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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. Now we'll look at some of the human cost of the Trump administration's USAID pause back in January of this year. Last week, The Washington Post, maybe you've seen it, published an extensive investigation that found nearly $140 million in HIV and malaria medications were delayed or never delivered, and the children died while those medicines sat in warehouses miles from the clinics that needed them. Joining me now to share her team's reporting on this is Meg Kelly, reporter at The Washington Post. Meg, thank you for coming on. Welcome to WNYC.

Meg Kelly: Thanks so much for having me, Brian.

Brian Lehrer: First, help us understand the timeline here. The Trump administration paused foreign aid back in January, shortly after he returned to the White House. There was a public reversal within days, so to be clear on that, but how long did the disruptions actually last? Big picture, what happened during that period?

Meg Kelly: Sure. As you said, as soon as the president came back into office, he put this 90-day pause in place. Then, within days, Marco Rubio said, "Lifesaving aid is going to continue. We're going to keep pushing forward this aid." What became tricky in there is, each program needed its own waiver. There were plenty of programs that people and advocates said, "Hey, this qualifies as lifesaving aid and should continue." The program that we looked at is called the Global Health Supply Chain. It has an annual budget of more than $900 million just for HIV and malaria aid, which are the pieces of it that the administration considered to be lifesaving.

Brian Lehrer: [crosstalk] Go ahead. Sorry, go ahead.

Meg Kelly: Sure. Go ahead.

Brian Lehrer: No, you go ahead.

Meg Kelly: With those two sections, they were meant to continue and got waivers very quickly, but there were a series of other things that happened, including that a third program didn't get a waiver, there were staff cuts, there was a cut to a critical payment system, all of which caused these disruptions. In the six months of data that we examined, which went through the end of June, those disruptions were ongoing. There were almost half of the aid that was meant to be delivered by the end of June had not been delivered by that point.

Brian Lehrer: I'm going to ask you in a couple of minutes the ultimate heartbreaking question of how many people, if there's a way to count or estimate, died as a result of this pause and these delays and these failures to deliver at all based on the bureaucracy that you describe in your article. I want to invite you first to talk about Suza and Gilbert, the two children whose individual stories you tell at the heart of your investigation. Who are Souza and Gilbert?

Meg Kelly: Suza and Gilbert were two children who lived in the south of Congo, I should say the Democratic Republic of Congo, both of which live in provinces that obtain most of the medication for HIV and malaria from USAID. Congo is a particularly complicated place to deliver medication to. Gilbert was a seven-year-old boy who-- He loved to play with cars. He loved to go to the market with his mom. He was diagnosed with HIV when he was very young, along with his brother and his mother. She was very diligent about making sure that he could get his medication on time, that he could continue to live as normal of a life as possible.

Suza lived a five-hour drive away from Gilbert. She was seven years old. She loved to wear her hair in pigtails and talk on the phone with her family, and loved frilly dresses and had been doing really well in school. She got sick. She started to get a cough on a Friday, but she still went to school. By Monday, her breathing was really in trouble. A couple days after that, she had passed away from malaria. Both kids didn't grow up in particularly well-off circumstances and relied on clinics and doctors that got their medication from the USAID programs.

Brian Lehrer: Now, in both cases, the medicine they required was already purchased and nearby, as I understand it from your reporting and what you're saying. Just how close was the medication, and why didn't it reach them on time?

Meg Kelly: The situation for each of them is a little bit different. In both cases, the medication was already in warehouses that was just miles from the clinics that they had attended. In Suza's case, the warehouse was, I think, 7 miles away or so. It was flush with the medication she needed. It had more than 200,000 doses of it. The delivery between that warehouse and the local distribution points, where the doctor could have gone or requested more of the medication from that program, had been stopped, and didn't receive a waiver as part of the lifesaving aid continuing. It continued to be paused, and it was eventually canceled in March.

It's since restarted. The delivery of malaria medication has since restarted, but that didn't happen until sometime in May, so months after Suza needed that medication, and that medication had been sitting there for months during the height of malaria season in that state.

