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    Be clear about what Trump and Musk’s aid axe will do: people will face terror and starve, many will die | Gordon Brown

    An earthquake of magnitude 7.0 or above could not have caused more carnage. Recent floods in Asia and droughts in Africa have been catastrophic, yet they have inflicted less damage and affected fewer people than the sudden withdrawal of billions of dollars of US aid from the world’s most volatile hotspots and its most vulnerable people. Coming alongside President Trump’s plan for a US takeover of Gaza, the US administration’s resolve to shut down its international aid agency sends a clear message that the era when American leaders valued their soft power is coming to an end.But while the Gaza plan is as yet only on the drawing board, USAid cuts – which will see funding slashed and just 290 of the more than 10,000 employees worldwide retained, according to the New York Times – have already begun to bite this week. We have seen the halting of landmine-clearing work in Asia, support for war veterans and independent media in Ukraine, and assistance for Rohingya refugees on the border of Bangladesh. This week, drug deliveries to fight the current mpox and Ebola outbreaks in Africa have been stopped, life-saving food lies rotting at African ports, and even initiatives targeting trafficking of drugs like fentanyl have been cut back. One of the world’s most respected charities, Brac, says that the 90-day blanket ban on helping vulnerable people is depriving 3.5 million people of vital services.One critical programme has been granted a limited waiver. Pepfar, created by Republican president George W Bush, offers antiretroviral prescriptions to 20 million people around the world to combat HIV and Aids. Its activities escaped the ban only after warnings that a 90-day stoppage could lead to 136,000 babies acquiring HIV. But it has still been blocked from organising cervical cancer screening, treating malaria, tuberculosis and polio, assisting maternal and child health, and efforts to curtail outbreaks of Ebola, Marburg and mpox.Not only does the stop-work edict mean that, in a matter of days, the US has destroyed the work of decades building up goodwill around the world, but Trump’s claim that America has been over-generous is exposed as yet another exaggeration. Norway tops the list as biggest donor of official development assistance (ODA) as a percentage of gross national income (GNI) at 1.09%; Britain is at just over 0.5%, albeit down from the UN target of 0.7%; but the US is near the bottom of the advanced economies at 0.24% – alongside Slovenia and the Czech Republic. It is simply the size of the US economy – 26% of world output – that means that the 0.24% adds up to more aid than any other country. The US provided $66bn in 2023, making USAid a leader in global humanitarian aid, education and health, not least in addressing HIV/Aids, malaria and tuberculosis.On Sunday night, Trump told reporters that USAid had been “run by a bunch of radical lunatics, and we’re getting them out”. “I don’t want my dollars going towards this crap,” his press spokesperson added, with one of the president’s chief advisers Elon Musk calling the agency a “viper’s nest of radical-left marxists who hate America”. “You’ve got to basically get rid of the whole thing. It’s beyond repair,” he said. “We’re shutting it down.”View image in fullscreenIndeed, in a post on X last weekend, Musk shared a screenshot quoting the false claim that “less than 10 percent of our foreign assistance dollars flowing through USAID is actually reaching those communities”. The implication is that the remaining 90% was diverted, stolen, or just wasted. In fact, the 10% figure is the proportion of the budget going directly to NGOs and organisations in the developing world. The remaining 90% is not wasted – instead, it comprises all the goods and services that USAid, American companies and NGOs, and multilateral organisations deliver in kind, from HIV drugs to emergency food aid, malaria bed nets, and treatment for malnutrition. It is simply untrue that 90% of aid falls into the wrong hands and never reaches the most vulnerable.In fact, the initial blanket executive order proved to be such a blunt instrument – the only initial exemptions were for emergency food aid and for military funding for Israel and Egypt – that it had to be modified to include exceptions for what the government called “life-saving humanitarian assistance”, although it stopped short of defining them. “We are rooting out waste. We are blocking woke programs. And we are exposing activities that run contrary to our national interests. None of this would be possible if these programs remained on autopilot,” said a statement released by the state department. The new secretary of state, Marco Rubio, now wants his department to control the whole budget and close