Nick, take us into that decision window and what did you want to document in the memos?

Yeah, I mean, it was it was an evolving process.

I mean, again, I think that the throughout the 42 days that this book covers, I one of the things I'm really trying to describe in this book is that that process.

of getting from being a stalwart civil servant whose responsibility is to administer the policies of the president, regardless of whether I agree with them personally, to a place where I'm making a decision to become a whistleblower, knowing it's going to end my career and knowing that it's potentially exposing myself and my colleagues to all kinds of potential retaliation, but knowing that it needed to be done because of how...

Because I had sworn an oath to faithfully execute my duties as a civil servant and what I had been asked to do and sometimes what I had actually done to an extent that I regret very much to this day had been kind of in conflict with that.

And so by... by the end of this period when I had witnessed the vast majority of the contracts that were needed to implement life-saving programs be terminated, it sort of felt like a last straw, especially this came a day after Elon Musk stood at the White House and told the cabinet and live TV that he had restarted Ebola prevention activities, when in reality he had just terminated the contracts that would have been needed to do that.

It just became clear to me that I needed to inform the world of what actually was happening in USAID.

So on day 42, a Sunday afternoon, March 2nd, talk to us about releasing the memos and what happened.

How did you come to work in global health? What was your experience at USAID and how did it all lead to you writing this book?

Sure.

So yeah, I became interested in working for USAID a long time ago, actually.

During college, I did a study abroad program in Kenya, studying development and health.

It was 2003, and it was kind of the height of the HIV epidemic in Kenya and surrounding countries.

And actually, while I was there, President Bush signed the President's Emergency Plan for Age Relief, PEPFAR, one of the, or maybe the largest public health initiative in history.

And so the timing of it really clicked for me.

What metrics or outcomes should we be thinking about to evaluate the effectiveness of global health assistance and that can actually make the case for global health assistance going forward?

What would be different in this outbreak, uh, if Elon Musk and Donald Trump had not destroyed USAID?

Yeah, I think a lot would be different.

Outbreak would have likely been detected earlier, and the response would've been, uh, uh, profoundly more robust and organized.

Um, but it's not just that the, uh, DOGE and the Trump administration canceled, uh, uh, disease surveillance and, um, a- and, and the kind of sloppy response that we've seen.

It's the trust that's been broken that's made it so difficult to respond.

I mean, w- you, you can't, uh, you can't blame communities for wondering why is the U- is the US government showing up now to respond to an Ebola outbreak when last year they walked away from, uh, fr- from, from s- uh, from supporting, uh, critical programming to...

That, that was, uh, uh, keeping children safe from malnutrition and malaria.

The reality is that money was being sent to corrupt politicians under the guise of aid! " Uh, is that true?

What convinced you to write it and, and, and what do you most want readers to learn after reading your book?

Yeah.

Right.

So, so the, the title of the book, Into the Woodchipper, comes from a tweet that Elon Musk made about two weeks into the Trump administration when he said that he had just spent the weekend feeding USAID into the woodchipper.

And I wanted to give readers a sense of what it actually felt like as a government employee from inside of that woodchipper as our programs were being destroyed and the impossible decisions that the civil service were, were faced to deal with while that was happening.

There's three main reasons that I, I wanted to get my story out broadly to the world.

The first was to really just set a record straight because I had seen the administration lying about it and I knew that was going to continue.

Can you talk to us about the broader impacts of what foreign aid and, and foreign assistance actually does?

I have to say, we didn't expect the kind of scorched earth, did you?

No, no, I did not.

And we also saw writing on the wall when Trump was elected, right? We weren't going into this blind.

We had been here for the first Trump administration and kind of had a sense of what his policy priorities were.

But, you know, there were some hints that while there were going to be changes for sure, there was broad support even among the administration for global health.

I mean, our objectives of increasing global life expectancy and expanding access to medical services and healthcare access were pretty universally supported.

So we weren't that concerned.

And what I hear frequently here is, when are the Americans going to say enough is enough?

By PPE you mean personal protective equipment?

Yes, that's correct.

Right.

It's the, the goggles, the masks, the gowns, um, doing, uh, uh, surveillance and community monitoring and investing heavily in, in training of community-based health workers that would be the, the eyes and ears that would first detect a potential viral hemorrhagic fever like Ebola.

