Battle Lines — The Telegraph

Episode: Trump’s USAID Legacy: 9 Million Deaths and a Global Power Vacuum
Date: February 11, 2026
Hosts: Venetia Rainey, Arthur Scott-Geddes
Guests: Paul Nuki (Global Health Security Editor), Anjali Ashrakar (UNAIDS Deputy Executive Director, former PEPFAR), Kevin Melton (Ex-USAID/OTI, founder of PAC Strategies)

Episode Overview

This episode delves into the massive global ripple effects following the shuttering of the US Agency for International Development (USAID), ordered by President Trump a year prior. Hosts Venetia Rainey and Arthur Scott-Geddes are joined by health editor Paul Nuki, UNAIDS deputy director Anjali Ashrakar, and former USAID/OTI official Kevin Melton to unravel the consequences for global health, stability, and security architecture. Center-stage is the debate over the millions of lives at stake, the broader power vacuum left behind, and whether the US "America First" approach has permanently altered the aid landscape.

Key Discussion Points & Insights

1. The Significance of USAID’s Closure

• USAID as Global Anchor: The US was the largest single funder of humanitarian aid, responsible for 47% of the 2024 global humanitarian appeal, equating to $68 billion (01:00–02:37).
• Sudden System Shock: The abrupt closure led to what Arthur describes as, “the aid system globally has had something akin to a heart attack and people are still racing to try and revive it.” (02:18)
• Impact: Projects relying on US funding either evaporated overnight or operate on unsustainable shoestring budgets (02:58).

2. Projected Consequences: Death Toll & Systemic Collapse

• Staggering Numbers: A Lancet study predicts at least 9.4 million additional deaths by 2030 if current trends persist; up to 2.5 million of these are children under five (03:13).

  • Alternative source "Impact Counter" estimates 250,000 adults and more than 530,000 children already dead due to aid cuts (03:13).

• Trustworthiness: While projections are imperfect, “there’s no doubt that many, many people will die as a result of these aid cuts.” — Arthur S-G (04:05)

• Conceptual Point: Aid isn’t charity, but strategic investment that grows economies and markets—for the US and globally (05:50–07:16).

  "He [Trump] looks at the world as if it’s a zero-sum game... But that is not how the world works. The aid that is poured into developing economies has grown the world."
  — Arthur Scott-Geddes (05:50)

3. The Trump Doctrine: Aid as an Investment—or Just Withdrawal?

• Transactional Mindset: Trump’s rationale is framed as wanting to “have more of his cake,” misunderstanding the dynamic nature of investment and economic growth through aid (05:50).
• Economic Returns: The aid legacy is likened to the Marshall Plan, directly linking past investments to present prosperity in both donor and recipient countries (06:27–09:10).
• Achievements at Stake:
  • Overseas development aid has reduced all-cause mortality by 23% and under-five mortality by nearly 40% in recent decades (09:10).
  • USAID assistance credited with saving 92 million lives in 20 years (09:10).
  • The fight against HIV/AIDS made antiretrovirals widely available for just $1 a day, a far cry from earlier exorbitant costs (10:06).

4. The Case Study: AIDS, Funding, and Resilience

• Ongoing Threat: Anjali Ashrakar asserts, “AIDS is absolutely still a threat... there are still 9.2 million people living with HIV that do not have access to treatment” (11:31).

• Initial Chaos, Policy Pivot:

  • Early 2025, abrupt funding pauses led to deep uncertainty and fear of resurgence (13:10).
  • By February 2025, Trump signed a bipartisan bill injecting nearly $5.9bn/year back into HIV response (13:10–16:00).
  • New “America First Global Health Strategy” focuses on co-investment and country-led action (13:10–17:25).

• Gaps & Cautions:

  • Despite renewed funding, allocations remain about 2% lower than pre-cuts (19:07).
  • Vigilance is needed to prevent a rebound in new cases and ensure at-risk populations are reached (19:16–20:58).

