A coalition of American non-profit, legal and small business groups welcomed a federal judge’s temporary restraining order (TRO) halting the Trump Administration’s executive order freezing virtually all USAID activities – followed by a “stop work” order on the agency by new US Secretary of State Marco Rubio. 

The ruling Thursday evening in a Washington DC District Court came in response to a lawsuit filed by the Global Health Council, the Small Business Association for International Companies, HIAS, the Jewish-American refugee aid agency; and the American Bar Association.

“This ruling is a vital first step toward restoring U.S. foreign assistance programs,” said Elisha Dunn-Georgiou, President of the Global Health Council, a member based body. “It clears the path for organizations to resume their life saving work, showcasing the best of American values: compassion, leadership, and a commitment to global health, stability, and shared prosperity.”

In their suit, the groups contended that by attempting to dismantle an independent agency established by Congress, the Trump Administration was “unlawfully withholding billions” in foreign aid. 

“The Administration has forced businesses large and small to shutter programs and lay off employees. These actions have caused widespread harm, weakening the infrastructure needed to combat mounting global health crises including bird flu, measles, and drug-resistant tuberculosis—diseases that have surfaced in the U.S.—and leaving hungry children without food, vulnerable populations without critical medical aid, and communities without life-saving support,” the charged the plaintiffs in the suit, which included Management Sciences for Health, Chemonics International, DAI Global, and Democracy International – non-profit and for-profit groups that are major USAID subcontractors.

Impacts and ongoing uncertainties 

On paper, the TRO blocks the government from taking actions that would disrupt U.S. foreign assistance programs including:

• Suspending, pausing, or otherwise preventing the obligation or disbursement of appropriated foreign-assistance funds in connection with any contracts, grants, cooperative agreements, loans, or other federal foreign assistance award that was in existence as of January 19, 2025; or
• Issuing, implementing, enforcing, or otherwise giving effect to terminations, suspensions, or stop-work orders in connection with any contracts, grants, cooperative agreements, loans, or other federal foreign assistance award that was in existence as of January 19, 2025.

However, with USAID personnel around the world on forced furloughs, budget systems frozen, and grain donations rotting in US ports, it remained unclear if a temporary order, on its own, could rapidly reboot the massive $40 billion-a year apparatus  – including $8.5 billion in global health assistance. 

“Despite the restraining order, much of the damage to US foreign assistance and to our agencies and humanitarian workers is already done. Within a matter of weeks, the President has succeeded in all but decimating USAID and has perhaps irreparably damaged the goodwill and reputation of the United States,” said Lawrence Gostin of Georgetown University.

“It is hard to describe the chaos at USAID, with funds frozen, staff let go, and partners all over the world feeling shattered. Even foreign aid programs that have received a waiver from the freeze cannot carry out their functions. This has caused enormous human suffering and hardship, with children starving and at risk of stunting, persons living with HIV unable to access their medications, and humanitarian assistance at a grinding halt,” he added, citing a recent article in the peer-reviewed journal Health Affairs.

Gostin, who heads a WHO Collaborating Center on law and global health policy, was pessimistic about the possibility of legal action changing policies in the long-term, saying, “no matter what the courts ultimately do, the harms will be real and palpable. And in the end, the President will probably prevail in the courts. He may be forced to actually follow a logical process and not be arbitrary and capricious. He may have to unfreeze funds until he can get Congress to join him in decimating USAID. But the president has a highly compliant Supreme Court that seems to back him on almost anything consequential.”

Pressure growing on  Trump administration 

At the same time, the pushback, coming from multiple corners could help swing the pendulum back over time.  “Some push back is good and in the end things will not be as bad as first thought,” one USAID insider, speaking confidentially, told Health Policy Watch. 

Pressures are building, for instance, from farmers in so-called “Red” or Republican states, who sell hundreds of millions of dollars in grain to USAID and, via USAID, to the World Food Programme (WFP) every year, to feed hungry people around the world. Ambassadors, who see USAID as a vital form of “soft power” for the US in the geopolitical competition with China, Russia and Islamic extremists, are also likely to protest quietly.

