Andrew Natsios on Famine, Moral Limits, and the “Ignorance” Behind USAID Scandals

Andrew S. Natsios has spent a lifetime inside the machinery of public service—Massachusetts politics, the U.S. military, USAID leadership, and humanitarian operations that unfold at the speed of catastrophe. A former state legislator and U.S. Army Reserve officer (including service during the Gulf War), he went on to become one of the most influential American voices on famine prevention and emergency response, shaping modern disaster-response systems and global early-warning efforts as both Administrator of USAID (2001–2006) and earlier as head of the Office of Foreign Disaster Assistance.
Along the way, Natsios has confronted some of the world’s most brutal regimes—from North Korea to Russia—work that has made him unusually vigilant, and unusually blunt. In this Pathway Blog conversation, Natsios explains the accidental career move that pulled him into humanitarian response, how famine policy is where morality and geopolitics collide, and why many viral “USAID waste” allegations are—by his account—either lies or misunderstandings of what aid actually does on the ground.
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This transcript has been lightly edited for clarity and flow.

The Career Turn That Changed Everything
BW: Thank you for joining me. To start off, early in your career, what decision or opportunity most shaped the direction you ultimately took in humanitarian and development work—and why did you choose it at the time?

AN: Good question. I was interested in public affairs when I was in high school. I participated in political campaigns in Massachusetts when I was 12, 13 years old.
I’m a Republican from the old order. I do not like the populist wing of the Republican Party. 

BW: Would you consider it neoconservatism? Or--

AN: --I’m friendly with the neoconservatives, I’m more of a traditionalist in the old sense of the word. The populist wing are not conservatives. They’re not fiscal conservatives—the largest budget deficits in history have been under Donald Trump. And I’m an internationalist; they’re isolationist. I want nothing to do with the populists.
I ran for the Massachusetts House when I was 22 years old and lost by 76 votes in the Republican primary in 1972. I ran again when I was 24 and won by a large margin, even though it was the middle of the Watergate scandal—not exactly a great time to be a Republican in Massachusetts. I served in the House for 12 years.
I later became Republican Party chairman in Massachusetts during the Reagan years. I admired Reagan, but I was particularly close to both President Bushes. I think George H. W. Bush was one of our greatest presidents. In 1988, after Bush was elected, which I co-chaired, a close friend of mine, Peter McPherson—who had been USAID Administrator under Reagan and later Deputy Secretary of the Treasury—called me and said, “You need to go to AID.” This was just after Bush was elected.
At the time, I said, “I know what AID is, but what would I even do there?” He made some calls. I wanted to be head of the Latin America Bureau at AID, since those countries were democratizing and I had experience with political systems and legislatures. But Alan Woods, the AID Administrator at the time, who was dying of cancer, said no—he wanted me to head the Office of Foreign Disaster Assistance.
I told him I wasn’t interested. I didn’t even know what that office did.
Then the White House intervened. Andy Card—who later became Chief of Staff for President George W. Bush—called and said I had already agreed to take the job. I hadn’t, but Woods was dying, so I didn’t push it. I started in June 1989.
Within a week, I knew it was the most interesting job I had ever had.

Learning Humanitarianism on the Job
AN: That job completely changed my career—from state politics to international humanitarian work. I learned on the job. I wrote extensively on emergency response systems and helped create much of what later became the modern international humanitarian response architecture.
Members of my family died during the Nazi occupation of Greece. The Germans stripped Greece of food to feed Rommel’s army in North Africa, and roughly 300,000 Greeks died of famine. My great-uncle was among them. That history made me deeply sensitive—almost obsessively so—to famine.
When I later became USAID Administrator, I told career staff that if a famine occurred in a country where they were serving and they failed to alert me, I would remove them from office. Famines are preventable if caught early. And during my tenure, we virtually eliminated famine deaths under our watch.
Alex de Waal, the British scholar at Tufts, later wrote a book called Mass Starvation saying that famine deaths dropped dramatically from the mid-1980s onward because the international humanitarian response system had matured. Only in the last few years have those numbers begun rising again.
But that’s what got me into humanitarianism and is something I remain deeply proud of. I wrote a book about it.

Why History Matters More Than People Think
BW: We’ll get back to the famine aspect of U.S. foreign aid. I want to ask you your thoughts on how it’s evolved to where it is today. But I’m first curious: I know during undergrad at Georgetown you majored in history. I’ve asked people before how much their specific degree influenced their later work. Some say not at all. Some say completely. 
You may like to hear that my professor Walter Isaacon, for example, has told me to switch my current major to history. In your experience, how much did what you majored in affect your career?

