Rubio’s USAID “Humanitarian Waiver” Fails for Lifesaving Programs

Secretary of State Marco Rubio’s humanitarian waiver for foreign aid is a “performative” bit of “lip service,” said former contractors with the U.S. Agency for International Development who worked on programs to stop the spread of HIV/AIDS and Ebola.

Instead of a functioning waiver system, they told The Intercept, the programs are grinding to a halt amid the chaos — putting aid recipients at grave risk.

With USAID staffers forced out on leave and agency contractors laid off, and with scattershot advice from the State Department, organizations outside the U.S. have been left with little idea of how to request new waivers or how to implement those already granted for HIV/AIDS treatment.

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Rubio, meanwhile, is placing the blame on aid workers themselves. On Tuesday, he lashed out at the foreign aid partners who have endured days of chaotic and shifting instructions from the U.S., suggesting that they might be “deliberately sabotaging” lifesaving projects “for purposes of making a political point.”

Inside the U.S., a major contractor that helped the government procure vital anti-retroviral drugs said Wednesday that it had yet to receive an explanation of what the waiver meant and has not restarted work.

“You don’t have the staff to oversee it, you don’t have the systems in place to move the products. It’s gone.”

A former USAID contractor who worked as a supply chain adviser on an HIV/AIDS project until their termination last month panned the waiver process.

“It’s beyond lip service at this point, given that you don’t have the staff to oversee it, you don’t have the systems in place to move the products,” said the aid worker, who requested anonymity for fear of retribution. “It’s gone.”

Waiver for What?

Rubio announced the waiver on January 28, a week after President Donald Trump signed an executive order freezing all foreign assistance for a 90-day review.

His announcement of the waiver came at the same time that Elon Musk and his allies were dismantling the agency that oversees much of foreign assistance, USAID.

The “humanitarian waiver” was supposed to ensure that lifesaving and politically popular programs such as President’s Emergency Plan for AIDS Relief, or PEPFAR — an HIV/AIDS treatment and prevention program launched by George W. Bush in 2003 — would continue.

Time is crucial when it comes to the anti-retroviral drugs that treat and prevent the spread of HIV. It can take just three weeks for viral loads to rebound once patients stop receiving the drugs.

Rubio’s announcement of the waiver process did not amount to an instant revival of PEPFAR, however. The program’s waiver wasn’t granted until February 1, and even the limited waiver has left America’s foreign partners piecing through what they can and cannot do with U.S. dollars and drugs.

HIV clinics in South Africa, where PEPFAR helps provide daily treatment to 5.5 million people, were still closed days after the waiver was announced.

Many groups have yet to receive further word after the initial stop-work instructions from U.S. government officials, the South African newspaper Daily Maverick reported Wednesday.

“Even though it’s been issued at the State Department level, a lot of programs on the ground haven’t gotten any formal communication yet that they can start,” said Jen Kates, senior vice president and director of the global health and HIV policy program at KFF. (The State Department did not respond to a request for comment.)

The partner organizations are also scrambling to figure out who to contact with questions.

USAID staffers have been locked out of the organization’s Washington headquarters since Monday, and the organization announced Tuesday that all direct hires will be placed on “administrative leave” starting Friday. Thousands had already been locked out of their email accounts and told to stay home.

The agency’s army of contractors — who perform critical work on PEPFAR and other programs — had already been furloughed or laid off in response to Rubio’s decision to issue “stop-work” orders on existing aid contracts on January 24, with the exception of Israel and Egypt.

Even if communications with foreign partners resume, it will take time to undo the damage of the initial freeze, Kates said. Community organizations abroad often have little in the way of cash reserves and in many cases have already laid off staffers.

She said, “If they’ve had to let go of providers, for example, it’s not so easy to turn a switch back on and start again.”

Rubio Blames Everyone but Himself

Two days after the waiver was issued, Sen. Bill Cassidy, R-La, said some patients still were not receiving HIV medication.

“PEPFAR is the epitome of soft power. It is a Republican initiative, it is pro-life, pro-America and the most popular U.S. program in Africa,” he posted on X. “There’s even a waiver acknowledging this, yet I’m told that drugs are still being withheld at clinics in Africa. This must be reversed immediately!!”

In response to complaints about the blizzard of vague and conflicting orders coming out of the State Department, Rubio decided, during a stop in Costa Rica on Tuesday, to shift blame to the workers scrambling to get the programs up and running again.

“I issued a blanket waiver that said if this is lifesaving programs, OK — if it’s providing food or medicine or anything that is saving lives and is immediate and urgent, you’re not included in the freeze,” he said. “I don’t know how much more clear we can be than that. And I would say if some organization is receiving funds from the United States and does not know how to apply a waiver, then I have real questions about the competence of that organization, or I wonder whether they’re deliberately sabotaging it for purposes of making a political point.”

