A major shake-up in U.S. foreign aid operations has sparked concerns among global health and humanitarian leaders. Billionaire philanthropist Bill Gates recently voiced his worries following the closure of several offices and the freezing of funds for the U.S. Agency for International Development (USAID), a government agency that partners with organizations around the world to support public health, disaster relief, and development initiatives.

Gates, whose foundation has worked closely with USAID on programs like nutrition and vaccine distribution, emphasized the importance of understanding the agency’s long-standing role in supporting vulnerable communities.

“There are incredibly dedicated people doing life-saving work,” Gates said. “Without continued support, millions of lives could be at risk.”

The changes come as a federal review of USAID’s operations is underway, led by the Department of Government Efficiency (DOGE). The investigation, which began under previous government directives, has reportedly uncovered cases of misused funds and poor oversight. Officials leading the review have suggested that criminal charges could be filed if fraud is confirmed.

A recent Capitol Hill briefing revealed that serious issues within USAID’s decentralized system may have allowed certain foreign aid grants to be used inappropriately. Lawmakers were told that several instances of potential wrongdoing are being evaluated for possible referral to the Department of Justice.

“The goal is to ensure that U.S. taxpayer dollars are being used responsibly and effectively,” said one attendee familiar with the investigation.

Despite the findings, many experts caution against dismantling programs that deliver essential services in areas such as health care and education. Gates stressed that while private foundations can provide support, they cannot replace the scale and infrastructure of government agencies like USAID.

Calls are growing for a balanced approach—one that addresses misuse without cutting off aid to those in critical need.