down USAid entirely. “Does it make America safer? Does it make America stronger? Does it make America more prosperous?” Rubio asked in a statement that suggested that the America which generally worked multilaterally in a unipolar era is now determined to act unilaterally in a multipolar one.This new stance is not just “America first” but “America first and only” – and a gift to Hamas, IS, the Houthi rebels, and all who wish to show that coexistence with the US is impossible. The shutdown is also good news for China, whose own global development initiative will be strengthened as it positions itself to replace America. Desperate people will turn to extremists who will say that the US can never again be trusted. And by causing misery and by alienating actual and possible allies, far from making America great again, the cancellation of aid will only make America weaker.The tragedy for the planet is that US aid cuts come on top of diminishing aid budgets among the world’s richest economies, from Germany to the UK. International aid agencies are now so underfunded that in 2024, for the second consecutive year, the UN covered less than half of its humanitarian funding goal of nearly $50bn – at a time when increasing conflicts and natural disasters necessitate more relief donor grants than ever. Yes, we can discuss how greater reciprocity can create a fairer system of burden sharing – but further cuts in aid threaten more avoidable deaths, and a poorer world will ultimately make the US poorer too.US generosity is often seen as mere charity, but it is in the country’s self-interest to be generous because the creation of a more stable world benefits us all. We all gain if USAid can mitigate the spread of infectious diseases, prevent malnutrition in the Democratic Republic of the Congo and Sudan, halt the upsurge of IS in Syria and support a fair, humanitarian reconstruction of Gaza and Ukraine. Only the narrowest and most blinkered view of what constitutes “America first” can justify the disaster America has unloaded on the world.

    Gordon Brown is the UN’s special envoy for global education and was UK prime minister from 2007 to 2010 More

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    Government workers sue Trump and Rubio over ‘catastrophic’ USAid cuts

    The largest US government workers’ union and an association of foreign service workers sued the Trump administration on Thursday in an effort to reverse its aggressive dismantling of the US Agency for International Development.The lawsuit, filed in Washington, DC federal court by the American Federation of Government Employees and the American Foreign Service Association, seeks an order blocking what it says are “unconstitutional and illegal actions” that have created a “global humanitarian crisis”.President Donald Trump, Secretary of State Marco Rubio and Treasury Secretary Scott Bessent are among the named defendants, but the text of the suit focuses extensively on actions, and statements on social media, by Elon Musk and his “department of government efficiency” initiative.“The humanitarian consequences of defendants’ actions have already been catastrophic,” the plaintiffs said. “USAid provides life-saving food, medicine, and support to hundreds of thousands of people across the world. Without agency partners to implement this mission, US-led medical clinics, soup kitchens, refugee assistance programs, and countless other programs shuddered to an immediate halt.”Among the actions called illegal are Trump’s order on 20 January, the day he was inaugurated, pausing all US foreign aid. That was followed by orders from the state department halting USAid projects around the world, agency computer systems going offline and staff abruptly laid off or placed on leave.The White House and the departments did not immediately respond to requests for comment.The gutting of the agency has largely been overseen by Musk, the world’s richest man and a close Trump ally spearheading the president’s effort to shrink the federal bureaucracy and replace career civil servants with politically loyal appointees. On Monday, Musk wrote on X, the social media platform he owns, that he and his employees “spent the weekend feeding USAid into the wood chipper”. That statement was presented to the court as an example of the reckless destruction of an agency created by congressional statute.As the Guardian has reported, Musk has also promoted a campaign of misinformation about the agency’s spending to tarnish its image, even sharing a hoax news report linked to a Russian influence operation that claimed, falsely, more than $40m was paid to Hollywood actors to visit Ukraine. Records from the USAid website that were used to debunk Musk’s false claim that the US planned to spend $50m on condoms for Gaza were removed along with almost the entire web history of the agency.