That's the part of this that has been systematically dismantled.

We're seeing the, the State Department responding much more slowly, kind of having to reinvent the wheel and these, this is a time when decisions need to be made in hours, not the days and weeks that we're seeing from the State Department.

This lack of time is actually costing lives.

What lessons should the US be learning right now as we speak, as we look at this outbreak, uh, uh, spread about the importance of preparedness, uh, for future global health emergencies?

The DOGE team, when you said there is this outbreak, we have actually committed to sending PPE protective equipment, I think it was in, was it in, uh, Kenya, Nairobi? They said, "Yeah, if you want it to get there, you can fly over there and hire a truck and take it yourself." This is astonishing.

Yeah.

Um, you know, it just kind of goes to show, like, the disdain that DOGE and, and the political leadership had for our, our processes and systems.

We, we had an outbreak response team that knew exactly how to respond to an Ebola outbreak because they've done it before, and all of those systems broke down, and, and it came to angry people who didn't understand what was happening just kind of like slamming the table and, and wondering how they could do things differently.

The problem was they didn't want us to, um, access the PPE that the US government had already paid for because it was being stored in a warehouse that was operated by the World Health Organization, which they were in the process of withdrawing from.

And rather than engage briefly with the WHO to get that PPE into the outbreak zone within hours, they decided that they would not do that.

And weeks later, when news stories started coming about the PPE sitting in a warehouse while an outbreak was going on, Pete Marocco, uh, again, the head of the agency at the time, ordered me to go and get it myself without talking to WHO, which I didn't understand what he meant.

You, you, you're not gonna have thought-out, clever reform in a climate like this." I just, I just wonder how you see it.

Yeah, so actually, a- as a first step, it would really be useful for, I think, all of us to understand how you ended up at AID.

Yeah, I was always drawn to public service since I was a, a kid.

My father was a local elected official in Massachusetts.

He was on the Board of Selectmen in the town I grew up in Lexington, Massachusetts.

But I chose global health later.

Actually, when I was in college, I did a study abroad program in Kenya.

Um, it was studying development and health.

Mm-hmm.

Uh, what is your sense of the current situation in this Ebola crisis, and what can be done given that our resources have been so destroyed, uh, by Elon Musk and Donald Trump?

Trump?Yeah, this is an outbreak that's we have not yet got under control, and I think the, the, the concern is that, um, we, we started off without the resources that we had.

Unfortunately, USAID, uh, used to be on the scene, and we had a playbook that allowed us to respond quickly to Ebola outbreaks, and we had in the past.

And unfortunately, with those resources, um, gone and, um, and, uh, w- with USAID no longer able to, um, to provide services or to, to partner with, uh, local organizations in the region, um, the State Department is left scrambling and, um, trying to, uh, uh, uh, ha- having to improvise and, um, make up, m- make up the playbook as they go along.

And unfortunately, decisions that need to be made in hours are un- uh, unfortunately slipping and, and it's taking days or sometimes even weeks, and that's what's letting this, uh, outbreak continue to, to spread out of control.

What happens if Ebola reaches the United States?

Um, I think, you know, uh, we, we, we, we are at risk.

Some of, some of, uh, uh, Americans already have tested positive, but I don't think that th- this current outbreak, uh, luckily is likely to be the one to cause the next pandemic.

So when we talk about political appointees, what are we referring to, and how are the political appointees who came in in the second Trump administration maybe distinct from the types of appointees that came in during prior transitions?

Yeah.

So, so unlike the career staff or the civil service and the foreign service and the, those that are kind of the consistent federal employees that stick around and non-partially or, or non-- in a non-partisan way implement the, the work of USAID, every four years, there's a new political leadership that's determined by and appointed by the president, and that, that's common.

That happens every four years.

And usually, uh, that's experts in, in the field where, like for, i-in global health, our, our previous, uh, political appointee that to lead, uh, global health was a guy named, uh, Atul Gawande, who's a renowned surgeon and, and global health strategist.

And so that, that's normally what, what you get in terms of political appointees.

In this case, the, the people that were brought in as the Trump political appointees were actually people that hadLittle to no information about what the agency did or really understanding of how government worked.

Can you talk about what the standard, if there is a standard, USAID response to an Ebola outbreak is, and then compare that to what happened last spring?

