Mycobacterium tuberculosis is a near-perfect predator. In 1882, Robert Koch, the physician who discovered the microbe, told a room full of scientists that it caused one in seven of all deaths. In 2023, after a brief hiatus, tuberculosis regained from COVID its status as the world’s deadliest infectious disease—a title it has held for most of what we know of human history.

Some people die of TB when their lungs collapse or fill with fluid. For others, scarring leaves so little healthy lung tissue that breathing becomes impossible. Or the infection spreads to the brain or the spinal column, or they suffer a sudden, uncontrollable hemorrhage. Lack of appetite and extreme abdominal pain can fuel weight loss so severe that it whittles away muscle and bone. This is why TB was widely known as “consumption” until the 20th century—it seemed to be a disease that consumed the very body, shrinking and shriveling it. On a trip to Sierra Leone in 2019, I met a boy named Henry Reider, whose mix of shyness and enthusiasm for connection reminded me of my own son. I thought he was perhaps 9 years old. His doctors later told me that he was in fact 17, his body stunted by a combination of malnutrition and tuberculosis.

The cure for TB—roughly half a year on antibiotics—has existed since the 1950s, and works for most patients. Yet, in the decades since, more than 100 million people have died of tuberculosis because the drugs are not widely available in many parts of the world. The most proximate cause of contemporary tuberculosis deaths is not M. tuberculosis, but Homo sapiens. Now, as the Trump administration decimates foreign-aid programs, the U.S. is both making survival less likely for people with TB and risking the disease becoming far more treatment-resistant. After decades of improvement, we could return to something more like the world before the cure.

[Read: The danger of ignoring tuberculosis]

Anyone can get tuberculosis—in fact, a quarter of all humans living now, including an estimated 13 million Americans, have been infected with the bacterium, which spreads through coughs, sneezes, and breaths. Most will only ever have a latent form of the infection, in which infection-fighting white blood cells envelop the bacteria so it cannot wreak havoc on the body. But in 5 to 10 percent of infections, the immune system can’t produce enough white blood cells to surround the invader. M. tuberculosis explodes outward, and active disease begins.

Certain triggers make the disease more likely to go from latent to active, including air pollution and an immune system weakened by malnutrition, stress, or diabetes. The disease spreads especially well along the trails that poverty has blazed for it: in crowded living and working conditions such as slums and poorly ventilated factories. Left untreated, most people who develop active TB will die of the disease.

In the early 1980s, physicians and activists in Africa and Asia began sounding the alarm about an explosion of young patients dying within weeks of being infected instead of years. Hours after entering the hospital, they were choking to death on their own blood. In 1985, physicians in Zaire and Zambia noted high rates of active tuberculosis among patients who had the emerging disease now known as HIV/AIDS. TB surged globally, including in the U.S. Deaths skyrocketed. From 1985 to 2005, roughly as many people died of tuberculosis as in World War I, and many of them also had HIV. In 2000, nearly a third of the 2.3 million people who died of tuberculosis were co-infected with HIV.

[Read: Tragedy would unfold if Trump cancels Bush’s AIDS program]

By the mid-1990s, antiretroviral cocktails made HIV a treatable and survivable disease in rich communities. While a person is taking these medications, their viral levels generally become so low as to be undetectable and untransmittable; if a person with HIV becomes sick with tuberculosis, the drugs increase their odds of survival dramatically. But rich countries largely refused to spend money on HIV and TB meds in low- and middle-income countries. They cited many reasons, including that patients couldn’t be trusted to take their medication on time, and that resources would be better spent on prevention and control. In 2001, the head of the U.S. Agency for International Development had this to say when explaining to Congress why many Africans would not benefit from access to HIV medications: “People do not know what watches and clocks are. They do not use Western means for telling time. They use the sun. These drugs have to be administered during a certain sequence of time during the day and when you say take it at 10:00, people will say, ‘What do you mean by 10:00?’” A 2007 review of 58 studies on patient habits found that Africans were more likely to adhere to HIV treatment regimens than North Americans.

In the mid-2000s, programs such as PEPFAR and the Global Fund finally began distributing antiretroviral therapy to millions of people living with HIV in poor countries. PEPFAR, a U.S.-funded initiative, was especially successful, saving more than 25 million lives and preventing 7 million children from being born with HIV. These projects lowered deaths and infections while also strengthening health-care systems, allowing low-income countries to better respond to diseases as varied as malaria and diabetes. Millions of lives have been saved—and tuberculosis deaths among those living with HIV have declined dramatically in the decades since.

