[Pages S2890-S2892]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

U.S. GLOBAL HEALTH PROGRAMS

Mrs. SHAHEEN. Mr. President, I ask unanimous consent that the
following documents be printed in the Congressional Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:

Summary--The Dangerous Consequences of Funding Cuts to U.S. Global
Health Programs

(April 2, 2025)

``In less than two months, the Trump Administration has
undone six decades of investments that made the United States
more respected and influential than any other nation. The
resulting chaos has left us weaker and more vulnerable. Like
all of my colleagues, I have always supported reforming
government and making sure our tax dollars are spent wisely.
But this administration has ignored U.S. laws enacted by
Congress--cutting foreign assistance programs and USAID staff
that are essential for our national security.'' Ranking
Member Senator Jeanne Shaheen
On April 2, 2025, Senator Shaheen hosted a public
roundtable for Senators to examine the profound consequences
of the Trump Administrations' cuts to U.S. global health
programs. The panel highlighted the increased risks to the
health of Americans from diseases, including drug-resistant
TB and Ebola, to Americans livestock and plant farmers from
bird flu and plant diseases, and the increase in global
mortality from cuts to vaccines, HIV prevention, malaria,
maternal care, newborn care and water and sanitation
programs.

top line impact of global health cuts

Our 50-country network for stronger surveillance to deadly
diseases from bird flu to swine fever [is] gone.
Our emergency response system that cut response times to
global outbreaks from greater than two weeks to less than 48
hours [is] gone.
AIDS programs to prevent new cases of HIV in high-risk
populations [is] gone
Programs for preventing child and maternal deaths that
reached 93 million women and children under 5 in 2023 and
added 6 years of life on average [has been] cut 92%.
Lifesaving tuberculosis programs cut [by] 56%.
Lifesaving water and sanitation programs cut [by] 86%.
Funding for GAVI, the global vaccine alliance, which was
set to vaccinate half a billion children [was] terminated
and, if not restored, will cost 500,000 lives a year and
drive higher exposure to measles in the U.S.
Dr. Atul Gawande, former Assistant Administrator for Global
Health, USAID

quotes from panelists on the consequences of the cuts are represented
below

Atul Gawande, former Assistant Administrator for Global
Health, USAID
Dan Schwarz, Vice President, Management Sciences for Health
Nicolas Enrich, former Acting Assistant Administrator for
Global Health, USAID

usaid programs are cost-effectiveness and accountability

``I led 800 health staff in [USAID] headquarters working
alongside more than 1,600 staff in 65-plus countries. With
less than half the budget of my Boston hospital system . . .
they saved lives by the millions and contained disease
threats everywhere. The new administration not only shuttered
this work, they fired the staff of the entire agency,
terminated 86% of its programs, and kneecapped the rest--all
against Congressional directives. They dismantled the US's
largest civilian force advancing global stability, peace,
economic growth, and survival. And they have done it in a way
maximized loss of life and mismanagement of taxpayer
dollars.'' Dr. Atul Gawande, former Assistant Administrator
for Global Health, USAID
``So, you know, for USAID, in the last six inspector
general reports, 94% of the spending had been audited, 0.3%
were found to have issues. Half of that was reclaimed. That
is not an enterprise that has been, you know, utterly driven
by, criminal behavior.'' Dr. Atul Gawande, former Assistant
Administrator for Global Health, USAID

cuts are increasing health risk for americans

``The safety of Americans is very much at risk as global
health security programs are shuttered. Programs that . . .
addressed things like the plague, Ebola, [and] drug-resistant
tuberculosis. Those have suddenly ended with no warning, even
as . . . the United States experienced the worst tuberculosis
outbreaks in decades. Emerging health programs . . . helped
address emerging health threats at their source in other
countries. They're gone.'' Dan Schwarz, Vice President at
Management Sciences for Health
`` . . . And I think it should be clear to all of us by now
that outbreaks abroad do not stay overseas. That's why
Congress has appropriated millions and millions of dollars to
shore up early warning systems, surveillance and fragile
health systems around the world so that we can protect and
detect and respond to diseases early and . . . so that we can
get them before they get out of control, before they come to
our borders. And unfortunately, these are exactly the
programs that have been terminated.'' Whistleblower Nichloas
Enrich, former Acting Assistant Administrator for Global
Health, USAID
``[W]e have had a global reduction in, childhood deaths,
childhood mortality in the U.S. and abroad of 75% over the
last 50 years. 40% of that benefit is from vaccines alone.
60% of that benefit is from measles vaccine alone . . . ''
Dr. Atul Gawande, former Assistant Administrator for Global
Health, USAID