“Not a single one of defendants’ actions to dismantle USAid were taken pursuant to congressional authorization,” the lawsuit said. “And pursuant to federal statute, Congress is the only entity that may lawfully dismantle the agency.”The agency’s website now states that as of midnight on Friday “all USAid direct hire personnel will be placed on administrative leave globally, with the exception of designated personnel responsible for mission-critical functions, core leadership and specially designated programs”.The Trump administration plans to keep fewer than 300 employees, out of more than 10,000, sources told Reuters earlier on Thursday.“The agency’s collapse has had disastrous humanitarian consequences,” Thursday’s lawsuit said, including shutting down efforts to fight malaria and HIV. “Already, 300 babies that would not have had HIV, now do. Thousands of girls and women will die from pregnancy and childbirth.”Samantha Power, a former USAid administrator argued in a New York Times opinion article on Thursday that the damage to American prestige was a boon for its foreign adversaries.“I am not surprised that the attacks are being cheered by Moscow and Beijing,” Power wrote. “They understand what those seeking to dismantle the agency are desperate to hide from the American people: USAid has become America’s superpower in a world defined by threats that cross borders and amid growing strategic competition.”Trump’s foreign aid freeze and the shutdown of USAid have also crippled global efforts to relieve hunger, leaving tons of food worth $340m in limbo.“We already see the shutdown’s cost,” Atul Gawande, a surgeon who led global health programs for USAid wrote on X. “Kids with drug-resistant TB, turned away from clinics, are not just dying – they’re spreading the disease. People around the world [with] HIV, denied their medicine, will soon start transmitting virus. The damage is global.”Gawande added that one one veteran foreign service officer told him: “Our government is attacking us. This is worse than any dictatorship where I’ve worked.”The lawsuit alleges that dissolving USAid, which was established as an independent agency in a 1998 law passed by Congress, is beyond Trump’s authority under the constitution and violates his duty to faithfully execute the nation’s laws.It seeks a temporary and eventually permanent order from the court restoring USAid’s funding, reopening its offices and blocking further orders to dissolve it. More

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    Doge v USAid: how Elon Musk helped his acolytes infiltrate world’s biggest aid agency

    USAid security personnel were defending a secure room holding sensitive and classified data in a standoff with “department of government efficiency” employees when a message came directly from Elon Musk: give the Doge kids whatever they want.Since Donald Trump’s inauguration last month, a posse of cocksure young engineers answering to Musk have stormed through Washington DC, gaining access to government computer systems as part of what Senator Chuck Schumer has called “an unelected shadow government … conducting a hostile takeover of the federal government”.The young men, who are all under the age of 26 and have almost no government experience, have tapped into the treasury department’s federal payment system and vacuumed up employment histories at the office of personnel management (OPM). Roughly 20 Doge employees are now working out of the Department of Education, the Washington Post has reported, and have gained access to sensitive internal systems there too. On Wednesday, the Wall Street Journal reported they had infiltrated the Centers for Medicare and Medicaid Services and accessed key systems as well.The young engineers, whose identities have been confirmed to the Guardian, wanted the same at USAid. One of them, Gavin Kliger, was a 25-year-old techie who has defended the failed attorney general nominee Matt Gaetz as a victim of the “deep state” and claimed he had left behind a seven-figure salary to join Doge and “save America”. Another, Luke Farritor, 23, was a former SpaceX intern who had been given top-level clearances to USAid systems and had requested similar to Medicare and Medicaid. A third, Jeremy Lewin, was reportedly assigned to the General Services Administration. A superior planned to lobby the CIA for a clearance for him after he failed to gain access to a secure area.Some US officials had begun calling the young engineers the “Muskovites” for their aggressive loyalty to the SpaceX owner. But some USAid staff used another word: the “incels”.The Guardian has identified three calls by Musk to USAid’s political leadership and security officers in which he demanded the suspensions of dozens of the agency’s leading officials, and cajoled and threatened senior USAid officials to give his acolytes private data and access to restricted areas. At one point, he threatened to call in the US Marshals Service.