FILE - In this July 2, 2020 file photo, nurse Nomautanda Siduna, right, talks to a patient who is HIV-positive inside a gazebo used as a mobile clinic in Ngodwana, South Africa. Researchers are stopping a study early after finding that a shot of an experimental medicine every two months worked better than daily Truvada pills to help keep uninfected women from catching HIV from an infected sex partner. The news is a boon for AIDS prevention efforts especially in Africa, where the study took place, and where women have few discreet ways of protecting themselves from infection. (AP Photo/Bram Janssen, File) — A nurse talks to an HIV-positive patient inside a USAID mobile clinic in Ngodwana, South Africa, on July 2, 2020. Photo: Bram Janssen/AP

His stance left leaders in the development world bewildered and angry.

“A very cheap shot by Rubio to accuse the NGOs of politicizing this, when the breakdowns are in fact coming from the (willful?) dysfunction within the administration,” Jeremy Konyndyk, a top USAID official under President Joe Biden who now serves as the president of Refugees International, posted on X.

Outside of the HIV/AIDS program, the emergency food programs that Rubio highlighted in Costa Rica are also experiencing problems, according to Kates.

“I have talked to an organization that does emergency food interventions, and they haven’t been given any indication that they can continue to do that. So, it doesn’t seem clear at all to people in the field,” Kates said.

One senator from a farm state took to social media on Tuesday to ask for help on that front.

“I urge @SecRubio to distribute the $340 million in American-grown food currently stalled in U.S. ports to reach those in need,” Sen. Jerry Moran, R-Kan., said. “Time is running out before this life-saving aid perishes.”

Prevention and Treatment

The State Department’s limited waiver for the HIV/AIDS program has a perplexing omission: the pre-exposure prophylaxis, or PrEP, that can prevent people from getting infected in the first place.

PrEP is only covered for pregnant and breastfeeding mothers to prevent the transmission to their children, according to Kates. Other patients do not appear to be included in the waiver.

“They granted a waiver in lip service, but they never turned on the payment system.”

“PrEP is extremely effective. If you take it in advance of an HIV exposure, your risk of becoming infected with HIV is reduced by 97 percent,” Kates said. “It would be this unfortunate irony if they got HIV because they couldn’t get PrEP, but now they can get treatment because the waiver allows for treatment.”

If the waiver for HIV/AIDS medicine and treatment does become more of a ground reality in the days to come, former USAID officials are still worried about what will happen further down the line.

Many of the anti-retroviral drugs that prevent HIV patients from getting sick were procured by a contractor, Chemonics, that received a stop-work orders from Rubio. The company has not been paid for any contracts since Trump’s inauguration and has laid off 70 percent of its U.S. staff, according to CNN.

“We are still awaiting clarifying guidance from USAID about how to apply the waiver to our programs. As of now, all work remains on pause,” a Chemonics spokesperson, Payal Chandiramani, said in a written statement Wednesday. “As a result of the stop-work order we are unable to procure or deliver lifesaving anti-retroviral therapy.”

The USAID contractor who provided support for the HIV drug supply chain, through another company, said the lack of action on the purchasing contract showed how hollow the waiver process has been so far.

“They granted a waiver in lip service, but they never turned on the payment system to be able to pay for work to continue,” they said. “This is again why I come back to this being lip service, because tell me how we expect private companies to work and function without being paid?”

Then there are other projects formerly overseen by USAID that do not appear to have received a waiver thus far — but which provide services just as vital to preventing the spread of disease.

For years, USAID has been working to build up African countries’ capacity to detect and halt the spread of Ebola and another hemorrhagic fever virus, Marburg. One former contractor, who was working as a senior adviser on that project and requested anonymity because they will soon be searching for another job in the field, said that the waiver process has not brought it back online.

“I think it’s largely performative, to quell some of the backlash that has been coming. I know for a fact that the programs that I was working on were not part of that waiver, and I very much think that work in this outbreak field is lifesaving, and keeps America safe,” they said. “I don’t really understand why people are no longer concerned when these are multiple, concurrent, viral hemorrhagic fevers.”

Future waivers for such projects should refer to specific federal government budget lines and departments to prevent confusion, Charles Kenny, a senior fellow at the Center for Global Development, wrote in a blog post.

The government also must reinstate the staffers and contractors who actually oversee the projects, he said.

“Otherwise, the waiver program is a fig leaf,” Kenny wrote, “and the deaths that will result squarely the responsibility of those who could act to fix it.”