Still, tuberculosis is great at exploiting any advantage that humans hand it. During the coronavirus pandemic, disruptions to supply chains and TB-prevention programs led to an uptick in infections worldwide. Last year, the U.S. logged more cases of tuberculosis than it has in any year since the CDC began keeping count in the 1950s. Two people died. But in some ways, at the beginning of this year, the fight against tuberculosis had never looked more promising. High-quality vaccine candidates were in late-stage trials. In December, the World Health Organization made its first endorsement of a TB diagnostic test, and global health workers readied to deploy it.

[Read: America can’t just unpause USAID]

Now that progress is on the verge of being erased. Since Donald Trump has taken office, his administration has dismantled USAID, massively eliminating foreign-aid funding and programs. According to The New York Times, hundreds of thousands of sick patients have seen their access to medication and testing suddenly cut off. A memo released by a USAID official earlier this month estimated that cases of multidrug-resistant tuberculosis will rise by about 30 percent in the next few years, an unprecedented regression in the history of humankind’s fight against the disease. (The official was subsequently placed on administrative leave.) Research on tuberculosis tests and treatments has been terminated. Although the secretary of state and Elon Musk have assured the public that the new administration’s actions have not disrupted the distribution of life-saving medicine, that just isn’t true. A colleague in central Africa sent me a picture of TB drugs that the U.S. has already paid for sitting unused in a warehouse because of stop-work orders. (Neither the State Department nor DOGE employees responded to requests for comment.)

Last year, roughly half of all international donor funding for tuberculosis treatment came from the U.S. Now many programs are disappearing. In a recent survey on the impact of lost funding in 31 countries, one in four organizations providing TB care reported they have shut down entirely. About half have stopped screening for new cases of tuberculosis. The average untreated case of active tuberculosis will spread the infection to 10 to 15 people a year. Without treatment, or even a diagnosis, hundreds of thousands more people will die—and each of those deaths will be needless.

By revoking money from global-health efforts, the U.S. has created the conditions for the health of people around the world to deteriorate, which will give tuberculosis even more opportunities to kill. HIV clinics in many countries have started rationing pills as drug supplies run dangerously low, raising the specter of co-infection. Like HIV, insufficient nutrition weakens the immune system. It is the leading risk factor for tuberculosis. An estimated 1 million children with severe acute malnutrition will lose access to treatment because of the USAID cuts, and refugee camps across the world are slashing already meager food rations.

For billions of people, TB is already a nightmare disease, both because the bacterium is unusually powerful and because world leaders have done a poor job of distributing cures. And yet, to the extent that one hears about TB at all in the rich world, it’s usually in the context of a looming crisis: Given enough time, a strain of tuberculosis may evolve that is resistant to all available antibiotics, a superbug that is perhaps even more aggressive and deadly than previous iterations of the disease.

[Read: Resistance to the antibiotic of last resort is silently spreading]

The Trump administration’s current policies are making such a future more plausible. Even pausing TB treatment for a couple of weeks can give the bacterium a chance to evolve resistance. The world is ill-prepared to respond to drug-resistant TB, because we have shockingly few treatments for the world’s deadliest infectious disease. Between 1963 and 2012, scientists approved no new drugs to treat tuberculosis. Doing so stopped being profitable once the disease ceased to be a crisis in rich countries. Many strains of tuberculosis are already resistant to the 60-year-old drugs that are still the first line of treatment for nearly all TB patients. If a person is unlucky enough to have drug-resistant TB, the next step is costly testing to determine if their body can withstand harsh, alternative treatments. The United States helped pay for those tests in many countries, which means that now fewer people with drug-resistant TB are being diagnosed or treated. Instead, they are almost certainly getting sicker and spreading the infection.

Drug-resistant TB is harder to cure in individual patients, and so the aid freeze will directly lead to many deaths. But giving the bacteria so many new opportunities to develop drug resistance is also a threat to all of humanity. We now risk the emergence of TB strains that can’t be cured with our existing tools. The millennia-long history of humans’ fight against TB has seen many vicious cycles. I fear we are watching the dawn of another.

This article has been adapted from John Green’s forthcoming book, Everything Is Tuberculosis.

At Donald Trump’s first Cabinet meeting, late last month, Elon Musk sheepishly admitted that DOGE had “accidentally canceled very briefly” Ebola-prevention programs. After a nervous chuckle, he claimed that the oversight had been swiftly corrected. But it wasn’t. The truth is far more disturbing—this administration didn’t just pause a line item; it has actively dismantled the infrastructure the country relies on to detect and confront deadly pathogens.