    One USAid employee said that the calls by Musk, two of which have not been previously reported, showed he had effectively usurped power at the agency even from the Trump administration’s political leadership. “Who is in control of our government?” the person said. “[Doge] basically showed up and took over.”In the Heritage Foundation’s Project 2025, USAid had been presented as a pilot test for a large-scale overhaul of the federal government that would downsize agencies and arbitrarily move federal employees to looser contracts that made them easier to fire.“If the Trump administration is successful here, they’re going to try this everywhere else,” said Senator Andy Kim of New Jersey, a former USAid employee who came to protest alongside fired and furloughed workers outside the agency’s headquarters on Monday. “This is just the beginning.”View image in fullscreenBut it has also been a primer on how Doge operatives have inserted themselves into federal agencies and cajoled and bullied their way to access their most sensitive systems. This account of Doge’s infiltration of USAid is based on interviews with more than a dozen current and former USAid, state department and other officials briefed on the events of the last week.Security staff initially rebuffed the engineers’ efforts to talk their way into the secure rooms, called sensitive compartmented information facilities (Scifs), because they didn’t have the necessary security clearances. But that evening, Musk phoned a senior official at USAid to demand access for his subordinates, the first of numerous calls to officials and employees of Doge at USAid that have continued into this week.Inside the building, chaos reigned. Areas that were once declared restricted, with limitations on electronics such as phones and watches, suddenly loosened their security protocols to allow in uncredentialed outsiders. Doge employees were said to obscure their identities to prevent online harassment, a tactic that was repeated at other agencies. And Peter Marocco, the controversial new director of foreign assistance at the state department, was stalking the halls and meeting in private with the Doge employees.By Friday, things had gone further downhill. After a tense all-hands meeting with senior staff, and outsiders in the sixth-floor conference room, the young engineers rushed around the offices with their laptops, plugging cords into computers and other electronics as they gathered data from the agency.After the meeting, Matt Hopson, a Trump appointee for USAid chief of staff, abruptly resigned. Jason Gray, the acting administrator, was removed from his position. The secretary of state, Marco Rubio, was soon to announce that he was the new administrator of USAid and appoint Marocco as his deputy. Musk was closing in on his goal.The Doge employees had open access to rooms throughout the sixth floor, including the offices of the administrator’s suite. But the Scifs were still off limits.At USAid, a newly installed leadership was formally in charge. But the real power lay with Marocco and Doge, which was plotting how to wind down the agency, a plan that Trump endorsed on Tuesday afternoon as he confirmed that teams were backed by the White House. That evening, USAid announced it would put all its direct-hire personnel around the world on administrative leave, a decision that would affect thousands of employees and their families.Inside of USAid, the operation to shut down the decades-old operation was being run by Marocco, four engineers in their early 20s and the Doge leadership that contacted them by phone.“It’s all being driven through Doge right now,” said a current USAid official, adding that Doge engineers in USAid headquarters continued to field calls from Musk and Marocco on Monday. “The folks in the building are turning the system off for [USAid employees], they’ve kept a small number of people from the different bureaus to help understand what programs will be kept and not kept, what the footprint will look like.”View image in fullscreenThe tension at USAid headquarters came to a head on Saturday evening, when Doge employees demanded access to the Scif on the agency’s sixth floor. They were stopped by the agency’s top security officer, John Voorhees.Among those present was Steve Davis, according to one current and one former USAid official. Davis, a Musk deputy, has worked with the billionaire for more than 20 years at SpaceX and the Boring Company. He reportedly sometimes slept in the Twitter offices to help Musk slash costs there after he acquired it in 2022.skip past newsletter promotionafter newsletter promotionThe argument over access to the Scif had grown verbally heated and senior Doge staff threatened to call in US marshals to gain access to it. During that standoff, according to one account made to the Guardian, a call was again made to Musk, who, as Bloomberg first reported, repeated the threat to involve the US Marshals Service.Shortly after, Voorhees was placed on administrative leave and the Doge staffers entered the Scif. They took over the access control system and employee records. Within hours, the USAid website went down. Hundreds of employees were locked out of the system that weekend, and many still don’t know their status. (The Guardian has seen emails in which USAid administrators admit they do not know the employment states of current USAid officials.)“I’ve been furloughed, I guess?” said one contractor with 15 years of experience for the bureau for humanitarian assistance, where she had helped coordinate urgent responses in Ukraine, Gaza, Somalia and Latin America. “I don’t know what my status is but I don’t think I work here right now.”By Monday, Kliger wrote an email to all staff at 12.42am to tell them not to bother coming into the building that day.The incident has illustrated how Doge employees with Musk’s backing were able to override USAid leadership and bypass government procedures for accessing restricted areas with classified materials, fueling criticism that his agency is a national security risk.