The U.S. government is not well known for efficiency, yet operations continue slowly in various sectors including health, education, defense and social security. There is a known history of slow progress, red tape and what I like to call snail mail (no offense to snails or the post office) that plagues our system. So, it is no surprise that in this new administration there was a change to the status quo, prompting a proposed new Department of Government Efficiency (DOGE). In reality, it sounds like a decent idea to carefully audit and manage the excess waste created by bureaucracy in Washington, but in practice it can be corrupted to cater to specific agendas.  

The federal government’s current wave of change has yielded an obvious shift to remove contributions and funding for global aid that assists with health and development worldwide. Parting ways with the World Health Organization (WHO), cutting the U.S. Agency for International Development (USAID), pausing funding for the President’s Emergency Plan for AIDS Relief (PEPFAR) and reforming the National Institutes of Health (NIH) with rumors to cut funding from the National Institute of Allergy and Infectious Diseases (NIAID) and the Fogarty International Center are just steps in this process. These are drastic attempts to take money, energy, focus and resources away from those who are less privileged and likely in need. Marco Rubio, the Secretary of State, has revealed plans to restructure USAID so that all efforts go towards “America’s interests.”  

This counters most endeavors in the philanthropic world, where efforts to improve communities are focused on a scale larger than any single country. But more importantly, what does that really mean? Understandably, there are efforts that strive to improve infrastructure in allied countries where the American government has a relationship that can manifest in trade, commerce and other interests (e.g. defense, intelligence). But I look at this policy and worry this is a means to maintain the large divide between the U.S. and low and middle income countries: a divide that can enforce ongoing exploitation of those vulnerable communities.  

All this effort to counter global health aid comes with no discussion of a bigger problem, domestic healthcare. This could be due to the fact that non-clinical facing entities and companies receive a share of profit, allowing for exploitation within the system. It also asks the fundamental question, why do we maintain a profit-driven health system? 

This discussion of government efficiency cannot be had without acknowledging one of the biggest drains on government funds: defense and national security. The defense and military aid we provide never seems to be negotiable. For context, the WHO annual budget for 2024-2025 was $6.83 billion. The USAID budget is estimated to be between $40-50 billion annually. Just in 2024, the U.S. gave at least $17.9 billion to Israel in military financing and arms sales. This is estimated to be only a fraction of the actual cost. One must question what the government’s real objective is when cutting global health funding. Is it a smokescreen to shift focus to other endeavors? It is similar to nominating various officials with limited to no qualifications to lead the government’s larger and more powerful agencies. All these actions are part of the Trump administration’s “flood the zone” strategy to distract the media coverage, push dissenters away and essentially numb the population. This changes any conversation that can be had from productive to panicked, and I now see some people counting down when a regime change may occur rather than challenging these actions. 

Recently, one of my good friends mentioned the term “The Shock Doctrine” which comes from Naomi Klein’s book. The concept details how true capitalism is linked to violence and shock where private contractors leverage times of crises to generate profits. We lived through that after the U.S. invasion of Iraq and may be in another cycle. While we need to fight for equity in this world (despite the word’s new negative connotation), we must also examine why these moves are being made. As a pediatric infectious diseases physician during the COVID-19 pandemic, I was most saddened by the lack of empathy from the public and society. We are living in that same compassionless world today and history will look back on our actions and silence during these times. We need to be on the right side of history and disrupt this cycle that fosters power and wealth for the few. This means standing up for humanity, human rights and equity. This means fighting to make our country and world a better place for ALL, even if that is not what our elected officials seem to want. 

Aslam Khan is a Clinical Assistant Professor and Pediatric Infectious Diseases Physician Scientist at the Stanford University School of Medicine