For more than a decade, I have worked as a physician and public-health expert responding to infectious diseases around the world. In 2014, while treating Ebola patients in Guinea, I contracted and survived Ebola myself. I know how lethal Donald Trump’s assault on America’s outbreak preparedness could be. We are sure to regret it.

DOGE’s slash-and-burn campaign has hit everything from the NIH to the National Weather Service. The cuts to global health, however, are especially alarming. It’s unclear what Musk thought would happen when he fed the U.S. Agency for International Development “into the wood chipper,” as he proclaimed with gleeful indifference on X, the social-media megaphone he owns. Ditto what Trump thought when he withdrew the United States from the World Health Organization and effectively muzzled the CDC. But the result has been that, in little more than a month, America has transformed itself from a preeminent global-health leader into an untrustworthy has-been. Undermining even one of these institutions would have posed a serious threat; gutting them all at once is an invitation for future outbreaks.

The fallout from these sweeping cuts is particularly evident when examining USAID, or what’s left of it. The agency’s tagline was “From the American people,” and perhaps the American people didn’t understand that it was also for them. Musk disparaged the agency outright—declaring it a “criminal organization.” The White House pointed to alleged wasteful spending, including funding for a “DEI musical” in Ireland (which wasn’t even funded by USAID, it turned out). In decrying the agency’s downfall, many Democrats focused more on the importance of “soft power” foreign policy than on-the-ground impact. Yet much of USAID’s budget was devoted to addressing humanitarian and health crises abroad with the implicit goal of preventing these emergencies from reaching our own shores. (Explicitly, the goal was to “advance American security and prosperity.”) Americans are safer when instability and infectious threats are effectively managed on foreign lands.

[Donald Moynihan: The DOGE project will backfire]

USAID was also the primary funder of the President’s Emergency Plan for AIDS Relief, established in 2003 under George W. Bush. PEPFAR has saved more than 25 million lives and helped smother the global HIV pandemic. More than 20 million people—500,000 of them children—were receiving HIV treatment through the program when Trump signed an executive order on his first day back in office pausing all foreign aid for 90 days. Secretary of State Marco Rubio promised that waivers would allow the life-saving work to continue, but few have materialized. Meanwhile, USAID staff who were placed on administrative leave can’t distribute medicines or cover costs for transport and personnel. After this dismantling, PEPFAR’s activities in hundreds of places around the world remain restricted at best, and fully paused at worst. Without the support long provided by the program, thousands of people will likely die far younger than they would have with proper medical care. PEPFAR’s current authorization ends later this month; its future after that is unclear.

Similarly, USAID’s efforts to stop Ebola at its source are also now gone. USAID’s role in Ebola containment has long been essential. During the 2014 West Africa outbreak—during which more than 11,000 people died—USAID oversaw training of local health-care workers, the building of Ebola treatment centers, and passenger screening at the borders and airports. A decade later and just days into Trump’s second term, Uganda reported another Ebola outbreak. This time, though, the foreign-aid freeze Trump had put in place meant that USAID was unable to supply the usual resources for transporting lab specimens or implementing airport screening. The day after Musk reassured the Cabinet that Ebola prevention had been swiftly restored, the State Department canceled crucial contact tracing and surveillance efforts for Uganda’s outbreak. With USAID nowhere to be found, the WHO scaled up its own response. That’s something, for now, but America’s absence is shameful.

Moreover, the WHO may not have the capacity to do so for much longer. On his first day in office, Trump signed an executive order moving to withdraw from the WHO, accusing it of demanding “onerous payments from the United States.” In 2023, the U.S. contributed $481 million—an eighth of what Americans spend on professional dog-training services every year—to WHO’s operating budget. Admittedly, many Americans—fueled by Trump’s denigration of the organization—developed a deep distrust of the WHO following perceived missteps during the coronavirus pandemic. Even its supporters can see the organization’s flaws—it’s bureaucratic, sclerotic, and overdue for reform. Despite these shortcomings, it is an organization we desperately need, and no real alternative exists.

WHO is the only international organization that can identify and respond to emerging threats early on, such as flare-ups of unidentified outbreaks like the one currently circulating in northwestern Democratic Republic of the Congo. Its global network of laboratories to detect infectious threats—known as the Gremlin—relies heavily on U.S. support and is now at risk of closure. And even as its partnerships alongside U.S. colleagues have strengthened surveillance, containment, and readiness abroad, the WHO also helps us here at home. On the same day as Musk’s Ebola comments, the FDA canceled the meeting where experts decide next season’s flu-vaccine composition. Going forward, the U.S. will have to wait on WHO guidance for that crucial decision and download the recipe for next year’s flu shot. If America keeps abdicating its leadership, it will be forced to rely on an organization whose funding it is slashing and whose collaboration it is severing. Although the WHO might still scrape together funds and staff, that’s not guaranteed—especially if other nations follow Trump’s example and cut ties or funding.

