WASHINGTON (NYTIMES) - The Trump administration is considering new rules that would limit how US humanitarian aid is used to buy masks, plastic gloves and other protective medical equipment to combat the coronavirus in some of the world's neediest nations.
Instead, the administration is working to secure those supplies for Americans first as the pandemic sweeps around the world.
The internal debate is the latest example of a global race for limited medical gear that puts countries that are poor, unstable or have deficient health systems at a deadly disadvantage.
Already, officials have told some non-profit aid groups that they cannot use money from the US Agency for International Development (USAID) to buy personal protective equipment for needy nations while US health providers face dwindling supplies.
A draft presidential memorandum, described to The New York Times on Thursday (April 16), would allow funds to be used to buy only protective gear that is produced in the countries where it was needed.
The issue is still under debate, officials said, and could be broadened to prohibit the government from paying to provide equipment to foreign medical systems when it is needed in the U.S.
"Where there is a critical shortfall in the United States, obviously, we can't pay for donations of materials that we can't actually procure," Mr Jim Richardson, director of the State Department's foreign assistance resources, told reporters March 26.
Four international aid officials said humanitarian workers in vulnerable communities had been informally alerted to the funding shift before the official White House decision. The aid workers spoke on the condition of anonymity out of fears that the Trump administration would withhold funding to their humanitarian organisations if they publicly criticised the policy.
Mr Michael Klosson, vice-president for public policy and humanitarian response at Save the Children, said he had heard of the new USAID guidance but did not know if it would become policy.
"We want to make sure the frontline health workers, wherever they are, are protected," said Mr Klosson, whose organisation receives funding from the US aid agency and the State Department.
"We've seen what's happened in developed countries, where very advanced health systems and social safety nets have been overwhelmed," he added. "Just imagine the challenges as this thing kind of multiplies in sub-Saharan Africa and places like that, with countries with much weaker health systems and much weaker social safety nets."
The US aid agency has shipped about 150,000 N95 masks and thousands of scrubs, coveralls and face shields to healthcare workers in Oregon from its warehouse in Dubai, United Arab Emirates.
Mr Andrew Phelps, Oregon's director of emergency management, said last week that it "will make a huge difference in Oregon's ability to fight this outbreak." In March, the aid agency was sending personal protective equipment from its own stockpiles to nations in need.
That changed after a meeting later in the month. Officials who were gathered from across the government were surprised to hear those shipments were continuing and told the agency to stop, according to a senior administration official who spoke on the condition of anonymity.
A representative from the aid agency who was at the meeting asked for a memo to formalise the shipment freeze, the senior administration official said. Within weeks, and faced with a projected shortage in the Strategic National Stockpile of medical supplies, President Donald Trump invoked the Defence Production Act to prohibit the export of face masks to other countries.
The aid agency and the State Department have provided about US$508 million (S$723.28 million) to the United Nations and non-profit humanitarian aid organisations to help confront the virus in 104 needy nations and the Palestinian territories.
Announcing the funding April 8, Secretary of State Mike Pompeo described it as an example of "the unmatched generosity of the American people." "The United States is the undisputed leader in the provision of health and humanitarian aid, around the world," Mr Pompeo said.
That money has largely paid for messaging campaigns to educate people on how to protect themselves from the virus, to provide water and sanitation services like hand-washing stations, and to offer health services to refugees, migrants and other homeless people. Some of the funds have been spent on what an agency fact sheet released Thursday described as "infection prevention and control."
The agency did not answer questions about whether that included personal protective equipment, although the fact sheet said funding could be used for "health commodities that are not required for the US domestic response" in Italy and Eswatini, also known as Swaziland. Masks and other gear were not listed on the document.
The fact sheet also omitted mention of millions of dollars in aid previously designated for the World Health Organisation (WHO). On Tuesday, Mr Trump announced that the US would halt funding to the WHO, which he faulted for mismanaging the global response to the coronavirus.
Representatives from the aid agency and the State Department's office of foreign assistance resources declined to comment when asked about the funding and whether it could be used to buy personal protective equipment.
It is not clear whether the funding limits, if enacted, would be lifted once the domestic demand for protective medical gear eased in the US.
Mr J. Stephen Morrison, director of the Global Health Policy Centre at the Centre for Strategic and International Studies, said the guidelines were not surprising, given that the US and other major donor countries confronting the virus have "turned inward and are adopting very narrow, nationalistic policies."
But if the limits remain, he said, it raises the risk that "low-income countries are just left in a catastrophic condition, walled off without hope of not much containment or recovery."