the PRC is stepping up where the U.S. is stepping back

``That support has been withdrawn and the sustainability
and the long-term system of strengthening . . . is
questionable for the future. The People's Republic of China
is filling that gap. The people in the communities that we
serve have lost services, and they are quick to, frankly
speaking, look towards other options for [the] . . . support
that they need.'' Dan Schwarz, Vice President at Management
Sciences for Health

People Are Dying Because Of Cuts To Foreign Assistance

``About the claim that no one has died. It's absolutely
false. [A] medical facility [in Burma] was cut off with no
access to oxygen [and] no alternative delivery system. A
woman who had come with severe pneumonia had to be turned
away because the facility was shut down. And she died three
days later from pneumonia. Dr. Atul Gawande, former Assistant
Administrator for Global Health, USAID

Malaria Deaths Are Increasing Unnecessarily

``U.S. global health efforts have led to a decline in over
48% of malaria deaths globally in Nigeria. During the time
that I am delivering these remarks to you, at least two
children will die of malaria in Nigeria.'' Dan Schwarz, Vice
President at Management Sciences for Health

Ebola Response Programs Terminated

``On February 25, 2025, Elon Musk said in a White House
cabinet meeting that Ebola activities had been accidentally
turned off, and then turned back on immediately. This was
also false, as none of the activities were approved, and no
funds had been made available for any Ebola response
activities.'' Whistleblower Nichloas Enrich, former Acting
Assistant Administrator for Global Health, USAID

[[Page S2891]]

HIV-Aids Transmission And Deaths Are Increasing Because Of Cuts To
Pepfar Funding

Cases of HIV have risen and they're seeing now
complications of HIV. There's a disease called Cryptococcus
meningitis [where] . . . a parasite get[s] to the brain
because of the loss of immune systems. [The] U.S. had
supported . . . a treatment for Cryptococcus meningitis and
it was sitting on shelves in the warehouse, but inaccessible
to this person. And this person died, and they still don't
have that treatment on hand to be able to address these
problems. Dr. Atul Gawande, former Assistant Administrator
for Global Health, USAID
American scientists had developed a drug called Lenacapavir
that could prevent or treat HIV with a single injection that
lasted six months and perhaps even a year. Deploying this
game-changer in high-risk communities through PEPFAR could
finally bring an end to HIV as a devastating public health
threat.'' Cuts to PEPFAR will prevent USAID from deploying
this game-changing tool. Dr. Atul Gawande, former Assistant
Administrator for Global Health, USAID
``We're in the opposite place now. We're seeing babies born
again with HIV at rates we haven't seen before. We're seeing
HIV transmissions now regularly occurring.'' Dr. Atul
Gawande, former Assistant Administrator for Global Health,
USAID

Tuberculosis

``USAID [had] launched a trial of a four-dose pill that
could prevent tuberculosis in exposed individuals and
dramatically reduce cases. This intervention is at risk from
funding cuts. Dr. Atul Gawande, former Assistant
Administrator for Global Health, USAID

Trump Administration Fraud, Waste And Abuse

``When the [USAID] Inspector General, Paul Martin, reported
on half a billion in food aid that was rotting in warehouses,
having lost controls to prevent diversion to actors who
should not get it, the response was not to address the
problem, but instead to fire the inspector general.'' Dr.
Atul Gawande, former Assistant Administrator for Global
Health, USAID
``If you want to see waste, look no further than the
interest accruing on unpaid bills since payments were
stopped--interest at levels we have never seen before. If you
want to see fraud, look into the contractual promises we have
made and then broken, forcing our partners into debt for
relying on the deals we made with them. If you want to see
abuse, look at how the administration has prioritized
payments for the few firms that have the ear of senior
officials.'' Whistleblower Nichloas Enrich, former Acting
Assistant Administrator for Global Health, USAID