[Katherine J. Wu: Inside the collapse at the NIH]

With USAID and WHO under siege, more responsibility for global disease detection and response would fall on the CDC. But the future of the world’s preeminent “disease detectives” is at risk as well. The plan to slash the next cohort of CDC Epidemic Intelligence Service officers—think Kate Winslet’s character in Contagion—was thankfully stopped at the 11th hour, but about 750 CDC staff were still let go in recent cuts, including many stationed on outbreak front lines across the country and around the globe (about 180 of those terminated were later reinstated). Certain pages on the CDC website were deleted, and when a judge ordered them restored, many had been dramatically altered. CDC communications such as the Morbidity and Mortality Weekly Report—which providers rely on to track health threats—were abruptly paused for the first time in more than 60 years. CDC staff were also ordered to stop communicating with, and to take their names off any scientific papers written with, anyone from the WHO, further weakening the CDC’s reach and insight into what’s happening around the world. Whether the issue is cuts to USAID, defunding the WHO, or hobbling the CDC, the end result is the same: America is walking away from global health leadership, making the entire world less safe—including us.

Understand how this will work at a practical level: Until recently, countries had compelling reasons to report outbreaks, even if such transparency sometimes came with travel bans or other stigmatizing restrictions. Those sticks were often worth the carrots, namely USAID funding and CDC expertise that would appear and help quickly end outbreaks. Now, with no carrots on offer, why would any country submit to the stick? Future outbreaks may be reported too late or not at all—leaving America oblivious to emerging health crises. Since 2014, seven public-health emergencies of international concern (PHEICs) have been declared by the WHO. The number of Ebola outbreaks is escalating, and climate change will intensify the emergence and spread of known and potentially unknown microbes.

It is in America’s interest to reverse course immediately and rebuild the crucial infrastructure needed to detect and respond to outbreaks. Not only is this the right thing to do, but it also makes economic sense. In 1980, at the height of the Cold War, the WHO declared smallpox eradicated—a milestone achieved through joint U.S. and Soviet support. Americans invested about $30 million to stamp out smallpox, a fraction of what the country now saves every year by no longer needing to vaccinate against or treat smallpox—to say nothing of the lives saved.

Americans believe that about 25 percent of the country’s budget is spent on foreign aid. In reality, the figure is 1 percent, or at least it was. USAID’s entire 2023 spending was $43 billion—a 20th of the U.S. defense budget and about what Musk’s enterprises have received in government funding. The CDC’s was even less, just $9 billion.

[Nicholas Florko: Spared by DOGE—for now]

Despite his actions, Musk clearly understands that these systems are essential for America’s security. After admitting his Ebola error, he quickly clarified: “I think we all want Ebola prevention.” That would require pulling USAID’s most essential remnants out of the dustbin. The U.S. must also reengage with the WHO and negotiate the terms of its renewed support and engagement with the organization before it’s too late. And for all the distrust many Americans harbor toward the CDC post-pandemic, they must rally around it—an agency whose role will become only more indispensable as measles, bird flu, and other pathogens spread across the country.

Now, and with startling speed, the country is turning its back on global health. In doing so, it is endangering other nations, and also itself. USAID’s account on X, once a digital chronicle of its achievements, is gone. When I search for it on my phone, I get an error message: “Something went wrong. Try again.” We must heed that warning. Musk and Trump have destroyed the shield that once protected America from the next global contagion. Deadly diseases don’t bother with borders; no wall will keep them out. If America stays the course, “Something went wrong” will become the epitaph of a great country, one that once led the world in global health preparedness. It will be deeply missed.

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At least the Oval Office meeting held by President Donald Trump and Vice President J. D. Vance with Ukrainian President Volodymyr Zelensky was held in front of the cameras. False friendliness in public by Trump and Vance, followed by behind-the-scenes treachery, would have been much more dangerous to the Ukrainian cause.

Instead, Trump and Vance have revealed to Americans and to America’s allies their alignment with Russia, and their animosity toward Ukraine in general and its president in particular. The truth is ugly, but it’s necessary to face it.