AN: I’m with Walter Isaacson. History gives you centuries of perspective. Our civilization is rooted in classical Greek thought. If you haven’t read Plato, Aristotle, Thucydides, or seen Aeschylus’ plays, you don’t really understand Western civilization. Some people think Western civilization is in decline—I think that’s partly because we’ve forgotten those lessons.
I’m a neoclassicist, and I say that not just because I’m Greek American. I would believe it regardless.
I also studied American history, which allowed me to place much of my career in context. Do you know who ran the first U.S. foreign aid program?

BW: I don’t.

AN: Alexander Hamilton. John Adams sent him to help Haiti’s leaders draft a constitution after a slave revolt. Hamilton was an immigrant. So when people attack immigrants, I get angry. If there was no Alexander Hamilton, there’d be no America. Ron Chernow wrote the definitive biography on Hamilton and called him the father of the federal government.
If you want to understand history, read biographies. That’s my advice.
History teaches lessons useful even in other disciplines. If you knew how business was run in the late 19th century during the robber barons, you’d see parallels now. High tech is on the edge of being like the big trusts of Theodore Roosevelt, a Republican president, and he put controls on it. It was Republicans who did it, not Democrats. I’m pro business, pro free market, but there’s an element of market constraint high tech companies are engaged in now. They’re too powerful. I’m increasingly uncomfortable. AI is a great boon. It’s another argument for immigrants—who is the founder of NVIDIA? An immigrant from Taiwan. Jensen Huang. And I bought some stock and made a lot of money. But there are troubling things about AI. Kissinger’s last book—he wrote when he was 99—was with the retired president of Google, on AI and the grave risks. There’s now evidence these programs can threaten people. There was an experiment at Google: they created a program and told it, “We are going to phase you out.” They also told it that one of the human programmers had had an affair. The program told the human creator that if he shut down the program, it would tell the board about the affair. This is a machine threatening a human creator using scandal. That’s very disturbing. This is the inception of AI. So we need to think through how far we want this to go before it gets out of control.

BW: That’s an interesting thought. I was watching the DealBook Summit with Andrew Ross Sorkin this past week—The CEO of Anthropic brought up something interesting: there’s a push in America to reach AGI before China for economic reasons, but it’s also a national security risk. If China reaches AGI first and their system becomes the default AI people use, imagine the data—what people tell their AI companion. That could be very damaging.

AN: I hadn’t seen that. Very interesting, indeed. 

Neutrality, Power, and the Moral Lines of Aid
BW: You’ve occupied many roles that operate between humanitarian idealism and geopolitical realism. We talked earlier about famine. At the beginning of your career, what did you most misunderstand about how aid actually functions once it enters a political system—as opposed to how it looks in theory or how presidents talk about it on the campaign trail?

AN: I separate myself from liberal internationalists, who I respect. Humanitarian assistance and global health should be based on the neutrality principle. It should be based on need. However, to argue that it doesn’t have any diplomatic or political consequences, or shouldn’t, is nonsense. All aid programs intervene in the structure of these societies, and it has a profound effect politically, locally, and diplomatically. It affects, usually favorably, the United States, but not necessarily. We had a huge fight as to whether food aid should be used during the North Korean famine in the mid-’90s, despite the fact that North Korea is one of the most repressive regimes in history. We were negotiating a nuclear deal with them, and the State Department tried to use a food aid program of AID to get the North Koreans to cooperate. The head of the Korea office—conducting negotiations in the Clinton administration—said to a group of NGOs: “We’re going to practice tough love. If the North Koreans are cooperative in the nuclear negotiations, you’ll eat. If they’re not, you won’t.”
And I said, “That is the most outrageous thing I’ve ever heard.”
Who dies in a famine? Children under five first. Pregnant women and lactating mothers second. Elderly people. Handicapped people. So you’re going to kill the most vulnerable parts of society to pressure the North Korean regime, which would gladly sacrifice them anyway to maintain political power. That is morally unacceptable. 
I was educated by the Jesuits at Georgetown. Jesuits taught moral reasoning. You have to think through the moral implications of what you’re doing. That doesn’t mean you run around trying to save the world, but it does mean there are moral constraints on what you can do. I wrote a book about it called The Great North Korean Famine. None of my books are bestsellers. They sell a couple thousand copies. I write them to purge myself of an obsessive focus. Once I get it down in print, I can move on. The famine was etched in my mind for five or six years. That’s all I focused on. I went up to the Chinese border during the famine and interviewed North Koreans escaping—surreptitiously. The Chinese didn’t know I was there. With a Buddhist monk friend of mine from South Korea, who had an underground NGO helping people escape and feeding them. A lot of my book was based on those interviews.

The “USAID Waste” Claims—and What They Miss
BW: As we wrap up here, one thing I’m eager to ask—I didn’t get the chance to bring it up with Mark Green—earlier in the Trump administration, there was a lot of attention on alleged waste and misallocation at USAID. Some projects cited did seem unusual at first glance to me. I remember the State of the Union—he talked about projects that, in all honesty, sounded a bit strange at face value. Like donating millions of dollars’ worth of condoms—As someone who ran the agency, how fair were those criticisms?