U.S. Withdrawal From The World Health Organization Means No Role In The
Flu Vaccine

``On day one . . . the United States not only said we were
ending membership in the WHO, but [that] our agencies could
no longer provide funds immediately to WHO . . . and could no
longer even communicate [with the WHO]. [There are i]ssues
like getting . . . the fall flu vaccine, which depends on a
WHO process that accesses specimens from people in China . .
. where we don't have direct access. [The WHO] directly
provides that capability for the United States to guide the
determination of our own fall flu vaccine. Now, that's still
going to happen . . . but not with direct U.S involvement and
not with [the U.S. on] an advisory committee doing the
technical oversight.'' Dr. Atul Gawande, former Assistant
Administrator for Global Health, USAID

Pandemic Risk And Zoonotic Viruses

``[The] Food and Agriculture Organization . . . is a
critical network that we have now brought . . . 49 countries
around the world [into]; 75% of our pandemic risks come from
animal to human transfer of disease. [FAO] are the ones who
are out in the communities monitoring bird flu, monitoring
for anthrax, monitoring for, African swine fever, which
doesn't necessarily transfer to humans but does devastate our
agricultural sector. And [FAO] enable[s] a response that can
contain matters before they, before they get out of control.
That capability alone . . . is often [the] highest priority
investment that [countries] . . . call for. And shutting off
that capability is blinding ourselves to what we need to be
able to see the surveillance in the first place and then
critical to getting that response time.'' Dr. Atul Gawande,
former Assistant Administrator for Global Health, USAID

Oral Statement by Nick Enrich

Ranking Member Shaheen, Members of the Senate Foreign
Relations Committee, Thank you for convening this important
round table.
I am Nicholas Enrich, a career civil servant with 15 years
in the federal government under four administrations--both
Democrat and Republican.
Currently, I serve as the Acting Assistant Administrator
for Global Health at USAID, overseeing approximately $10
billion annually appropriated by Congress to strengthen
health systems to:
Prevent and respond to infectious diseases,
improve maternal and child health,--and
diagnose and treat HIV, TB and Malaria.
As a result of my lawful whistleblowing, I was placed on
administrative leave on March 2, 2025.
On January 28, the day I was designated as the Acting
Assistant Administrator, Secretary of State Rubio issued a
waiver for Life-Saving Humanitarian Assistance to President
Trump's Executive Order pausing foreign assistance.
From Day One, implementing this waiver was my highest
priority. My team recognized it as the only way to mitigate
the harm caused by the sudden halt of over a thousand of our
programs preventing pandemics and suffering worldwide.
I challenge the administration to provide evidence of the
waste, fraud, and abuse they claim to have found at USAID. In
reality, USAID is among the most effective agencies in terms
of return on investment, with strong financial oversight
ensuring accountability of our programs.
If you want to see waste, look no further than the interest
accruing on unpaid bills since payments were stopped--
interest at levels we have never seen before.
If you want to see fraud, look into the contractual
promises we have made--and then broken--forcing our partners
into debt for relying on the deals we made with them.
If you want to see abuse, look at how the administration
has prioritized payments for the few firms that have the ear
of senior officials.
Despite our efforts, by the time I was placed on Leave, we
had been fully prevented from implementing the waiver. Our
lifesaving programs had been effectively shut down.
By March 2, when I was pushed out:
Nearly all of the contracts needed for our life-saving work
had been terminated--abruptly shuttering clinics,
interrupting supply chains, and cutting patients off from
treatment for deadly diseases, like tuberculosis, risking a
rise in new, potentially untreatable, drug-resistant strains.
All Global Health programming--aside from HIV--had been
excluded from the Agency's definition of lifesaving. Contrary
to the common understanding of the term ``lifesaving'', USAID
was no longer able to respond to deadly outbreaks under the
waiver.
With very few exceptions, payments were halted for our
lifesaving work. USAID's efficient and reliable financial
system was destroyed, and replaced by a wasteful and
inaccurate patchwork that fails to provide needed funding to
implement our programs.--and--
And--The Global Health workforce was slashed from nearly
eight hundred to just over sixty, eliminating key experts--
doctors, epidemiologists, and public health specialists.
Those of us who have dedicated our careers to helping the
most vulnerable are all too aware of the damage the
dismantling of USAID has caused. However, this damage will
not only affect people in need, around the world, but also
us, here at home. This will impact our health, our well
being, our national security.
This crisis has resulted from deliberate actions and
obstructions by leadership at USAID, the Department of State,
and DOGE. Their reckless disregard for human life and
national security prevented me and my team from implementing
lifesaving assistance.
Ultimately, with nearly all of the awards terminated, and
with no path for funding new activities, it had finally
become clear that there was only one thing left to do. That
was to document, in a series of memos, our repeated and
increasingly desperate requests, pleas, and warnings,
regarding the need to implement activities to avert loss of
life on a massive scale,--and substantial risks to U.S.
national security.
On March 2, as my last official act before I was sent home,
I sent those memos to the Global Health staff, to keep for
their records, in the event the blame game ends up pointing
the finger at them.
That brings us to today.
Thank you again for the opportunity to speak before you.

