Lethal Dominos

A year on from the dismantling of USAID, the consequences are propagating. An update to Tearing the Seamless Garment.

On April 27th, I published Tearing the Seamless Garment: USAID as a Pro-Life Reckoning for American Catholics on Liturgy and Truth. That essay had taken shape over several weeks of reading and prayer, beginning with Nicholas Enrich’s harrowing book Into the Wood Chipper: A Whistleblower’s Account of How the Trump Administration Shredded USAID, which had appeared in mid-April. Enrich, the senior USAID official whose internal memos warned in writing of the deaths the dismantling would cause, laid out the moral and administrative facts with a clarity I had not expected. My essay attempted to do what his account compelled: to bring the Catholic moral tradition — particularly Cardinal Bernardin’s consistent ethic of life — to bear on what had been done to USAID, and to ask honestly what American Catholics, who had voted decisively for the administration that did it, now owe to those whose deaths they had unintentionally helped to make possible.

The essay was, by necessity, prospective in its empirical core. The peer-reviewed projections in The Lancet told us what would happen if the dismantling was carried through. The Enrich memos told us what those inside the agency had warned would happen. The hard counting of bodies — children who would not be vaccinated, mothers who would die in childbirth, tuberculosis patients whose treatment regimens would be interrupted — had only just begun.

It is no longer prospective.

Nicholas Kristof of The New York Times has over the past year, been doing what almost no other major American journalist has done: bearing witness, on the ground, to what the policies decided in Washington have produced in the villages where the policies land. His column of May 9th entitled This Is What Happened When Trump Abandoned the World’s Poorest Children is the most concentrated indictment yet published of what has unfolded since January 2025. Because the Times column lies behind a subscriber paywall, I will quote and summarize from it more liberally than I otherwise would, so that readers who cannot reach the original can absorb the substance of what Kristof has documented.

A Boston University researcher estimates, as Kristof reports, that the aid cuts have already cost more than 750,000 lives in their first year alone. A study published this winter in The Lancet Global Health projects 9.4 million additional deaths by 2030, including 2.5 million children under the age of five — and that is the milder of the two scenarios the authors modeled. The administration’s response has not been to dispute the numbers, which it cannot, but to dispute the framing. Contrary to false media narratives, the State Department now insists, the data shows that President Trump’s foreign assistance review maintained and improved frontline lifesaving programs.

Kristof, with characteristic restraint, names the move for what it is: a glossy public-relations narrative produced to hide the body count. He notes, accurately, that the administration has cut the very data-collection programs that would allow precise measurement of the deaths it has caused. Are these figures correct? Exaggerated? he asks. He cannot be sure, he writes; nor can the President or anyone else, partly because the surveillance has been deliberately ended.

This is the second-order cruelty of the policy. The first cruelty was to terminate the programs that kept people alive. The second is to terminate the surveillance that would have counted the dead.

I want to walk through what Kristof has documented, because the moral picture is now significantly worse than the picture I described at the end of April. The dismantling of USAID was not a single act with a single set of consequences. It was the first domino in a sequence. The pattern is what the title of this update names: lethal dominos.

The First Domino: USAID Itself

The original cuts amounted to a 71 percent reduction in humanitarian aid between fiscal year 2024 and fiscal year 2025. American humanitarian assistance, in Kristof’s measured phrasing, did save one life every 10 seconds until last year. The cuts ended that. Programs were terminated en masse. Catholic Relief Services lost roughly half its annual budget. Caritas Internationalis described the action as “an inhumane affront to people’s God-given human dignity.” The bishops sued the administration. None of it stopped what was happening.

The administration now claims, through Jeremy Lewin, the acting under secretary of state for foreign assistance, that the cuts merely “reduced NGO bloat.” This is a phrase that requires some imagination to apply to malaria nets, antiretroviral medication, polio vaccines, and severe-acute-malnutrition treatment. The children who have died of those treatable conditions over the past year were not bloat. They were children.

Kristof’s column relays a particular exchange from Enrich’s book that bears slow reading. A newly arrived Trump appointee at USAID, briefed on what the agency actually did in global health, told Enrich that he had had no idea you did all this. Pressed, the appointee elaborated: as a Republican, he said, he had assumed it was just, you know, abortions.Kristof’s parenthetical correction is one sentence: no American aid dollars went to abortions.