“I have been waiting for the agriculture sector to weigh in. They will take a big hit from the President’s actions,” Gostin said. While WFP said on Tuesday that its deliveries of food aid stuck in US ports were allowed to resume on 11 February, the Trump-ordered pause in new food aid purchases and stop work orders on new WFP purchases has remained in effect.

Biggest provider of global health foreign aid

“By attempting to dismantle an independent agency established by Congress and unlawfully withholding billions in foreign-assistance funding, the Administration has forced businesses large and small to shutter programs and lay off employees,” said the Global Health Council in its statement on the temporary restraining order.

“These actions have caused widespread harm, weakening the infrastructure needed to combat mounting global health crises including bird flu, measles, and drug-resistant tuberculosis—diseases that have surfaced in the U.S.—and leaving hungry children without food, vulnerable populations without critical medical aid, and communities without life-saving support.”  

With a global health budget of $8.5 billion annually, USAID is the largest US provider of global health assistance, far outpacing the Department of Health and Human Services, and PEPFAR, the President’s Emergency Plan for AIDS Relief.  In fact, USAID implements most US bilateral global health funding, including 60% of  PEPFAR’s $4.2 billion budget for HIV/AIDS in 2023. 

Along with the already well-reported impacts of USAID’s collapse in battles against infectious diseases like polio, HIV/AIDS, influenza, malaria, marburg and Ebola, there has been a ripple effect to an even broader range of activities related to global health security,  health services, and nutrition, the GHC noted in a briefing note issued last week. Some of those include: 

• A halt to the flow in over $1 billion in pharmaceutical donations, including HIV drug supplies; as well as USAID facilitated global biotech and research partnerships with US companies; 
• Interruption in the services of thosuands of maternal and child nutrition centers; care for pregnant women and orphans; in conflict zones and the world’s poorest countries.
• A halt to USAID support for thousands of frontline health clinics in vulnerable countries and conflict zones, including: Afghanistan, Ethiopia, Myanmar, the Democratic Republic of Congo; Guatemala and Honduras.

For maternal and child health and TB, USAID was the implementer of all US bilateral support in 2023. It also managed 99% of family planning and reproductive health funds and 96% of funds for malaria control efforts.

CDC finally reports on avian flu spread   

In other developments, the US Centers for Disease Control, finally issued an update on Avian flu to its Morbidity and Mortality Weekly Report (MMWR), which showed that some veterinarians working with cattle were unknowingly infected with the H5N1 (avian flu) virus last year.

The report is the latest to indicate that the outbreak in dairy cattle is spreading further under the wire. The CDC report was one of several MMWR reports on avian flu that were to have been released three weeks ago. 

Inother report published this week, the CDC cited new USDA data on the rapid spread of H5N1 bird flu in poultry, showing some 157 million birds have so far been affected, since the first detections in 2022. The outbreak has caught the attention of the US public as the price of eggs soars to a 50-year high. 

States can opt out of testing dairy cattle for avian flu 

As for the dairy herds, USDA tables and maps showing trends in the spread of the highly pathogenic virus in dairy herds, across different states, which typically linked to the MMWR reports were no longer visible on the web page.  The USDA pages have not been updated since 17 January.  

But even that data, when available, was incomplete since federal law allows states to opt out of testing dairy cattle, noted Kay Russo, a dairy and poultry veterinarian.  He said the new CDC report on the silent spread of the virus among veterinarians underscores an urgent need for more routine monitoring of animals in agriculture.

“The frequency may be insufficient to proactively warn and safeguard workers,” Russo told the Washington Post. 

“This is a critical worker safety issue for farm and processing plant workers,” said Russo, who has worked on the outbreak since last March. “I can’t help but feel we’re missing huge pieces of the puzzle at this time.”

–Updated 16 February, 2024

Image Credits: Arnaldo Salomão Banze, ADPP Mozambique, USAID, KFF , US CDC , US CDC .