Senate Roundtable on the Dangerous Consequences of Funding Cuts to U.S.
Global Health Programs

(Tuesday, April 1 from 2:30-3:30 p.m.)

Testimony of Atul Gawande, MD, MPH

I was the Assistant Administrator for Global Health at
USAID during the last administration. It was the best job in
medicine most people haven't heard of. I led 800 health staff
in headquarters working alongside more than 1,600 staff in
65-plus countries. With less than half the budget of my
Boston hospital system--about $9 per U.S. household--they
saved lives by the millions and contained disease threats
everywhere.
Before my departure on January 20, I briefed this committee
about several major opportunities ahead for the next few
years. Among them were three breakthroughs. The journal
Science had just declared one of them the scientific
breakthrough of 2024. American scientists had developed a
drug called Lenacapavir that could prevent or treat HIV with
a single injection that lasted six months and perhaps even a
year. Deploying this game-changer in high risk communities
through PEPFAR could finally bring an end to HIV as a
devastating public health threat.
Similarly, USAID launched a trial of a four-dose pill that
could prevent tuberculosis in exposed individuals and
dramatically reduce cases--while three TB vaccines complete
testing.
And USAID was just about to scale up a novel, inexpensive
package of existing drugs and treatments that was found to
reduce severe hemorrhage after childbirth--the leading cause
of maternal hemorrhage--by 60%.

[[Page S2892]]

American companies, nonprofits, and scientists played key
roles in these breakthroughs, and they were poised to
transform global health over the next five to ten years. The
next administration had no reason not to pursue these
objectives. Congress had already funded them. There was
nothing partisan about them at all.
But instead of saving millions of lives, we got surgery
with a chainsaw. The new administration not only shuttered
this work, they fired the staff of the entire agency,
terminated 86% of its programs, and kneecapped the rest--all
against Congressional directives. They dismantled the U.S.'s
largest civilian force advancing global stability, peace,
economic growth, and survival. And they have done it in a way
maximized loss of life and mismanagement of taxpayer dollars.
Here are few specific examples of the global health damage:
Our 50-country network for stronger surveillance to deadly
diseases from bird flu to swine fever--gone.
Our emergency response system that cut response times to
global outbreaks from >2 weeks to <48 hours--gone.
AIDS programs to prevent new cases of HIV in high-risk
populations--gone
Programs for preventing child and maternal deaths that
reached 93 million women and children under 5 in 2023 and
added 6 years of life on average--cut 92%
Lifesaving tuberculosis programs--cut 56%
Lifesaving water and sanitation programs--cut 86%
Funding for Gavi, the global vaccine alliance, which was
set to vaccinate half a billion children--terminated and, if
not restored, will cost 500,000 lives a year and drive higher
exposure to measles in the U.S.
The damage is already devastating. And it is all part of a
larger dismantling of America's world-leading capacity for
scientific discovery, health care delivery, and public health
that goes well beyond USAID. They are using the same playbook
to purge staff and destroy programs in across our entire
domestic infrastructure in government, universities, and
medical center. And they inserting political controls on NIH
science research, FDA approvals, and CDC guidance.
For the sake of power, they are destroying an enterprise
that added more than 30 years to U.S. life expectancy and
made America the world leader in medical technology and
innovation. We need you in Congress to stop this process.
USAID cannot be restored to what it was. But we must salvage
what we can of our health, science, and development
infrastructure and stop the destruction.