I devoted an entire section of my original essay — Section IV, on family planning, proportionality, and the principle of cooperation — to exactly this misperception. The Helms Amendment has prohibited the use of foreign assistance funds for abortion since 1973. The U.S. bishops have defended that prohibition continuously. USAID did not fund abortion. It was legally prohibited from doing so. And yet the misperception drove the dismantling. It drove it not because the architects of the policy had bothered to learn what the agency did, but because they had not. Enrich’s own description of the appointees who terminated programs whose purposes they did not understand is, as Kristof relays it, callousness, dishonesty, and ineptitude. The phrase belongs in the historical record.

The Second Domino: Vaccines

Kristof’s most urgent disclosure concerns Gavi, the international vaccine alliance that has, by a wide margin, the strongest cost-benefit record of any global health program in the world. One study found that every dollar spent on vaccines in poor countries returns fifty-four dollars in reduced health costs and other benefits. The Trump administration has not only slashed funding for Gavi; it is now refusing to release $600 million already appropriated by Congress, money that must be obligated by September or it disappears.

Kristof writes from personal experience here. He was once hospitalized with a serious case of malaria contracted while reporting in the Democratic Republic of Congo, and he calls it a miracle that a few doses of a three-dollar vaccine can now save a Congolese child’s life from the same disease — and a scandal that the administration is willing to let those children die out of ideological hostility toward vaccines.

Gavi also pays for the human papillomavirus vaccine that prevents cervical cancer, a disease that kills more than 900 women a day worldwide. Kristof describes cervical cancer with the exactness of a journalist who has seen it: an excruciating, humiliating way to die, sometimes diagnosed partly by the odor of rotting flesh. The vaccine that prevents it costs four dollars. Gavi’s HPV vaccinations have already averted nearly one million such deaths.

Gavi estimates that 600,000 additional lives will be lost by 2030 as a direct consequence of the funding cuts. Kristof asks his American readers to perform a brief act of imagination: Think of your mother, wife, daughter; multiply by 600,000.

I want to dwell on this for a moment, because the moral question it poses is not a difficult one. The Catechism teaches in §2288 that human life is a gift from God of which we are not the absolute masters but the stewards. Concern for the health of its citizens requires that society help in the attainment of living-conditions that allow them to grow and reach maturity: food and clothing, housing, health care, basic education, employment, and social assistance. What is true of a society’s obligation to its own citizens is true a fortiori of an obligation we have voluntarily extended, over decades, to the world’s poorest. We may debate the prudential modalities. We may not, as Catholics, debate the substance.

A government that has appropriated funds for childhood vaccines, and that withholds those funds out of ideological hostility toward vaccines, is a government engaged in something the Catholic moral tradition calls by a hard word. I will not write the word again. I named it once in the original essay. The reader knows what it is.

The Third Domino: The Iran War’s Collateral Hunger

Here Kristof opens a dimension I had not anticipated when I wrote in April. The administration’s catastrophic war with Iran has not merely killed combatants and displaced more than 2.2 million women and girls in Iran and Lebanon. It has produced a global fuel and fertilizer crisis whose consequences for the world’s food supply may prove the deadliest of any single dimension of the past year.

Diesel prices have risen 160 percent in Myanmar. They have risen 87 percent in Nigeria. Forty percent of gas stations have closed in Laos. Rising fuel prices mean rising transportation costs, which mean rising food prices, which mean — in the world’s poorest places — that some people who were already at the margin of survival are no longer at it.

If the Gulf crisis does not end by next month, Cindy McCain of the World Food Program estimates, an additional 45 million people will suffer severe hunger in the latter part of this year.

The fertilizer dimension is graver still. Roughly one-third of the world’s fertilizer production depends on oil and gas byproducts from the Persian Gulf. If the Strait of Hormuz remains closed, fertilizer shortages will mean lower crop yields, higher food prices, and what José Andrés of World Central Kitchen has called the possibility of a multiyear famine beginning as early as the end of this year.

Kristof captures the underlying reality with a sentence that should be read slowly: artificial fertilizers keep roughly half of humans alive. Without them, the earth’s biosphere can sustain perhaps four billion human beings. We are eight billion. The arithmetic is its own sermon.