Today’s meeting gave the lie to any claim that this administration’s policy is driven by any strategic effort to advance the interests of the United States, however misguided. Trump and Vance displayed in the Oval Office a highly personal hatred. There was no effort here to make a case for American interests. Vance complained that Zelensky had traveled to Pennsylvania to thank U.S. ammunition workers, because, Vance charged, the appearance amounted to campaigning for the Democratic presidential ticket. “Let me tell you, Putin went through a hell of a lot with me,” Trump angrily explained. “He went through a phony witch hunt where they used him and Russia, Russia, Russia.”

Both the president and vice president showed the U.S.-led alliance system something it needed urgently to know: The national-security system of the West is led by two men who cannot be trusted to defend America’s allies—and who deeply sympathize with the world’s most aggressive dictator.

Through the Cold War period, Americans were haunted by the fear that a person with clandestine loyalties to a hostile foreign power might somehow rise to high office. In the late 1940s, the Alger Hiss case convulsed the country. Hiss’s accusers charged—and it later proved true—that Hiss had betrayed U.S. secrets to Soviet spymasters in the 1930s, when Hiss served as a junior official in the Department of Agriculture. The secrets were not very important; they included designs for a new fire extinguisher for U.S. naval ships. But Hiss himself was a rising star. The possibility that a person with such secrets in his past might someday go on to head the Department of State or Central Intelligence Agency once tormented Americans.

But what if the loyalties were not clandestine, not secret? What if a leader just plain blurted out on national television that he despises our allies, rejects treaties, and regards a foreign adversary as a personal friend? What if he did it again and again? Human beings get used to anything. But this?

It’s not hard to imagine a president of Estonia or Moldova in that Oval Office chair, being berated by Trump and Vance. Or a president of Taiwan. Or, for that matter, the leaders of core U.S. partners such as Germany and Japan, which entrusted their nations’ security to the faith and patriotism of past American leaders, only to be confronted by the faithless men who hold the highest offices today.

We’re witnessing the self-sabotage of the United States. “America First” always meant America alone, a predatory America whose role in the world is no longer based on democratic belief. America voted at the United Nations earlier this week against Ukraine, siding with Russia and China against almost all of its fellow democracies. Is this who Americans want to be? For this is what America is being turned into.

The Trump administration’s elimination of PEPFAR, the American program to combat HIV infection in Africa, symbolizes the path ahead. President George W. Bush created the program because it would do immense good at low cost, and thereby demonstrate to the world the moral basis of American power. His successors continued it, and Congresses of both parties funded it, because they saw that the program advanced both U.S. values and U.S. interests. Trump and Vance don’t want the United States to be that kind of country anymore.

American allies urgently need a Plan B for collective security in a world where the U.S. administration prefers Vladimir Putin to Zelensky.

The American people need to reckon with the mess Trump and Vance are making of this country’s once-good name—and the services they are performing for dictators and aggressors. There may not be a deep cause here. Trump likes and admires bad people because he is himself a bad person. When Vance executed his personal pivot from Never Trump to Always Trump, he needed a way to prove that he had truly crossed over to the dark side beyond any possibility of reversion or redemption; perhaps his support for Russia allowed him to do that. But however shallow their motives, the consequences are profound.

In his first term, Trump sometimes seemed a rogue actor within his own administration. The president expressed strange and disquieting opinions, but his Cabinet secretaries were mostly normal and responsible people. The oddball appointees on the White House staff were contained by the many more-or-less normal appointees. This time, Trump is building a national-security system to follow his lead. He has intimidated or persuaded his caucus in the House to accept—and his caucus in the Senate not to oppose—his pro-authoritarian agenda.

The good and great America that once inspired global admiration—that good and great America still lives. But it no longer commands a consensus above party. The pro-Trump party exposed its face to the world in the Oval Office today. Nobody who saw that face will ever forget the grotesque sight.

By reputation, Elon Musk and Donald Trump are builders. Musk has grown two of the largest hardware-innovation companies in the world, Tesla and SpaceX. As for Trump, he once told Golf Digest: “I own buildings. I’m a builder; I know how to build. Nobody can build like I can build.”

But now, united in Washington, the duumvirate of Trump and Musk has made its mark not by building, but by the opposite: demolition.

With the creation of the Department of Government Efficiency, Musk has claimed for himself an extraordinary amount of power: Serving as the iron fist of the White House, he’s rooting out what he sees as the plague of wokeism in government, halting grants, freezing payments, lighting fires in various departments, and generally firing as many people as he can get away with. On Monday, DOGE claimed to have already saved the government more than $50 billion. Meanwhile, federal judges have ruled that Trump and Musk have violated the law, typically by exceeding the powers of the executive branch and attempting to defund agencies that were initially funded by Congress.