In Gilbert's case, it's a little bit different. The medication he needed was just 4 miles away. The government did provide USAID permission within the middle of March to start delivering HIV medication. I know that the contractor who was in charge of that did it as quickly as they possibly could, but you're talking about hundreds of sites and having had to shut down their entire infrastructure. There were lots of kids that were scrambling for different types of medication. We heard from lots of patients and community workers that said-- We'd hear that somebody would have some and someone else would have some, and it was very difficult to just close that loop.

Brian Lehrer: I guess, at the policy level, at very least, and I realize you're reporting on what actually happened to children and to families in these places, and we'll get more into it.

At the policy level, one could at least argue that this is the height of petulant irresponsibility to cancel something with as much life and death implication as these programs that you're talking about and then go back and look at which ones to restart or then go back and say, "Oh, but the lifesaving ones, we're going to keep those going," rather than investigate those first and give them some time to unwind if the administration decides that these are not good programs or not in the interest of the US or whatever they would decide, but a kind of petulant irresponsibility to just say, "No, we're cutting it off," and then look later. Have people in Washington had to answer any question like that?

Meg Kelly: I think that Secretary Rubio has been grilled on similar questions when he has spoken to Congress in testimony. He has said several times, which we proved to not be true, that no one had died from these cuts. He said that there would be some sort of hiccups over time, but didn't anticipate or certainly didn't speak to the type of disruption that we proved with this investigation.

Brian Lehrer: We will play a clip of Rubio in a minute. You've talked about Suza and Gilbert, the two children at the heart of your investigation, but you found at The Washington Post that these were not isolated incidents. How many countries were affected, and how much medicine was withheld from people who needed it?

Meg Kelly: The time period that we looked at, which is the first six months of the year, the first half of the year, we found that there were $190 million worth of, or more than $190 million worth of supplies that were meant to be delivered during that time period. They were meant to go to 41 countries. It's a pretty wide swath of the world that was expecting either HIV or malaria commodities during that time. By the end of June, we found that nearly or almost half of that medication and supplies had not been delivered. It was in warehouses, it hadn't left manufacturers, it was sitting in customs, it was in transit.

Then we had found that of the supplies that were delivered, which was around $63 million, they were late, which by USAID standards historically is seven days. It's more than seven days past the delivery date that they were supposed to arrive by. We found on average, those supplies were more than 41 days late. In typical times, folks that we chatted to said anything really more than 30 days late was a huge problem. Seven days late, they could move things around; they could kind of make it okay. When we're seeing these averages in the 41 era, it raised a lot of eyebrows and made folks who previously and currently worked on the pipeline quite concerned.

Brian Lehrer: Listeners, if anybody has a question or a comment or maybe even a story, if you are connected to any of these places where HIV and malaria medications were delayed or never delivered since the start of the Trump administration because of the pause in foreign aid pause in programs for USAID where they were given a stop work order at the beginning of the Trump administration, we invite your calls or texts, 212-433-WNYC, 212-433-9692, for Meg Kelly, senior reporter at The Washington Post, which did this investigation and just published it the other day.

Here's a text from a listener that asks, "Why didn't the local Congolese authorities just deliver the drugs? Who was preventing them from doing that?"

Meg Kelly: That's a great question. It's something that we looked into and tried to sort out. There was some confusion and concern about if they had the authority to do that. That was one piece of it. The other issue, which came up in some of what the US Ambassador to Congo said, is basically, it's a very difficult and very expensive place to deliver medication. We think of delivery in an Amazon drops a package on your doorstep kind of straightforward way.

Congo is the size of the whole eastern half of the US and has very limited infrastructure, so it's expensive to fly medication into rural areas. A lot of the infrastructure that was built up by the US to get medication to further parts of the country stopped along with the aid pause. Those were two critical issues, along with the confusion over who actually had the right to and could deliver the medication, since USAID oversaw so much of the last-mile delivery.

Brian Lehrer: Another listener asked, and maybe you were just beginning to address this, but why didn't other countries volunteer to step in and make the payments?