The Iran war has been justified to the American public as a discrete strategic intervention. It is producing, as a near-mathematical consequence of decisions made in Washington, conditions that may starve tens of millions of the world’s poor. And it is doing so in a season in which the very humanitarian apparatus that would normally have absorbed the shock — USAID, the World Food Program, the international NGO network — has been deliberately gutted.

This is what lethal dominos names. The first domino is USAID. The second is vaccines. The third is fertilizer. They do not fall in isolation. They fall against one another.

The Last Domino: Selective Mercy for the Wealthy

Kristof closes with the detail that, in any honest accounting of the moral character of an administration, deserves the longest pause. The Trump administration is in fact considering emergency financial support — for one nation. The nation is the United Arab Emirates, which is pinched by the Iran war and may receive a lifeline from Washington to support its currency.

The UAE is roughly as wealthy as Britain or France. It is currently fueling the world’s worst humanitarian crisis, in Sudan, by arming a militia engaged in mass murder and mass rape. Its high-level officials have approved investments of approximately half a billion dollars in a Trump family cryptocurrency company.

To put this in plain Catholic moral language: the administration has cut off life-sustaining aid to the world’s poorest, while preparing to extend financial assistance to a regime arming a genocide and to which the President’s family has direct, half-billion-dollar private financial exposure. The medieval moral theologians had a category for this kind of pattern. They called it iniquitas — not merely injustice in the technical sense but the deliberate inversion of right ordering. The poor are abandoned; the predatory are subsidized; the Crown profits.

It is the precise opposite of what the Magnificat sings about.

Kristof’s column closes with a sentence I find difficult to improve upon: the world’s richest men are crushing the world’s poorest children. That is the policy of the past year, named with the directness it requires. Kristof observes elsewhere in the column that the dismantling of USAID has consumed an estimated $6.4 billion in shutdown costs alone — a figure, he notes, that could have saved more than one million children’s lives. He calls the entire enterprise vandalism, accompanied by wasted food, ruined contraceptives. The phrasing is precise.

What Catholics Now Owe

When I wrote the original essay just weeks ago, the Catholic moral question was whether the dismantling of USAID could be justified by the claim that the agency funded contraception. That was the question conservative Catholic readers brought to the piece, and it deserved — and received — a careful answer in the language of proportionality and remote material cooperation.

The question has now moved. It is no longer whether the dismantling can be justified. The cascading record of the past year has made that question moot. The Catholic question now is what we owe — those of us who are members of the Body of Christ in this country, whose prayers and parishes and political voices were claimed by the campaign that produced this — to those whose names we will never know but whose deaths are nonetheless on our common ledger.

I do not have a ten-point program. I have only the discipline of the seamless garment, which I tried to articulate in the original essay and which seems to me more urgent now than it did then.

It begins with refusing the comforting story the administration is now trying to tell. Aid continues. Lives are being saved. Bloat has been reduced. These are not findings. They are excuses. The peer-reviewed evidence, the on-the-ground reporting from journalists like Kristof, and the testimony of organizations like Catholic Relief Services and Caritas Internationalis are unanimous. To repeat the administration’s framing — even as a way of hedging — is to be complicit in the laundering.

It continues with naming the dead. Catholic moral seriousness has always included the spiritual work of mercy of praying for the dead. The 750,000 already counted in the first year are not abstractions. They were children, mothers, fathers, persons in whom Christ was present. They deserve to be named in our intercessions. The names we will not know God already knows.

And it ends — for those of us who remain — with the conversion the original essay closed on. The seamless garment can be torn. With grace, with humility, and with what the Church has always called metanoia, it can also be rewoven. That work belongs to all of us. It is the only Catholic answer to a year of lethal dominos.

The Lord himself once said, of those who do not feed the hungry, give drink to the thirsty, clothe the naked, or visit the sick: “Truly I tell you, whatever you did not do for one of the least of these, you did not do for me.” He did not add a clause exempting His followers when their government claims the spending was bloat.

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Monsignor Arthur Holquin, S.T.L., is a retired Catholic priest of the Diocese of Orange, California, and retired rector of Mission Basilica San Juan Capistrano. He writes at Liturgy and Truth.