In theory, DOGE exists to promote efficiency. And the need for efficiency is real. The federal government is deeply in debt. Its interest payments now exceed what it spends on defense. Even if the United States had no issue with its debt, it would still be a mitzvah to find ways to make government work better—to take the same tax dollar further, to do one more unit of good. But judging by DOGE’s early returns, the only objective conclusion one can reach about the agency seems to be that it’s out of control. What we’re witnessing in government right now—across the Departments of Energy, Veterans Affairs, Education, and beyond—is not only a bonfire of cruelty but a reign of ineptitude.

[Read: It’s a model of government efficiency, but DOGE wants it gone]

Let’s start with the Department of Energy, which recently faced the brunt of massive DOGE layoffs. Among those who lost their job were dozens of staff members at the National Nuclear Security Administration—scientists, engineers, and safety officials responsible for safeguarding and assembling nuclear warheads. Roughly 100 people were reportedly laid off from the Pantex Plant, in Texas, the most important nuclear-assembly-and-disassembly plant in the country, before they were called back to the office. As Daryl Kimball, the executive director of the nonpartisan Arms Control Association, said: “The DOGE people are coming in with absolutely no knowledge of what these departments are responsible for.”

Next, there’s Veterans Affairs, where the Trump administration offered buyouts to tens of thousands of employees before realizing that, once again, they’d made a mistake. Far from the typical impression some might have of government workers just moving paper around all day, the VA provides health and psychiatric care to millions of U.S. veterans. That means if you offer buyouts to the VA, what you’ll get is a lot of underpaid doctors, nurses, and psychologists taking up offers to leave offices that are already understaffed—which is exactly what happened. Days after the buyout offer, thousands of doctors, nurses, psychologists, and other essential staff got a notice that they were exempt from the offer.

At the Department of Education, which the Trump administration seems to want to destroy, DOGE terminated $1 billion in contracts. But rather than end ideological programs that Musk says he wants to eliminate, these cuts decimated the Institute for Education Sciences, which funds many of the longest-running and most famous studies in education research, including several longitudinal studies on student achievement and school effectiveness. It’s hard to think of a better nonpartisan role for government than data collection. But Musk and his team have gutted some of the best education-data tools we have. Nat Malkus, a senior fellow at the American Enterprise Institute, a conservative think tank, told The Washington Post: “There’s a lot of bloat in IES. There’s a lot of problems to be solved. These are problems you solve with a scalpel and maybe a hatchet, but not a bulldozer.”

[Read: The government waste DOGE should be cutting]

DOGE’s cuts will go much further. At the FDA, the Trump administration has fired hundreds of employees, including those involved in testing food and medical devices. At the CDC, more cuts have reached the Epidemic Intelligence Service, which pays disease detectives around the world and stops epidemics in other countries before they spread. At the National Institutes of Health, the administration is set to slash personnel and funding in a variety of ways. If you’re a fan of Musk and Trump, your hope is that these cuts will be all fat and no bone. But remember: This is the same administration that, in an attempt to refocus the Department of Energy on nuclear security, initially gutted the division with the words nuclear security in it.

So far, few DOGE actions have received more attention than the agency’s attack on USAID, which is responsible for foreign aid and global-health spending. Musk seems to be on a gleeful and personal mission to destroy USAID, placing most of its employees on leave, closing its headquarters, and moving what’s left of it to the State Department. According to one report, the administration says that it plans to reduce USAID staffers from 10,000 to about 600. As Musk recently posted on X, “We spent the weekend feeding USAID into the wood chipper.”

There is irony here. And there is tragedy. The irony is that, when he was a U.S. senator, Marco Rubio was one of the most outspoken defenders of global aid. In February 2017, he called foreign aid “critical to our national security.” In 2019, he said: “Anybody who tells you that we can slash foreign aid and that will bring us to balance is lying to you.” Today, however, Rubio is in the morally compromising position of overseeing, as secretary of state, the dismantling of the very aid agency he once praised.

[Read: DOGE is failing on its own terms]

The tragedy will be felt at the individual level, with immense human costs. Unless the administration course-corrects and immediately replenishes our global-health grants, there’s just no getting around the fact that a lot of people around the world are going to suffer and die in order to save the typical American taxpayer a negligible sum. The U.S. pays for insecticide sprays in Uganda, for pregnancy services in Zambia, for health-care clinics in the poorest parts of the world. Most notably, the President’s Emergency Plan for AIDS Relief has saved an estimated 25 million lives and prevented more than 5 million babies from being born with HIV. It’s not yet clear whether PEPFAR will be spared or left to wither away. This wrecking-ball approach to reform has astonished even the most famous critics of U.S. aid programs. William Easterly, an economist who has written that much of American aid props up dictators and goes to waste, told The New Yorker that Trump’s USAID-demolition plan is “horrific,” “illegal,” and “undemocratic.”