Meg Kelly: That I don't know. If I were guessing, and I think it probably has to do with the same issue I was just describing, which is the ownership. Does the US still own the medication? Does Congo have the right to own the medication and distribute it, and wanting to not sour some of those relationships?

Brian Lehrer: It wasn't just a question, even though we're talking about this in the context of USAID funding being paused, it's not just a question of who is paying for the delivery of these medications. It was also a stop-work order, like "Don't do it."

Meg Kelly: Right. Exactly.

Brian Lehrer: Is that a fair characterization? Yes.

Meg Kelly: Completely.

Brian Lehrer: Here's a clip of Secretary of State Rubio speaking with ABC's George Stephanopoulos just two weeks ago, September 23rd. He's pushing back strongly on the notion that people died due to USAID cuts.

Rubio: Then they died because England didn't give enough money, or Canada didn't give more, or China did. Let's blame the other countries that don't do any foreign aid. How about China? I mean, China's the second-largest economy in the world. They don't give money to this project. Did people die because China didn't give more money?

George Stephanopoulos: You're no longer disputing that the aid cuts have cost people's lives? You're no longer disputing that?

Rubio: It didn't. I think anybody who tells you that somehow it's the United States, if we cut a dollar, somehow we're responsible for some horrific thing that's going on in the world, it's just not true. Beyond that, I would say that in some of these places that they decide, the reason why the aid didn't get there--

George Stephanopoulos: If that dollar is not going into feeding someone in medicine, someone's going to die, aren't they?

Rubio: No, excuse me, George. One of the reasons why some of these places didn't get the aid is not because we cut the aid; it's because there's a war going on, and the aid never got to the people.

Brian Lehrer: Meg, there are a few implications in that answer. First, the one at the end, which says, "There's a war going on, and the aid never got to the people." I mean, in some places, there were wars going on, but it's at the same time as suddenly this aid got cut off. Did you, in your Washington Post investigation, try to pick apart those two things?

Meg Kelly: We did. Congo is one of the places that fits into that category. There are sections of the country where the war is the reason that the aid didn't continue. The parts of the country that we looked at, that doesn't apply. There are also distributions and commodities that were intended for Ukraine, so somewhere that the US had been delivering aid to over the course of the war there.

Brian Lehrer: I guess the other thing, which I guess is just a distraction, is when Secretary Rubio said, "I think anyone who tells you that somehow it's the States, the United States, if we cut a dollar, somehow we're responsible for some horrific thing that's going on in the world," that China's the second-largest economy in the world. They don't give money to foreign aid programs like this the way the United States does. That may be true, but that's different than the US was providing this program, and all of a sudden, it stopped, and the medicines that the US had in the chain didn't get through. Those are really two different issues, aren't they?

Meg Kelly: They are. I think that, as you pointed out earlier in our conversation, there's a point to be made that you could have gone about changing the USAID structure in a different way. Then, perhaps, that point would be a more fair one that Secretary Rubio made. In this case, the way things were shut down and the obstacles that were created between the broken payment systems, the added layers of oversight, the obstacles that people inside and outside of USAID had in terms of getting payments approved to suppliers, the staffing cuts that left a program that once had 80 people inside of USAID running it down to around 10.

There's more obstacles that are created that certainly create the impression that, at least in these cases, the way this was handled very much contributed to the deaths of these two children.

Brian Lehrer: Lou on Staten Island, you're on WNYC with Meg Kelly from The Washington Post. Hi, Lou.

Meg Kelly: Hi, Lou.

Lou: Good morning, Brian. Thanks for taking my call. What I'm saying is that I hope my fellow Africans, particularly the leadership, I hope they will use this USAID thing as a learning curve. The dangers in being too dependent on other people is what put us in this kind of situation. We have enough resources, enough manpower to take care of these kind of things here, rather than relying on foreigners to do it for you, because, at some point, that person's going to dislike the way you dress, the way you look, or the way you talk on a particular time, so you have to make sure that you can provide these things for yourself.

We have the resources there. It saddens me, it bothers me, it angers me that we are so dependent on other people. I was in Liberia last year and then recently too. The people just sit there. There are USAID vans all over the place, and when they come, there is nothing to do. They just sit there. I keep asking, but why can't we provide this thing yourselves? You have been in a civil war for 15 years. The Civil War is over. This is the time to start doing these things, roll up your sleeves.