  “We want to make sure that those people living with HIV that still haven't received ARVs are getting their ARVs... There are still gaps we have to fill and it means we have to work quickly, urgently.”
  — Anjali Ashrakar (19:30)

5. Security & Stability: The OTI Story

• Direct Impact on Global Stability:
  • Kevin Melton, ex-USAID’s Office of Transition Initiatives (OTI), mourns the loss of capacity for supporting post-conflict transitions and democratic change worldwide (27:05–27:54).
  • OTI, a Cold War legacy, specialized in “bringing stability to societies not just through police force, but also through civil entities and governance” (28:00–28:36).
• Broader Security Risk:
  • “Not having a capability that understands how to engage in a stability environment... there are many lessons in history that have taught us you can't do that.” — Kevin Melton (30:13)
  • True security requires both a military and developmental approach; “My argument is that it's always both.” (32:03)
  • The abrupt axing left a “gap” in US and allied ability to shape stable environments crucial for economic investment and counter-extremism (37:18).

6. Rapid Adaptation: The Rise of Private Sector Solutions

• PAC Strategies: Melton quickly founded a consultancy to “capture some of the expertise that had been born by, with and through OTI” (29:00–35:01).
  • The firm’s focus: supporting investment and stability in conflict and post-conflict regions, reflecting the vacuum left by USAID and OTI.
  • Demand is high, but there’s a need to “educate” public and private clients on why stability is still fundamental (38:32).
  • The expertise “the US taxpayer had paid for over the last 30 years” is now being offered privately (35:01).

7. Strategic Reflection & What Comes Next

• Parallels to Security Spend: The hosts compare the debate over aid to broader US military strategy—was America bankrolling too much for too long, and is there any alternative to US leadership? (20:58–21:27)
• Historical Lessons:
  • American investments in the Cold War and post-war reconstruction benefited both America and its allies—these are not mere acts of charity but “strategic investments which bring huge returns not only to us, but Americans.” — Arthur S-G (21:27)
  • The collapse of these long-standing systems is an “upheaval,” marking a moment of deep transition and uncertainty (39:24–39:41).

Notable Quotes & Memorable Moments

• On the catastrophic impact of the shutdown:

  "The aid system globally has had something akin to a heart attack and people are still racing to try and revive it."
  — Arthur Scott-Geddes (02:18)

• On the transactional perspective of aid:

  "He [Trump] looks at the world as if it’s a zero-sum game... But that is not how the world works."
  — Arthur Scott-Geddes (05:50)

• On the vast human cost:

  "Every one of these lives, whether it’s 10 or 10 million, those are lives that won’t exist in the way that we’ve enjoyed our lives and children have enjoyed theirs."
  — Arthur Scott-Geddes (04:05)

• On the new America First Global Health Strategy:

  “We’re seeing the U.S. actually coming back with strong leadership and commitment financially in the HIV response… So what we saw in the early part of 2025 is definitely different and we're seeing real leadership coming back now and into the future.”
  — Anjali Ashrakar (13:10)

• On the security void:

  "I will say it’s not lost, certainly here in the United States, that this is still an important issue... there's still bipartisan support... they just now need to be understood of how does the executive branch truly move that forward."
  — Kevin Melton (30:13)

• On adapting to a post-USAID world:

  "We had USA people sit next to four-star commanders. That’s gone now. And that's pretty much why PACS exists... It's a gap."
  — Kevin Melton (37:11)

• On the new global order:

  “It’s become the air that we breathe. It's hard to imagine what else it looks like. But we are in that moment of transition right now, aren't we?”
  — Venetia Rainey (39:28)

Timestamps for Important Segments

• [02:18] — USAID’s shutdown and the “heart attack” analogy
• [03:13] — Lancet study statistics: projected 9.4 million deaths
• [05:50] — Rebuke of Trump’s zero-sum economic logic
• [09:10] — Review of USAID’s measurable achievements
• [10:59–20:58] — In-depth interview with Anjali Ashrakar on HIV, rebound, and "America First" pivot
• [27:05] — Kevin Melton on OTI’s legacy and post-conflict stabilization
• [30:13] — Security versus development approaches in fragile states
• [35:01] — Formation of PAC Strategies and the migration of expertise to private sector
• [39:24–39:41] — Hosts reflect on the transition and upheaval in global aid/security models

Conclusion

This episode expertly covers how the shuttering of USAID fundamentally destabilised global health and security systems. Despite a partial pivot and restored US investment in high-profile disease fighting, notably HIV/AIDS, the loss of a system that proactively built capable societies and underpinned post-conflict transitions is leaving palpable gaps. Private sector actors are racing to fill the void, but the interviewees and hosts agree: millions of lives hang in the balance, and the new "America First" paradigm marks a watershed moment in global power and responsibility.

For listeners seeking a macro-level and granular understanding of US foreign aid’s global consequences, this episode is unflinching, sobering, and essential.