Attack waste, not lifesaving aid

Tuberculosis patients who have had their medications cut off halfway through their course of treatment. HIV patients scrambling from hospital to hospital trying to hoard drugs for fear that they might never be able to get them again. Mission hospitals forced to make hard decisions about which programs to cut after their funding was abruptly stopped. These are just a few of the effects of cuts to the U.S. Agency for International Development (USAID) and the President’s Emergency Plan For AIDS Relief (PEPFAR.)

I’ve worked as a medical missionary in East Africa since 2015, and I have seen incredible results from some foreign aid programs. Perhaps the most critical program was PEPFAR, a program initiated by Republicans in 2003 that has provided antiretroviral drugs to patients with HIV across sub-Saharan Africa. Evangelical Christians were a key part of the original coalition that helped bring this revolutionary program into being. Since then, PEPFAR (working closely with USAID) has saved millions of lives and has been researching long-acting treatments for HIV that could eradicate the virus within our lifetime.

The first blow to mission hospitals and Christian healthcare workers came in January, when a foreign aid “freeze” and a stop-work order came through an executive order. There was a theoretical exemption for lifesaving programs, but because the Department of Government Efficiency was actively attempting to dismantle USAID, many of the supply chains and logistical functions that lifesaving programs (including PEPFAR) needed were disrupted. It took several weeks before payments were restored, and even then many critical programs have still been slashed. With budget discussions underway, many people are fearful that the few programs left will be destroyed for good.

Elon Musk boasted about feeding USAID “into the woodchipper,” but it really needed a scalpel instead. While there was certainly waste and fraud at USAID that needed to be rooted out—as well as programs that promoted LGBTQ ideology—these programs made up a relatively small share of the overall foreign aid budget. Until President Trump’s executive order, the United States spent about 1% of its federal budget on foreign aid and a great deal of that funding went straight to helping people in need. That small percentage went a very long way in many poor countries, many of which are growing towards self-sufficiency but need time and planning to build their own capacity.

Foreign aid can reap huge benefits from small investments. Combating diseases around the world can help prevent serious illnesses from reaching America, but cutting off funding abruptly raises the risk of resistant infections that antibiotics can’t treat. Building critical infrastructure helps to build goodwill among our allies, but sudden withdrawals allow adversaries like China to grow their sphere of influence in strategic locations. For Christians, foreign aid has long worked to augment and assist missionaries and Christian health workers, sometimes even giving them a platform to work in countries where they otherwise might not be able to enter.

Many Christians are concerned with using government funds for Christian charity, but the very first hospitals in history were a joint effort of churches and the government. Since then, Christians have always worked with taxpayer dollars or alongside government programs in order to maximize their impact. There are some things—for example, distributing millions of antiretroviral drugs every day across the globe—that are much harder, perhaps even impossible, to do with private donations. Organizations like African Mission Healthcare have rallied to help stand in the gap and support mission hospitals that have lost funding, but it’s a drop in the bucket compared to what’s been lost.

The successes of PEPFAR demonstrate important principles by which we can judge all U.S. foreign aid going forward, while also underscoring why it should still be funded. PEPFAR has always had close monitoring and clear targets to ensure that taxpayer dollars aren’t being wasted, with a focus on the number of lives saved rather than trying to achieve nebulous ends like “bolstering democracy.” From the start, PEPFAR programs have built capacity in institutions on the ground to avoid long-term dependency on foreign experts. PEPFAR has also funded research into treatments that could help to end HIV in our lifetime, thus giving itself a clear end goal—the sort of moonshot that only the United States of America could accomplish because of how good and great our country is.

I’m grateful for all that the United States has done over the years to support the work of Christian healthcare providers all over the world, and I’m heartbroken to see so much of that support end. American Christians need to make it clear to this administration that they want to see their tax dollars used to save lives overseas, not promote corrupt sexuality. If we don’t make it clear that PEPFAR and the USAID programs it depends on should remain strong and well-funded with a clearer mandate, we may see decades of work on behalf of the world’s poorest simply end. Our brothers and sisters around the world—not to mention people who don’t know Christ and might first encounter Him through an African doctor prescribing medicine paid for by American tax dollars—are counting on us.