Make foreign aid great

What it means to take "efficiency" seriously, not as a pretext for destruction

The biggest substantive news of Trump’s term so far has been his somewhat unexpected war on USAID, the agency responsible for most of the country’s foreign aid.

The administration has conducted its assault primarily through means that I would describe as “flagrantly illegal,” and my suspicion is that their real goal is to see what they can get away with.

A famous truism of politics is that most voters agree, abstractly, that the government should spend less money, but almost every specific program turns out to be popular. The big exception to this is foreign aid, which voters don’t like. Questions of process, legality, and the constitutional order matter, but they don’t really matter as much to voters as more substantive issues. So if you want to get away with something that involves an extremely dodgy process, it’s smart to start with the most substantively unpopular program you can find. The humanitarian work of USAID seems largely irrelevant to this administration. George W. Bush, for all his flaws, had a genuine interest in global public health that was motivated by a sincere idealism, and that’s just not the case for Trump or anyone influential on his team. USAID is a soft target to beat up on while testing the theory that the president can ignore the law and unilaterally kill off duly authorized programs.

At the same time, Russian propaganda has become increasingly influential on the American right, and Elon Musk has a warm relationship with the Communist Party of China. There is clearly some level of specific animus against this agency operating at an elite level.

And the elite politics are arguably the bigger deal here.

If courts force Trump to follow the law (which they should and, I think, probably will), he’s still the president and has a lot of influence over what the laws will say in the future. USAID has traditionally existed not because the mass public loves it, but because of a bipartisan elite consensus that it’s good. That consensus has involved a mishmash of do-gooders and national security hawks, and while national security hawks still wield influence in the Republican Party, their star is greatly diminished. Secretary of State Marco Rubio used to be a big proponent of USAID, until he became one of its undertakers. I have to believe that on some level, Rubio thinks that in subsuming the agency into the State Department, he can protect some of its functions. But a Senate-confirmed senior member of the cabinet currently has less influence on American foreign policy than the main owner of what Rubio previously (and accurately) identified as a “stateless corporation” in hock to foreign autocracies.

USAID just doesn’t work politically without the support of conservative hawks.

Meanwhile, though, I certainly believe foreign aid has some national security benefits, I will admit that my personal interest is primarily in the humanitarian mission.

USAID funds a wide range of programs, and those programs have a wide range of cost-effectiveness in terms of promoting humanitarian goals. The good programs are very good and easily make the whole agency cost-effective. But lots of individual programs aren’t particularly cost-effective. And while I don’t want to kick anyone while they’re down, it’s worth taking seriously the fact that foreign aid money is likely to be scarce in the long-run, so we should think carefully about how to make it as cost-effective as possible.

Chaos is harmful and stupid

Whatever problems exist with American development assistance, though, there is no excuse for proceeding the way Trump and Musk have.

I think Amtrak is a profoundly dysfunctional and poorly run agency. If I were in charge, I would, in fact, try to pull off some kind of broadly Muskian changes there, including purging large numbers of employees and creating a “fork in the road” mindset. But even so, I couldn’t just “pause” the operation of the trains or shut the agency down indefinitely. Pulling out of ongoing health programs in a chaotic manner is creating huge problems for the global poor and disrupting initiatives that have multiple sources of funding.

Here’s a particularly horrifying story from Stephanie Nolen about a clinical trial funded by USAID for a new combination contraceptive and HIV prevention device in the form of a silicone ring inserted in the vagina. With the stop-work order, researchers aren’t able to continue monitoring women who have an experimental medical device in their bodies and also can’t remove it:

The stop-work order was so immediate and sweeping that the research staff would be violating it if they helped the women remove the rings. But Dr. Leila Mansoor, a scientist with the Centre for the AIDS Programme of Research in South Africa (known as CAPRISA) and an investigator on the trial, decided she and her team would do so anyway. “My first thought when I saw this order was, There are rings in people’s bodies and you cannot leave them,” Dr. Mansoor said. “For me ethics and participants come first. There is a line.”

Much of what’s been going on reminds me of the line from The Great Gatsby, “They were careless people, Tom and Daisy — they smashed up things and creatures and then retreated back into their money or their vast carelessness.” Musk strikes me as the kind of person who is so focused on his amazing dreams for the long-term future that he simply cannot spare any consideration for actual human beings. We have food shipments stuck on American docks because no thought or planning went into any of this. There’s no excuse for behaving this way.

The many missions of USAID

Samantha Power, who ran USAID for four years under Joe Biden and was UN Ambassador during Barack Obama’s second term, wrote a strong defense of the agency for The New York Times last week.

In the course of doing so, she flags the following ideas:

1. USAID supports global public health programs “such as those that combat malaria, tuberculosis, H.I.V./AIDS and infectious disease outbreaks.”

