It was January, my final week in the outgoing Administration. In a few days, Donald Trump would be inaugurated as President. I had come to the United States Agency for International Development in early 2022, leaving my surgery practice and public-health research in Boston to lead the agency’s global-health efforts. Now I’d be returning to my previous life.

I spent my last days at U.S.A.I.D. in meetings with our civil- and foreign-service leaders, thanking them. Their work with partner countries had helped to contain twenty-one outbreaks of deadly disease, sustain Ukraine’s health system after Russia’s invasion, combat H.I.V., tuberculosis, and polio, and reduce maternal and child deaths worldwide. On a budget of just twenty-four dollars per American—out of the fifteen thousand dollars in

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