Musk has hinted, amid rising criticism, that DOGE will simply reverse any measures that go too far. This sounds good in theory. Move fast; cut stuff; add back whatever you miss. But in practice, you can’t just slash 10,000 programs at once and then reinstall them on a one-by-one basis depending on whether the volume of criticism passes some imaginary threshold. Whatever you think of the failures of progressive governance, “mess around and find out” is not a suitable replacement. Unfortunately, it does appear to be the current methodology of the executive branch.

The extraordinary evolution of American leadership over the past decade can be grasped from just two moments. In 2016, Senator Marco Rubio, a member of the Senate Foreign Relations Committee, lectured Donald Trump, then an upstart presidential candidate, on the Middle East. “The Palestinians are not a real-estate deal, Donald,” Rubio quipped during a primary debate on CNN. “With your thinking,” Trump retorted, “you will never bring peace.” Turning to the audience, Rubio got in a last word: “Donald might be able to build condos in the Palestinian areas, but this is not a real-estate deal.”

On Wednesday, President Trump sat alongside the king of Jordan and reiterated his plan for the U.S. to take over Gaza from its inhabitants and rebuild the area. “We’re going to hold it; we’re going to cherish it,” he said. “It’s fronting on the sea. It’s going to be a great economic-development job.” Sitting on Trump’s left was Rubio, the secretary of state tasked with carrying out the plan he’d once publicly derided. In the span of 10 years, U.S. foreign policy had transformed from the domain of expert-brokered consensus to the province of personality-driven populism.

[Read: Nobody wants Gaz-a-Lago]

In his first term, Trump could be dismissed as an accident of the Electoral College, someone to be humored domestically and internationally before the resumption of traditional elite-managed American governance. Today, with Trump returned to office and a host of like-minded leaders ascendant around the globe, he looks less like an aberration from the old international order and more like the apotheosis of a new one. But what will that new order look like? The past few weeks, during which Trump has hosted multiple leaders from the Middle East, rattled sabers with traditional American allies, and proposed his radical plan for Gaza, provide some early clues.

A new era of American empire

While Trump was out of office, a mythology arose that cast him as not simply a dissenter from military misadventures abroad, but a fundamentally anti-war figure dedicated to American restraint. Promulgated by prominent commentators such as the right-wing pugilist Tucker Carlson and the libertarian gadfly Glenn Greenwald, this narrative helped Trump present himself as the “peace candidate” to a war-weary electorate. “Why do they hate Trump so much?” asked the John Jay College professor Christian Parenti in an influential essay. “To the frustration of those who benefit from it, Trump worked to unwind the American empire. Indeed, he has done more to restrain the US imperium than any politician in 75 years.”

In reality, Trump supported the Iraq War before he turned against it, failed to pull out of Afghanistan during his first term, and escalated American arms sales and drone strikes in the Middle East while in power. Since returning to the White House, he has governed not as a neo-isolationist, but almost as a neo-imperialist, calling for the United States to “get Greenland,” musing about making Canada the 51st state, and demanding that America take over Gaza. He has also fast-tracked arms sales to Israel and likely soon to other states in the Middle East, while his border czar recently threatened military action in Mexico. Trump’s team has signaled its desire to wind down the war in Ukraine, in accordance with the preferences of most Republican voters. But otherwise, “Donald the Dove,” as the New York Times columnist Maureen Dowd once dubbed him, has once again failed to report for duty.

[Read: The political logic of Trump’s international threats]

On balance, Trump’s personnel choices align with this aggressive posture. The small but capable neo-isolationist wing of the Republican Party and its leftist sympathizers can fairly point to Vice President J. D. Vance and several notable hires in the Pentagon as fellow travelers. But those calling the shots at the top are far more hawkish—Trump, Rubio, Secretary of Defense Pete Hegseth, and National Security Adviser Mike Waltz—and the administration’s policy to date has largely reflected their inclinations.

A Middle East policy that includes the Palestinians, but not the Palestinian national cause

Trump’s first administration famously brokered the Abraham Accords between Israel and the Gulf Arab states without including the Palestinians in the process. The success of this endeavor disproved decades of conventional wisdom that Israeli normalization in the region would not happen without a comprehensive peace deal with the Palestinians. For a time, the momentum of the Abraham Accords looked as though it would carry all the way through to an Israeli agreement with Saudi Arabia, leaving the Palestinians in the cold.