2. USAID delivers “humanitarian assistance to respond to emergencies and help stabilize war-torn regions.”

3. USAID makes investments that “are less visible but pay dividends in the longer term, such as giving girls a chance to get an education and enter the work force, or growing local economies.”

4. USAID “expanded its activities recently in areas that are particularly threatening to China and Russia — increasing efforts to expose corruption, supporting countries as they try to renegotiate usurious debt they have incurred to China, and developing frameworks to diversify U.S. supply chains and expand critical mineral imports to the United States — which are essential to powering America’s economic future.”

5. USAID supports “thousands of American jobs and billions of dollars of investment in American small businesses and farms.”

This is a wide range of undertakings for such a small agency. And for those of us who are primarily upset about the devastating impact on vulnerable people of wrecking (1), the variety of missions in play here is undesirable.

In some ways, the key to the whole puzzle is the failure of (3). The acronym “AID” spells “aid,” but it stands for Agency for International Development. There was a lot of New Frontier optimism around the hope that American technical assistance could be a critical difference-maker in turning poor countries into rich ones. If that worked, the humanitarian benefits would be considerable. But so would the strategic benefits! If the United States had a reliable toolkit for getting countries to shift from the Guatemala trajectory to the Dominican Republic trajectory, that would be an incredible way to reward friendly countries and build strategic relationships.

The problem is, we don’t have that kind of toolkit or anything close to it.

We can do cost-effective public health interventions that save lots of lives (1) and we can do grant-making that basically amounts to pro-American information operations abroad (4). But it’s hard to fit ideas like (4) into a cost-benefit framework. And while we can certainly support NGOs that advocate causes we agree with, like girls’ education (3), it’s very unclear whetherUnited States is actually effective at this or that we really know how to make anything like that stick.

These programs serve as a kind of bridging concept between the humanitarian work and the foreign policy work, but they don’t make a ton of sense on a dollar-for-dollar basis. I don’t have a huge problem with lumping it all together if that garners more political support. But to the extent that the agency’s political coalition is evaporating, it’s worth focusing on what’s most effective. And while obviously plugging benefits for American jobs and small businesses makes a certain amount of sense in the context of the current political moment, this should not be the purpose of foreign aid spending.

Do more of what aid does best

I’ve written previously about the Unlock Aid campaign and the effort to try to ensure that a higher share of rich countries’ official development assistance goes to actually helping people.

It’s, of course, a little bit awkward to talk about this with foreign aid currently under assault, but it’s genuinely true that a non-fake “government efficiency” drive would be beneficial in this space. A very large share of aid dollars don’t actually leave the United States and end up supporting overhead here at home. This is frustrating to admit, because it plays into Trump and Musk’s hands, but it’s also true.

Characterizing this as corruption, though, is way off base — it’s downstream of the dysfunctional contracting models used by many government agencies. Submitting grants is a highly specialized and labor-intensive process, and rather than putting money into cost-effective programs, the American government engages in extensive oversight initiatives that require laborious documentation and have high compliance costs.

The specific programs supported, meanwhile, are all over the map.

USAID supports Gavi and PEPFAR, both of which save tens of millions of lives at a low cost. The organization is also one of the contributors to BBC Media Action, a philanthropic subsidiary of the BBC that is “working in 30 countries and reaching more than 100 million people each year with media and communication for stronger democracies, a safer, more habitable planet and inclusive societies.” This seems clearly less valuable than life-saving public health interventions. It’s typical of the US government (and also deeply unfortunate) that the agency is so fastidious in its accounting as to ensure much of the aid stays in the United States, but so un-opinionated about which programs are worth funding that the ratio of lives saved to dollars spent is much lower than it could be.

I don’t really know the best way to respond to the flood of propaganda coming from the right about all of this. But the best propaganda usually wields elements of truth in service of its aims, and the basic claim that a lot of stuff gets funded that probably shouldn’t seem true. I also think there’s probably nothing you could say to the mass public about this that would be persuasive, because at the end of the day, even the really great aid programs are helping people in other countries rather than Americans, and my sense is most people don’t really approve of that.

Politics aside, I think two things are clearly true here:

• The most valuable USAID programs are so valuable that crashing the whole agency is, on net, extremely harmful.

• The most valuable USAID programs are so valuable that you could dramatically increase efficiency by sunsetting most of what the agency does and plowing all the money saved into its global public health programs.

And don’t take my word for it: Bill Easterly, probably the most prominent and distinguished critic of western aid programs, says that what Trump is doing is terrible. Because it is terrible! Inflicting harm on some of the poorest and most vulnerable people in the world as a political stunt is a genuinely terrible thing to do. Elon Musk could convince me that he’s making a narrow point about the proper role of the state if he were to throw a billion or ten at GiveWell (he can spare the money), but I’m not holding my breath. Taking the efficiency question seriously and doing more to make sure that scarce aid funds do as much good as possible is really important, and it’s sad that we haven’t seen a serious effort around that.