Uh, and, um, and then w- I also wanna talk about PEPFAR.

Great.

Um, yeah, so in, in Sudan, maybe, maybe I can start there.

That was a country where we were largely providing humanitarian aid and support.

In the global health field, that meant providing emergency food assistance and emergency, uh, medical assistance, which, um, honestly, when the agency was shut down in, um, i- in, in the spring of last year, these were where we started to see the first anecdotal examples of people losing their lives due to the cuts.

It was because...

And just absolutely atrocious stories of families walking all day to the clinic with the USAID logo on the side, only to find it closed, and then having to go home and decide which of their children to feed because they were not able to get food.

So, uh, just give us your sense of that.

Can you tell us about your experience?

Yeah.

I mean, a-again, as a civil servant, um, a-as so many of us were, you know, we did n- we were not in this role as advocates or activists.

We were, um, public servants responsible for administering the policies of the president.

And that had never in my career, including under the previous Trump administration, created any sort of, uh-Uh, like moral compromise issues whatsoever.

But as I started to be tasked with illegal action like, uh, getting rid of staff or signing off on the destruction of contracts or, um, ending projects that were in the process of saving lives, um, it- I, I became more and more uncomfortable with w- how, uh, w- with, with where my line was to, to, to stand up and say, "You know, this is no longer okay." And it, it w- it was, it was a very difficult journey for me because I, I, I saw myself as a career civil servant, and I, um, always thought that I would continue to work from, um, from within those, um, from within those confines.

And actually, you know, the, the first time I stood up and said no, um, w- it wasn't related to a policy decision at all, um, or, or, or related to our contracts or anything.

Do you wanna comment just on, on the layoffs? I'm seeing also that the District of Columbia has the highest unemployment rate in the nation at 6.7% in large part because of major reductions such as the one at USAID.

What are, what are the worst things you saw?

Well, I guess the, maybe the worst things that I saw that really kept me up at night at the time were when they would ignore warnings that were directly threatening US national security.

So just to stay on that example that you were, you read from the book about the Uganda, Uganda Ebola outbreak, they wouldn't even allow us to screen passengers on international flights for symptoms of Ebola before getting on planes that potentially were going onward to the United States.

That, that was just one example, but-

Uh, were, did, did, were there any moments where it seemed they understood any bit of the damage they did?

I think that there were moments when I was able to brief them on specific threats that were, um, that, that were facing based on the cuts, again, where we were unable to provide malaria services at the beginning of the rainy season that was gonna threat, threaten, um, to m- put us in a much worse position for one of the diseases that's the top killer of children around the world.

But again, all they could really do was smack the table, blame the staff, and, like, look around at each other because they did not know how to fix the mistakes that they had made because of their just general level of-

Tell us about the book and your decision to write it.

I, I wrote the book because I...

It, it, it wasn't just...

I, I think that there's two, uh, critical factors that people should, um, take away from this book.

The first is that we pulled the wor- the rug out from under, uh, people around the world.

We had...

We broke promises to millions who were relying on USAID services and left them hanging out to dry.

I remember when, um, Elon Musk, uh, said, "Oh, we made a little mistake, but we fixed that."

Tell us about the book and your decision to write it.

I, I wrote the book because I...

It, it, it wasn't just...

I, I think that there's two, uh, critical factors that people should, um, take away from this book.

The first is that we pulled the wor- the rug out from under, uh, people around the world.

We had...

We broke promises to millions who were relying on USAID services and left them hanging out to dry.

I remember when, um, Elon Musk, uh, said, "Oh, we made a little mistake, but we fixed that."

You said you could divide them into those who were cruel and those who were buffoons, and that's the only possible explanation I could come up with s- watching it from out here about what they were doing.

Yeah, that's correct.

Um, I think especially the DOGE side of, of thingsWe were mostly dealing with what I refer to as buffoons.

They were uninformed, they were unqualified, they came in on a mission to destroy the agency without having any idea what it did.

Um, that example that our chief of staff of the whole agency, when he, he didn't know what USAID did in global health, he thought that the only thing we did was abortions, which, uh, just goes to show how ignorant, uh, the leadership was of the agency that they were trying to destroy.

It was all so predictable how deadly this would be.

Right.

As you mentioned, over 750,000 people have already died.