It is urgent to restore operation of America’s life-saving assistance programs, halted under the ongoing 90-day pause of all foreign assistance. Two examples: First, PEPFAR is currently providing lifesaving HIV treatment for 20.6 million people, including 566,000 children. When people come off HIV medications, it takes about three weeks for viral loads to rebound. And, second, while the long-term picture on famine worldwide is positive, the short-term picture is anything but: about half a million people have already died of hunger and related diseases in Sudan since the civil war began, with the picture for this year suggesting that could rise into the millions without considerable additional food aid.
Emergency food assistance and PEPFAR are two of the programs where Secretary of State Marco Rubio has already issued waivers meant to ensure support continues. But the process isn’t working. Reports on the ground suggest stop-work orders are still in place, clinics are shuttered, and assistance is still paused.
This should come as little surprise. While the PEPFAR waiver is at least reasonably clear as to what parts of the assistance it covers, the previous emergency assistance waiver is vague, relating to a broad list of things that can be funded (“medical services’) when bureaucracies function around budgets and chains of implementation (“Global Health Programs Malaria Subaccount” or “Bureau for Humanitarian Assistance”). That makes it a complex judgement call for each contract. And USAID staff in particular are in absolutely no situation to make those calls: there are bans on communication with implementing partners, senior staff have been put on leave, two thirds of those working on the President’s Malaria Initiative, who worked under contract, have been fired, and in the last two days, USAID staff have simply been locked out of their offices.
Secretary Rubio should act to fix this and ensure his waivers have the intended impact:
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Further waivers and clarification should be issued that match waived activities to State and Foreign Operations subaccount budget lines (malaria, maternal and child health, and so on) and to organizational units necessary to restart contracts (Bureau of Humanitarian Assistance, Bureau for Management—see a (dated) USAID organization chart below.
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Staff and units overseeing these budget lines need access to their offices, the ability to communicate with implementing partners, and discretion over implementation of waivers.
Otherwise, the waiver program is a fig leaf, and the deaths that will result squarely the responsibility of those who could act to fix it.
CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise.
CGD is a nonpartisan, independent organization and does not take institutional positions.