Podcast Summary: Trump Tore Down JFK’s USAID Program (w/ Atul Gawande) – Bulwark Takes

Date: November 12, 2025
Host: Jonathan (Bulwark Takes)
Guest: Dr. Atul Gawande (surgeon, writer, former director of global health at USAID)
Documentary Discussed: Rovina’s Choice

Main Theme

This episode centers on how the Trump administration abruptly dismantled the U.S. Agency for International Development (USAID), ending decades of bipartisan global aid work. Dr. Atul Gawande discusses the devastating real-world consequences of these actions, focusing on the collapse of global health support, rising deaths, and his new documentary Rovina’s Choice, which gives a human face to the policy fallout.

Key Discussion Points & Insights

1. Legacy & Purpose of USAID

• (02:09–05:44)
  • USAID, founded by JFK, enjoyed six decades of bipartisan support.
  • Atul Gawande, as director of global health, oversaw 2,500 people in 65 countries, focusing on major global health threats (HIV, polio, maternal/child mortality, extreme poverty).
  • Impact: "in a recent analysis had saved 92 million lives...reduced child mortality by a third."
  • USAID’s model: "moving countries from extreme poverty to being middle income countries and higher in the world."

2. Trump-Era Dismantlement of USAID

• (05:44–08:38)
  • Gawande did not anticipate the rapid destruction because of long-standing bipartisan support.
  • Within hours of inauguration, executive orders halted foreign aid; by the weekend, all global health dollar flows halted.
    • "That meant HIV medicines, tuberculosis medicines, malaria nets on the shelf could not be given. Food aid could not be given."
  • Staff were purged, "termination of more than 80% of the awards and projects underway, the kneecapping of the rest, all against legal mandates."
  • Modeling shows enormous human cost: “estimated 600,000 people have died already so far, 400,000 of them children.”
    (Quote: Atul Gawande, 03:52)

3. Making Harm Visible: The Documentary

• (08:38–12:56)
  • Rovina’s Choice focuses on malnutrition and refugees in Kenya to illustrate USAID’s impact and the fallout when support vanishes.
  • Kenya was chosen for progress made in moving towards middle-income status and hosting refugees from unstable regions (South Sudan, Somalia).
  • On severe acute malnutrition:
    • "Changed the protocol that has now pushed care out of the hospital into community health…dropped the mortality rate from over 20% to under 5%. In the areas where we were working, we had achieved a 1% or less mortality." (10:43)
  • The documentary’s protagonist, Rovina:
    • South Sudanese mother of 7, widowed after her husband was killed trying to earn income.
    • U.S. cuts led to food rations dropping to 40% of minimum for children; one child, Baby Jane, becomes severely malnourished.

4. Real-World Impact of Food Aid Cuts

• (14:37–16:47)
  • Families reduced to one meal per day, often lacking protein.
    • "Baby Jane became so weak from lack of protein that she began to not even be able to breastfeed...you see some really terrible things happen. Loss of skin integrity, swelling..." (14:57)
  • The school feeding program, often run by local governments with USAID tech support, described as "one of the most life-saving steps."

5. Medical Consequences: Malnutrition

• (16:20–19:01)
  • Severe acute malnutrition: "You may get some calories, but you may not get protein. Without protein and basic vitamins, you can't create skin...at a certain point...the skin simply starts sloughing off..."
  • "We have made severe acute malnutrition deaths a rarity that they do not need to happen."
  • Discontinuing programs abruptly hurts ongoing progress and fails to prepare local systems.

6. Larger Philosophical and Strategic Critique

• (19:01–21:07)
  • Sudden cuts are different from gradual transition.
    • "There is an assault on the idea of cooperation to solve big problems in the world and instead a belief that domination, predatory transactions are how the US wins. And the thing is, they don't." (19:23)
  • USAID built on cooperative principles; led to eradication of smallpox, vanquishing famine, and creation of trade partners.
    • "USAID was formed in out of the lessons of the Marshall Plan." (19:57)

7. Counterarguments Addressed

• (21:07–24:51)
  • On waste and inefficiency:
    • "This is $24 per American taxpayer...tiny fraction of our spending. The total amount for USAID is less than half of the budget of my hospital in Boston...the highest impact agency in the US Government per dollar." (21:54)
  • Policy difference versus destruction:
    • "The destruction of USAID has nothing to do with any of that critique. It’s made the ability of the United States to do work around the world without needing the cost of the military phenomenally higher."
  • On global disease surveillance:
    • "We were tracking bird flu...all of that's been dismantled, which only makes us weaker." (24:11)

8. What Can Listeners Do?

• (25:07–27:29)
  • First, “making the invisible visible”—spread the word and documentary.
  • Support organizations working on the ground: UNICEF, International Rescue Committee, Helen Keller International, World Food Program.
    • "A few dollars is another life saved." (25:53)
  • Political accountability:
    • "We are in the face of a public man-made death now at large scale...hold people accountable for that. And we can do that in the way we vote and the way we turn out to call out what's being done." (26:39)

Notable Quotes & Memorable Moments

• On suddenness of the destruction:
  "When the inauguration happened, I left office at 11:59 and within hours the President signed orders halting the foreign aid. By the weekend, Secretary Rubio had implemented and sent letters out that no US dollars could be spent in global health."
  — Atul Gawande, (03:26)

• On lives lost:
  "Brooke Nichols has led a team that has estimated 600,000 people have died already so far, 400,000 of them children."
  — Atul Gawande, (03:52)

• On progress accomplished:
  "Changed the protocol that has now pushed care out of the hospital into community health…dropped the mortality rate from over 20% to under 5%. In the areas where we were working, we had achieved a 1% or less mortality."
  — Atul Gawande, (10:43)

• On philosophical shift:
  "There is an assault on the idea of cooperation to solve big problems in the world and instead a belief that domination, predatory transactions are how the US wins. And the thing is, they don't."
  — Atul Gawande, (19:23)

• On impact per taxpayer:
  "This is $24 per American taxpayer...The total amount for USAID is less than half of the budget of my hospital in Boston...It is the highest impact agency in the US Government per dollar."
  — Atul Gawande, (21:54)

• On what listeners can do:
  "The first task is making the invisible visible. And so I ask you to spread the word around about the, the documentary and make sure that, you know, we're holding people to account simply by acknowledging what the reality is."
  — Atul Gawande, (25:11)

Important Timestamps

• Dismantling of USAID Begins: 02:09–05:44
• Real-world Consequences & Documentary Focus: 08:38–12:56
• Medical Details of Malnutrition: 16:47–19:01
• Debunking the “waste” argument: 21:36–24:51
• Call to Action for Listeners: 25:07–27:29

Where to watch “Rovina’s Choice”:

• YouTube
• The New Yorker website

Tone & Takeaways

The tone is urgent, somber, and deeply evidence-based. Gawande offers both data and personal stories, illustrating the high human and strategic cost of undermining America’s signature global aid program. The episode is a call to recognize, discuss, and act against avoidable suffering caused by political decisions.

For listeners seeking to understand how sweeping policy change translates directly to global suffering, and what can be done to fight it, this episode is essential and harrowing listening.