As for China, China does help. It provided training for some doctors in a specific area. One of those doctors is my brother-in-law. China itself is just coming out of poverty. It's a developing country, so it cannot take what USAID has been doing all this time and just multiply it. My whole point is, we Africans have to cut off this business of depending too much on other people. It is dangerous. This is exactly what is happening now.

Brian Lehrer: Lou, does your position, to some degree, back up the Trump administration argument or the argument of conservatives over time that African countries, as well as some other developing countries, shouldn't be relying on US foreign aid permanently, it should be something that's been temporary and been going on for many decades now at this point, and that they should be doing more to develop self-sufficiency, and also, therefore, that these aid programs have been delivered in a way that fosters dependency rather than self sufficient development?

Lou: African people are more conservative than American people. I think if you recall, I told you before that Mr. Trump lacks merits of morality. Whatever his administration come up with, I got no use for it or for himself. This is the peril when you depend on other people for your livelihood. It's dangerous. It's dangerous. African people are more conservative than conservatives in the United States. Whatever Mr. Trump says, I got no use for it.

Brian Lehrer: Lou, thank you very much for your call. We appreciate it. Meg, what do you think African leaders would say to Lou there, who he hopes were listening for the reasons that he stated? Again, this may go beyond the scope of your reporting, I don't know, but what were you thinking when you were listening to that call?

Meg Kelly: Listening to Lou made me think about one thing we saw the Nigerian government do, which was immediately say, "Okay, we're going to shift these resources around and we're going to make sure that we are able to provide more malaria aid and invest differently." It's so country-by-country specific, and it's so region-by-region specific. I think there are certainly countries that have made some moves in that way, as Lou suggested, and there are other countries that have not been able to for a variety of reasons.

Brian Lehrer: In February, Nicholas Enrich, then acting assistant administrator for USAID's Bureau of Global Health, released two memos stating that the Trump administration created obstacles to restarting lifesaving programs that would, in the memo that he wrote, result in "preventable death, destabilization, and threats to national security on a massive scale." In a similar vein, there's a Lancet study estimating 14 million deaths by 2030, and granted that's by 2030, if these cuts aren't reversed.

Based on your reporting thus far, do you have an actual number or a credible way to estimate how many people around the world have died because of the US pause or, in some cases, maybe permanent halt in foreign aid, especially having to do with medication or lifesaving food?

Meg Kelly: I wish that I did. I think that there are researchers that are working on that now. I think the way that the cuts have changed continuously has made it difficult to get an exacting estimate out. I think what is clear is that people are suffering and have died as a result of these cuts.

Brian Lehrer: Let's take one more phone call, and then we'll wrap it up with me asking you, what's the state of all of this now, since the heart of your reporting was really back in the early part of the year when that pause was more explicitly in effect. Labiba in Brooklyn, you're on WNYC. Hi, Labiba.

Labiba: Hi.

Brian Lehrer: Go ahead.

Labiba: Hello? My question was about aid localization. I was wondering, what does USAID use? What is the process, or how do you guys collaborate with local stakeholders in terms of giving this aid?

Brian Lehrer: Do you understand the question, Meg?

Meg Kelly: Yes, I do. I can't speak to USAID as a whole, and I will say that as I went through this reporting, every country and every topic in each country often had a different answer. There was an asterisk on everything. In this case, what I can say, speaking just for Congo, is that USAID contracts the entire global health supply chain program to a DC-based development contractor called ChemoniCS, and they work very closely with different NGOs and have a sort of on-the-ground structure for that delivery system.

There's also separate programs that USAID funds within Congo that specifically help people who are like community health workers make sure that they have funding to do work. Gilbert was actually part of one of these programs where a community health worker would go around and make sure that people got the medication they needed. He would check in on them, make sure that they were still taking their doses. USAID did work at both sort of a national scale and funding really local projects along the same way.