After October 7 and the ensuing brutal war in Gaza, however, the Palestinians can no longer be sidelined from the discussion. Trump has responded to this new reality by attempting to include them in his diplomacy while sidelining their aspirations for statehood. He has downplayed the prospect of a two-state solution and, with his Gaz-a-Lago proposal, called for millions of Palestinians to leave the decimated Strip in favor of “beautiful communities” in third-party countries “away from … all the danger.” Speaking to Fox News, Trump’s Middle East envoy Steve Witkoff made the logic behind this thinking explicit. “Peace in the region means a better life for the Palestinians,” he said. “A better life is not necessarily tied to the physical space that you are in today. A better life is about better opportunity, better financial conditions, better aspirations for you and your family. That doesn’t occur because you get to pitch a tent in the Gaza Strip and you’re surrounded by 30,000 munitions that could go off at any moment.”

Trump is not wrong that Gaza is a “demolition site” and that its people desperately need something better than the decades of war they’ve experienced while caught between Hamas and Israel. And contrary to the claims of many activists, the preferences of the Palestinian people are not always congruent with the demands of Palestinian nationalism. If given the chance, many Gazans would jump at the opportunity to escape the trap they find themselves in, even if it means moving abroad. But to address Palestinian material needs without regard to their historical and national ones is to bracket a core component of Palestinian identity and ignore what makes their conflict with Israel so intractable. Perhaps Trump’s gambit will once again confound the experts with its outcome. But for now, his policy seems more like an answer provided by someone who failed to read the entire question.

The eclipse of the rules-based international order

For decades, American foreign policy has been guided by the assumption that the United States is the benevolent shepherd of a global system, underwriting international security and trade through positive-sum alliances and international institutions. “We’ll lead not merely by the example of our power but by the power of our example,” President Joe Biden declared in his 2020 inaugural address. “We’ll be a strong and trusted partner for peace, progress, and security.”

Arguably no concept was invoked more frequently by his foreign-policy team than the “rules-based international order,” the notion that there ought to be evenly applied standards for all state actors. Like most ideals, this one was often observed in the breach, with critics regularly pointing to perceived American hypocrisy, most recently in Gaza.

But the postwar order has been under severe strain for some time. Russia, a revisionist power, flouted it with an expansionist assault against neighboring Georgia back in 2008, resulting in little pushback and ultimately leading to the war on Ukraine. China, a rising power, subverted Hong Kong, menaced Taiwan, and sterilized Uyghur Muslims in camps, all while the liberal international order effectively shrugged and made its next purchase from Temu. Even those who purported to venerate the rules-based order regularly made a mockery of it. The United Nations, the avatar of internationalism, stood by haplessly as all of these events unfolded—that is, when it wasn’t actively abetting them, as when the members of its human-rights council rejected debate over China’s treatment of the Uyghurs. South Africa took Israel to The Hague over the war in Gaza, while simultaneously backing Vladimir Putin in Ukraine.

Trump, by contrast, has never felt constrained by such ideals in the first place, having long preferred power over pieties. He has expressed admiration for dictators, used American muscle to extract concessions even from allies, and dismissed the protests against his approach from bureaucrats, nongovernmental organizations, and international institutions as the grumblings of the “deep state.” With Trump’s return to Washington, critics of the flawed U.S.-led rules-based order are discovering what a world without it looks like.

Freed from the need to justify his actions in traditional terms, the president has enacted policies no predecessor would have countenanced while moving to purge any internal dissenters. He has dismantled USAID, putting desperately needed American assistance around the world in jeopardy, including George W. Bush’s anti–HIV/AIDS program, PEPFAR; proposed relocating Gazans from their land, feeding far-right dreams of ethnic cleansing; and sanctioned the International Criminal Court.

[Read: The cruel attack on USAID]

Whether one considered the rules-based order a faulty but essential engine of collective prosperity or a sclerotic hypocritical holdover from another era, it now appears to be in decline. Trump is transitioning the old order to a new regime remade in his image—one where statecraft is entirely transactional and the strong, not international lawyers, write the rules. After all, how many divisions does the United Nations command?

Yesterday, during Trump’s meeting with Jordan’s King Abdullah II, he was asked “under what authority” he was permitted to take the “sovereign territory” of Gaza. The president responded: “U.S. authority.” In the Trump World Order, no more explanation was required.