahead and to source crucial HIV tools, such as condoms or medicine, at the best prices. This could ultimately imperil the people that rely on the fund’s support, the spokesperson warned.The symbolic power of a five-year commitment will also be lost, says Honermann. “It shows partner countries that the US is invested for a significant period of time and that Pepfar won’t just disappear.”The threat of a permanent ‘gag rule’Another factor has swirled around Pepfar’s funding drama: some lawmakers have said they’ll only agree to restart the five-year funding regime if the fund is once again subject to the “Mexico City policy”, also called the “gag rule”.The gag rule bans organisations and governments from providing or promoting termination of pregnancy services regardless of whose money they’re using to do it. It was expanded to apply to Pepfar for the first time in 2017. It is only ever enforced when there’s a Republican president in the White House, so is not currently in effect.And while there is no finalised legislation that would make a permanent gag rule a reality (and Honermann argues it would be unlikely to get past the Democrats), the threat of it may already have done some damage.Research conducted by Fòs Feminista, a global alliance that advocates for sexual and reproductive rights, found that the 2022 decision to roll back the national right to an abortion in the US had a contagious impact in a number of countries. In Nigeria, for instance, respondents told Fòs Feminista that local lawmakers were using the change in US abortion laws to push back on a more liberal law in their country. Terminations are legal in Nigeria only if carrying the foetus to term threatens the mother’s life.Recipients of US government funding are often so worried about losing it that they enforce abortion laws more harshly than is necessary. Research shows that confusion about whether the gag rule had been revoked at the start of the Biden administration resulted in the policy – and its harms – being in place for much longer in practice.And the Pepfar wrangling and attendant media coverage has already resulted in mixed messages reaching health advocates in Africa. Some South African activists told the Guardian they were concerned that the news would be calamitous for civil society in the country. Such organisations receive the most Pepfar dollars (44%) in South Africa according to 2020 tracking data. The government gets just under 1.5% of the money.Honermann says that there is an intentional political strategy to keep communication about the changes in restrictions vague. “It’s a way to encourage over-enforcement for fear of falling on the wrong side of this.”He adds: “For now, Pepfar will continue as long as funding is made available. But these political threats to the programme are ultimately playing with the lives of millions of people worldwide who rely on this programme.”What has the reaction been in Africa?Dave Clark is the chief operating officer at the Aurum Institute, a non-profit that works on HIV and tuberculosis (TB) projects in South Africa, Mozambique, Ghana, Lesotho and Eswatini.Aurum is a partner for Pepfar’s Dreams project which works towards an Aids-free future for girls and women aged 10 to 24 by providing HIV services, contraception and violence prevention support for women, adolescents and their sexual partners.One of the major strengths of Pepfar, Clark says, is that it’s a sure-fire source of carefully planned funding for global health in a world that is often more talk than action.He explains: “The debate in America should not throw us off saving lives. Pepfar is what it says on the label: president’s emergency plan for Aids relief. That’s its extraordinary power and legacy.” More