Brian Lehrer: Last question. USAID's funding was paused at the beginning of the year. Your reporting lives within the first half of 2025. Are these disruptions still ongoing? What's the situation now? Has the supply chain of these medications been fixed?

Meg Kelly: I can't say the exactitude of that. What I can tell you is that doctors that we spoke with in August in Congo were still struggling to get consistent flows of medication. They said that they would get it in drips and drabs, and then they were making these terrible decisions about which of their patients they would give the medication to. I know that the malaria distribution hadn't completed by then. It was still ongoing. There were plenty of clinics that still didn't have malaria medication across the nine provinces in Congo that USAID serviced.

I know that on a structural and institutional level, the office that oversaw the supply chain as a whole was 80-plus people. Once USAID was folded into the State Department, the people that look after this program is closer to 10 people. The process for obtaining commodities and buying supplies has never reverted to what it was before the pause. There's still additional layers of approval that have to go through a single senior State Department official. It creates these continual roadblocks that appear to be quite frustrating for staff and contractors alike.

Brian Lehrer: You know what? I'm going to sneak in one additional caller whose call just came in, and it looks like he works in the field, so it's extremely relevant. Andrew in the Bronx, you're on WNYC. Hi, Andrew.

Andrew: Hi, good morning. I just actually turned into this show, too. My daughter called me. My perspective is I'm a pediatric allergist/immunologist, caring for children for about 40 years, HIV-infected children, and part of an NIH group that has been able to get many drugs FDA-approved for use in children with HIV. An important part of the work was always trying to get, how do we get these drugs overseas? There was actually a concerted effort. The Vatican started getting involved in 2016 to say, "All right, we have these drugs here for use in the United States. Put a child on the medication here. They will be completely suppressed. The virus will be suppressed."

I'm caring for 38-year-olds that have been born with the virus. The question was, how do we get these drugs overseas? The Vatican got involved and multiple other NGOs and created a system by which the drug companies would license the patent of the medications to a nonprofit. The nonprofit would then be able to license the patent to generic makers for sale in 160 poorest countries in the world. It took a long time to get this effective.

By about 2023, there was an international drug, it's three drugs: dolutegravir, abacavir, and lamivudine, which is a simple dispersible pill that became available for children generically 4 weeks of age to 18 years old. The cost was $37 a year per child. Within the last, from about 2022 to 2025, there are about 700,000 children worldwide, internationally, in 160 poorest countries who are on these medications.

Brian Lehrer: Andrew, let me just, for time, ask you to jump ahead and ask if, with the story that you've told, you see this being disrupted or if you're concerned about what's going on with the Trump administration's foreign aid policies at this point.

Andrew: We basically abandoned these children. Happened overnight with the drugs, as the speaker spoke about, that was in repository. It was difficult to getting there. I work with people overseas, and what I'm hearing is, we're in multiple countries, South Africa, Botswana, Zimbabwe, Uganda, that it's not one thing that's happening. Some areas have drugs, some areas don't have drugs. The infrastructure that was funding these sites, working in conjunction with the local government, fell apart.

Brian Lehrer: Andrew, thank you very much. Wow, what a stark description. I don't know if you're familiar with the program that he mentioned. This will be the last thought, Meg, but that it had gone down to a $37 cost per year to keep many people with HIV alive, and now the infrastructure has fallen apart. Is that what your reporting found?

Meg Kelly: Yes. I think that those medications, including the one that Andrew was speaking about, were in this pipeline. I don't know if it's connected to the specific program, but certainly that medication was one that was being brought to these countries and that people were depending on, children were depending on, for not huge amounts of money. I'm just going to sneak this last bit in there. One thing that continues to stick with me about this story is, Suza's dad went to go look for the injection that she needed. It costs less than $10 an injection. Somewhere between $3 and $9, depending where you are in the country. That's a huge amount of money for her family. For the US government, $3 is less than a cup of coffee these days.

Brian Lehrer: Meg Kelly, Washington Post reporter, on their investigation called Trump's USAID pause stranded lifesaving drugs. Children died waiting. Thank you so much for sharing this important reporting with us.

Meg Kelly: Thank you so much for having me.

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