AN: They were either a lie or a gross misunderstanding of what we did and why we did it.
Let me give you three examples.
The president said—and Elon Musk told him to say this—that we bought condoms for Gaza. We did not buy any condoms for Gaza. It was Gaza, Mozambique, which was a province in Mozambique, it has nothing to do with Palestine. Why would we be buying condoms? Because there’s a very high HIV/AIDS rate in Gaza, Mozambique. That’s why. It’s cheaper to buy condoms than to buy antiretrovirals—$10,000 a year once you get the disease. So we don’t want people to get sick.
Second: he said we sent them to the Taliban in Afghanistan. We built many of the health clinics they were sent to. Why did we do that? There is famine in Afghanistan right now. People are dying of starvation. It’s not widely known—there’s not a lot of news media around Afghanistan. Who dies in famine? Children under five, particularly babies. Pregnant women. Lactating mothers. If you are a poor woman in Afghanistan right now, you are likely to be dead by the end of next year. What is the way you prevent people from getting pregnant? Condoms. In this case, condoms were saving human life—poor women’s lives in Afghanistan. Is that a good thing? Absolutely. I would do it again. I’d triple the number of condoms purchased. And I’m a conservative on these issues generally, but we’re living in a fantasy world here. 
Third: all these gay-rights grants supposedly we made. The great majority of those grants that Elon Musk said USAID was responsible for were State Department grants. They had nothing to do with USAID. When the Trump press secretary was asked why they were abolishing AID, she cited four grants. One of the four was an AID grant—dealing with violence against gays in Serbia. The other three were State Department grants. Did the President propose abolishing the State Department? There are gay rights courses being required under Biden at West Point and the Naval Academy. Does anyone propose abolishing the Defense Department because of these courses? Of course not. These were excuses. 
Sesame Street: I gave the order to start using Sesame Street in Egypt, Jordan, Bosnia, Pakistan—and Iraq as well. I would do it again. It’s AID’s answer to al-Qaeda. Have you ever watched Sesame Street and thought they teach children to kill each other? Absolutely not. What does Sesame Street teach? Don’t fight. They teach you how to read and write. Ninety-eight percent of the young men who join militias and commit atrocities in the developing world are illiterate. One of the reasons they join is poor job prospects, including radical Islamist groups—they’re almost all illiterate. The best solution is to educate kids—young men and young women. Sesame Street helps teach literacy. There is a Sesame version in Egypt. Studies show that 98% of Egyptian women and children watch Sesame Street every morning. We ran it for 20 years. There was discrimination in Egypt against Coptic Christian children. They kidnapped them. Locally there was a rumor that Christians were cannibals and were eating babies. Coptic parents tattooed a cross on their baby’s hand to identify them if they were kidnapped. So we put a Coptic puppet in Sesame Street to educate the public about Coptic Christianity in a subtle way. That’s a good idea. 
Then they attacked us for doing tourism. They said we’re spending money on tourism. Development tourism is a major economic growth portfolio of AID. We did it in Morocco, Egypt, Jordan, Bosnia. We were about to do it in Tunisia until the program was shut down. I was going to do it in Afghanistan if we ever had peace there, because there were Greek cities Alexander the Great built that lasted 400 years. They’re in ruins. No one’s excavated them. Afghanistan could have had a booming tourist industry. Ten percent of Egypt’s workforce works in tourism and hospitality. We helped modernize tourism programs, invested in archaeological sites. We don’t build hotels, but we build infrastructure that hotels depend on—water and sewer.
Have you ever seen Indiana Jones and the Last Crusade?

BW: Of course! I grew up watching it with my dad.

AN: What’s the last scene? Petra. Those scenes were shot in Petra in southern Jordan. We helped do the excavation of that.

BW: That’s awesome.

AN: Millions of tourists go to Petra. There were no hotels and no roads. We built roads, water, and sewer so hotels could move in. That produced hundreds of thousands of jobs in Jordan. We excavated the area where Christ was baptized. There is huge interest in the West—especially in the United States—in visiting it. There’s a parking lot there. We built that. People come to Jordan just to see it. They go to see Petra because they saw it in Indiana Jones. It’s called development tourism. It’s a huge success story. It created literally millions of jobs in the developing world. We should be proud of it. And what did they do? They attacked this work because of their ignorance of what AID did. They had young kids going in, crossing out programs. It was astonishing to me—the ignorance of the people on Elon Musk’s staff doing this. It was scandalous.

Closing
BW: Professor Natsios, thank you so much for your time. This was incredibly insightful, and I really appreciate how candid you were.
AN: Happy to do it.