“Did Secretary Rubio allow this kind of access by Musk’s employees?” asked Kim. “It worries me about USAid but if it’s happening here, I’m guessing it’s probably happening at all these other national security agencies.”Formally, Rubio has delegated responsibility to Marocco, who has been pressed by congressional staffers to give details of the changes affecting USAid and the $40bn in foreign aid it manages each year.“The question at hand is: who’s in charge of the state department?” Senator Brian Schatz told the Guardian. “So far the answer has been Pete Marocco.”Doge did not respond to questions about what security clearances, if any, the engineers held. “No classified material was accessed without proper security clearances,” wrote Katie Miller, a Doge spokesperson, on social media.But Scifs are regulated by a strict protocol and it is unclear who could have verified the Doge employees’ credentials and filed the necessary paperwork to allow them to enter.Inside the building, staffers said that Doge cultivated a culture of fear.“It’s an extreme version of ‘who do you trust, when and how?’” said Kristina Drye, a speechwriter at the agency, who watched dozens of senior colleagues escorted out of the building by security. “It felt like the Soviet stories that one day someone is beside you and the next day they’re not.”People started meeting for coffee blocks away because “they didn’t feel safe in the coffee shops here to even talk about what’s going on”, she added.“I was in the elevator one morning and there was an older lady standing beside me and she had glasses on and I could see tears coming down under her glasses and before she got off her elevator she took her glasses off, wiped her eyes, and walked out,” she said. “Because if they see you crying, they know where you stand.” More

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    US federal workers weigh Trump’s buyout offer: ‘We’re feeling petty as hell’

    Amy*, a federal US government employee working for homeland security who was hired by the Joe Biden administration’s refugee programme, has not left her phone out of her sight since last Tuesday, when the Elon Musk-led push for mass voluntary redundancies of government workers began.Since the US office of personnel management (OPM) sent nearly all of the federal government’s 3 million employees an email offering them deferred resignations and warning that, if they choose to stay, they may be laid off or reassigned, US career civil servants have been weighing their options.“It’s just been crazy. A billionaire is taking over a government,” Amy said. “The executive orders against the federal workforce feel designed to create chaos and fear. Musk calls us lazy and described workers at the US Agency for International Development (USAid) as a ‘ball of worms’. They’re trying to dehumanise us to make these changes more palatable, and are trying to rattle enough of us so that a majority of federal employees leave.”Amy was among scores of civil servants from across America who shared with the Guardian what they intend to do with the Trump administration’s “fork in the road” buyout offer, designed to dramatically reduce the ranks of left-leaning federal workers.“While many may think federal employees should take the offer and run, I haven’t spoken to a single person jumping at it,” she said. “Everyone is still digging their heels in and is intent on not taking it. We’re also feeling petty as hell.”Although her department does not qualify for voluntary redundancies, Amy is affected by the blanket return to the office order that was issued.“I was hired for a fully remote position,” she said. “I spend six to eight months every year overseas helping refugees who are trying to enter the US. So many of us are trying to continue focusing on our work while being told to immediately return to the office, but also to not return to the office yet because there is not space for all of us nor the resources to relocate everyone.“The refugee program has been suspended, so we don’t know the future of it, but I feel really determined to stick it out so that the budget for me cannot be used for somebody else who doesn’t care about refugees and [will] infiltrate this line of work to do harm or to prevent good from being done.”Amy’s remarks reflected those of scores of other federal government workers who presented themselves as a united front in defiance of Musk and Trump, but there were some who felt it was possibly time to resign from their careers.For Riordan*, a trans, autistic, disabled veteran who has worked for nearly 20 years for the government, the last few weeks have been stressful and “too much” for their mental health. Feeling “tired”, Riordan wants to hold on until they can retire early.“It’s upsetting. The stereotype of the lazy government worker has persisted for a long time but the majority of us have been working our asses off to serve our populations.”Federal workers have been told that those eligible for voluntary early retirement (Vera) can combine it with their deferred resignation, but Riordan is cautious.“I’m not going to take the chance right now. We’re not even sure what is being offered is legal. [If I’ll be eligible for Vera] I will take it in a second because I’m ready to get out of here. I don’t want to work for Trump and I don’t want to work for Musk. I’ll sell the house and move to a blue state where I can be with my family. For now, I’m just going to delete the emails and ignore them.”A long-term government employee at USAid from the east coast who had been working on programs in the developing world shared her disbelief at how her agency has begun being dismantled.