Dan Schwarz--Vice President at Management Sciences for Health

testimony at senate global health roundtable

Good afternoon Ranking Member Shaheen and members of the
Committee. Thank you for giving me the opportunity to speak
with you today about the impact of the recent terminations of
global health programs.
My name is Dan Schwarz, I grew up in a small town in
Appalachia and am a practicing pediatrician and a Vice
President at Management Sciences for Health.
MSH is a Virginia-based nonprofit that works with
communities to save lives by sustainably strengthening
country health systems. MSH has been in operation since 1971
and has worked in more than 150 countries, often in close
partnership with the U.S. Government.
My remarks today are informed by my career as a doctor,
both here in the U.S. and abroad. They are guided by my oaths
to care for all and to do no harm. I offer them in the spirit
of an objective analysis of the impact recent program
terminations will have on the health of the most vulnerable
communities around the world.
I would like to begin by telling you about one of the most
effective methods of stopping malaria. Quite simply, it
involves providing preventative treatment to women and
children most at risk throughout the rainy season--the most
dangerous time for malaria. In Nigeria, where we work, they
have over 25% of the world's malaria infections and 30% of
malaria deaths--that's about 200,000 deaths a year. 70% of
those deaths are children under the age of 5. During the time
that I am delivering these remarks to you, at least two
children will die of malaria in Nigeria.
Every year, with the generous support provided by the
American people, at the beginning of the rainy season we work
with the Nigerian ministry of health to get the medicines and
train the health workers who provide it to those children.
This has prevented millions of cases of malaria and saved
hundreds of thousands of lives. It's extraordinary life-
saving work that Americans should be very proud of.
This year, however, this will not happen. That is because
these U.S. government-funded projects have been terminated.
Millions of children are at risk of sickness and many will
die. We should not be proud of that.
These stories are not unique. Thousands of programs have
been terminated without warning, with deadly consequences for
communities around the world. At MSH we had 15 USAID projects
terminated; only five remain. We have let go of over 1,000 of
our team members--colleagues who live and work in these
communities, providing this life-saving treatment.
At MSH, we focus on building strong health systems. Viewed
from this perspective, the recent terminations are even more
concerning. The elimination of foundational programs like
maternal health or health worker training only serves to
undermine the effectiveness of what programs remain. These
cuts will devastate entire communities.
But let's bring it home, right here in this city, in this
very room. The safety of Americans is very much at risk as
global health security programs are shuttered. Programs we
implemented that responded to the plague, Ebola, and drug-
resistant tuberculosis have suddenly ended, even as the
United States experiences its largest TB outbreak in decades.
These programs helped address emerging health threats at
their source and built the capacity of country governments to
confront disease themselves.
Today, we should be discussing how to make America's
investment in global health more efficient and effective. We
should be discussing how we can integrate programs such as
HIV and malaria treatment into countries' primary health care
systems and reduce reliance on outside sources. Or how we can
help countries to finance their own health needs. Instead, we
are asking if lifesaving foreign assistance is of benefit to
the U.S. The answer to that question is and always has been a
resounding ``yes.'' We have so much to be proud of. But with
the recent program terminations, we are turning our backs on
that. So much progress has already been lost in the past two
months, and so many lives will be lost with it.
Thank you again for allowing me the opportunity to speak
with you today. I look forward to your questions.

____________________