“After going dark for several days, the USAid website was relaunched to tell the world that the entire workforce is being put on administrative leave,” she said. “Every message to my agency’s workforce has been hostile and intimidating with threats of disciplinary action and no space for disagreement with orders from the White House. All of the communication we have received expresses lack of trust in us and our judgment.“As a result of the stop-work order that has affected most of the work USAid funds, our workforce is glued to our computers with nothing to do. The American public is not benefiting from this in any way.”Deaths and illness around the world could result from the halt of USAid assistance that contributes to global security, she warned, adding that despite everything she had decided to stay.“For a second, the [buyout offer] sounded kind of appealing, but I quickly heard voices I trust – employee unions, lawyers, Senator Tim Kaine from Virginia – who raised questions and told people to be very cautious. There’s no funding for this [buyout programme], there’s no guarantee, so I’m not going to take it. This is unprecedented.”skip past newsletter promotionafter newsletter promotionMartin Heyworth, a former chief of staff at the US Department of Veterans Affairs (VA) in Philadelphia between 1999 and 2009 who retired from federal employment in 2017, disagreed and pointed out that Bill Clinton as well as Barack Obama had ordered large buyout programmes of federal workers during their presidencies.“Offering buyouts is not new and has been standard practice in the US federal government for the last several decades, whether under a Republican or a Democratic president. The phenomenon is neither Republican- nor Trump-specific, and it’s being construed as a sort of Trump-related dysfunction, which I think is not accurate.“I did not vote for Trump, I voted for Jill Stein, and although he does things that are problematic, I think he needs to be given a chance.”Elizabeth, a federal immigration enforcement attorney from the west coast, learned a few days ago that her department would be exempt from the buyout, but that she would have to return to the office despite her flexible hybrid union contract.“I’m a single mother, and the flexibility of this job is what is keeping me sane,” she said. “I have so many court appointments, I just don’t know whether I could handle having to come into the office all the time in between for the next four years.“I currently have no plans of quitting, but I’d have to strongly consider other job options, depending on how draconian they want to be on this.”Elizabeth, who is Black, added that the administration’s decision to suspend DEI practices and departments across the federal government was also “extremely upsetting”. “I’ve been having problems concentrating all week. A handful of people in my office support Trump, but others are very liberal. Politically like-minded people and I are concerned. Power is being given to Elon Musk.”Another major worry, Elizabeth said, was the prospect of being subjected to loyalty tests as part of future workplace evaluations, while she insisted that her political dislike of the Trump administration would not undermine her professionalism.“I’m not taking a loyalty test for any president. We all take an oath, our job is to uphold the laws of the United States. It is not to pledge loyalty to anyone. I can have my views about any politician but still be able to do my job.”An older remote worker for the Department of Veterans Affairs said her office had been “swamped with calls from stressed-out employees considering the deferred resignation but without sufficient information to make a decision within the very limited timeframe”.“If they don’t take the deferred resignation,” she said, “will they need to return to the office even though there is no identified office space? Will they have to relocate in order to keep working? Will their jobs be eliminated? Exactly how does this affect their retirement benefits?”She described emails coming from the administration as “callous” and “staggering”.“Even though we try to refrain from any overtly political comments,” she said, “it was clear that most people I spoke to viewed the ‘[fork in the road]’ email as craven and hypocritical. ‘Enhanced standards of conduct’ – from an administration headed by a felon, a sexual predator, a pathological liar with no respect for the rule of law? What a joke.”A probationary Department of Homeland Security employee from the midwest who wanted to stay anonymous said she would be taking the deferred resignation offer.“I do believe [this offer] is likely illegal and the administration will stiff me, but it doesn’t really matter in my case,” she said. “I only signed on to the federal government for the remote and telework benefits, and now that’s gone, I can cut ties and return to my old job, where I made more money, worked fewer days and hours, and had a shorter commute.”A combat veteran federal government worker from the north-west expressed a steely resolve to resist.“We laugh at [Trump] during meetings, trying to make sense of the nonsense spilling out of the White House,” she said. “His disregard for laws, morality and humanity proves how intimidated he is by real Americans making real contributions. I hold the line and dare him to fucking fire me.”*Names have been changed More

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    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