This article is part of The D.C. Brief, TIME’s politics newsletter. Sign up here to get stories like this sent to your inbox. For the first time in weeks, it looks like Democrats are summoning something passing for a plan to counter the unapologetic chaos radiating from the reinstalled administration of President Donald Trump. House Minority Leader Hakeem Jeffries has laid out a 10-step plan for slowing down Trump. Sen. Brian Schatz of Hawaii says he will force Republicans to waste valuable floor time on State Department nominations by attaching blanket holds to all of them. First-term Sen. Lisa Blunt Rochester of Delaware, a Bidenesque pragmatist of the first order, declared flatly that she was a no on all Trump nominees going forward, a gutsy move that signaled even the most centrist of lawmakers were nearing the end of their patience. And, among Democratic strategists, there is a not-even-subtle chatter about recruiting candidates for districts laden with federal workers, including four where Republican incumbents have more than 25,000 feds underfoot. There are also three Republicans representing three districts that went blue in the 2024 presidential campaign. Nothing spurs a conversion like a potential shift in power. The proof-of-life moment for Democrats comes as Trump’s third week begins with the same fury as the last two. The difference now may be Trump’s new hatchet man, Elon Musk, stepping to the front of the stage, as he gleefully remakes government as a shadow of itself. In response, a feisty pushback has finally started to take hold, replacing prop-driven press conferences with a rallying cry for voters to pay attention to what is unfolding with breakneck velocity. Democrats may not have the votes, Trump may have an above-water net approval rating, and the rank-and-file liberal base is bluntly exhausted, but nothing is permanent in politics. That’s not to say any of this gnashing is going to actually result in anything. Two of Trump’s most aggressively trolly nominees, Tulsi Gabbard and Robert F. Kennedy Jr., cleared their committee votes on Tuesday. Despite raising serious misgivings among even some conservatives, that pair now heads to full confirmation votes for gigs running the nation’s spy network and health systems. Similarly, Kash Patel seems to remain on a glide path to take over the FBI. Outside of marquee personnel choices, widespread disruption across the federal government seems inevitable. Trump is close to finalizing his legally questionable plans to shutter the Education Department. A consumer-protection bureau is on borrowed time after Trump canned its chief over the weekend. Anyone who touched politically sensitive cases at the FBI now expects to be next in the purge, following Justice Department skeptics out the door. Trump has already dispatched just about everyone in the U.S. Agency for International Development. It’s why, despite some signs of fight, some Democrats remain utterly despondent. But the reining emotion was anger on Monday, as a bustling crowd of hundreds listened to Democrats like Reps. Gerry Connolly of Virginia and Jamie Raskin of Maryland—both representing communities with outsized shares of feds—outside the shuttered headquarters of the U.S. Agency for International Development, not far from the White House. "Elon Musk may get to be dictator of Tesla, and he may try to play dictator here in Washington. D.C., but he doesn't get to shut down the Agency for International Development," Sen. Chris Van Hollen of fed-heavy Maryland said. (A similar such confrontation played out on Tuesday at Treasury headquarters, where a crowd led by more than a dozen Democrats in Congress were rebuffed from entering the building where Musk's DOGE team has raised alarm bells by gaining access to the department's payments system.) Back at the Capitol, Sen. Patty Murray of Washington, a member of the Democratic Leadership team, threw all her Musk messaging into one blast: “Let’s not mince words here. An unelected, unaccountable billionaire with expansive conflicts of interest, deep ties to China, and an indiscreet ax to grind against perceived enemies is hijacking our nation’s most sensitive financial data systems and its checkbook so that he can illegally block funds to our constituents based on the slightest whim or wildest conspiracy.” Musk may have finally got Democrats fired up, but "All Things Elon" isn’t a durable messaging plan. Banking on the public to rally against a billionaire and his buddies proved a losing strategy in 2016 and 2024 alike. Beyond that, Musk is not accountable to anyone except for Trump, and the President seems to like what Musk is unleashing. That’s not that there are no ideas to push Trump and his Republican allies to shift away from some of the more dizzying ideas. A scuttled plan to pause federal spending got heavy rejections from courts. FBI agents are trying to block the release of a list of those involved in the Trump legal sagas. A legal challenge to Trump’s anti-trans policies is moving ahead on a separate track. And two top Senators are asking Congress’ watchdog, the Government Accountability Office, to open an investigation involving Musk and his access to some of the most sensitive government spending records.

First it was buy Greenland, then make Canada a state. Now Donald Trump wants to own the Gaza Strip. The President proposed on Tuesday that the U.S. should “own” the Gaza Strip, “level the site” and develop it, explicitly calling for displacing 2 million Palestinians from their homeland as the region’s leaders struggle to maintain a fragile ceasefire. During a wide-ranging press conference with Israel’s Prime Minister Benjamin Netanyahu, Trump laid out a sweeping plan for the U.S. to colonize Gaza and build resorts there. “I don’t want to be cute. I don’t want to be a wise guy, but—the Riviera of the Middle East. This could be so magnificent,” Trump said. The idea would upend a centuries-old conflict over ownership of the land along the eastern edge of the Mediterranean Sea by permanently relocating the Palestinian people. Netanyahu didn’t dismiss the concept. “I think it’s worth paying attention to. We are talking about it,” Netanyahu said. “I think it is something that could change history, and it is worthwhile really pursuing this idea.” Democrats largely balked at the suggestion, labeling it “crazy” and “morally bankrupt.” Progressive Rep. Rashida Tlaib, who is Palestinian American, accused Trump of “openly calling for ethnic cleansing.” Trump ally Republican Sen. Lindsey Graham said he would “keep an open mind” but suggested the plan would receive pushback both at home and abroad. “We’ll see what our Arab friends say about that,” he said. Saudi Arabia’s foreign ministry issued a statement reaffirming its “unequivocal rejection of any infringement on the legitimate rights of the Palestinian people, [including] attempts to displace them from their land.” The Kingdom had previously joined Egypt, Jordan, Qatar, the UAE, and the Palestine Liberation Organization in a joint letter to Secretary of State Marco Rubio on Monday that emphasized: “Reconstruction in Gaza should be through direct engagement with and participation of the people of Gaza. Palestinians will live in their land and help rebuild it.” Trump’s outlandish real-estate pitch comes at a delicate moment in the cease-fire agreement announced on Jan. 15 between Hamas and Israel, as Israel is still trying to get Hamas to hand over Israeli hostages and the remains of those who died while being held by Hamas. Ownership of the Gaza Strip and Israeli land is a central part of the conflict, with Hamas leaders threatening another invasion of Israel and right-wing Israeli settlers continuing to call for claiming land in Gaza. In a statement, Hamas called Trump’s proposal “a recipe for generating chaos and tension,” adding: “Our people in the Gaza Strip will not allow these plans to pass.” More than two million Palestinians live in Gaza, where many own land and have lived there for many generations. Trump proposed ignoring all that history and having the U.S. take ownership, alluding to the monumental rebuilding facing the Palestinian people as a reason such a transfer makes sense. “The U.S. will take over the Gaza Strip, and we will do a job with it, too. We’ll own it and be responsible for dismantling all of the dangerous unexploded bombs and other weapons on the site. Level the site and get rid of the destroyed buildings. Level it out,” he said. When asked who would live there, he said: “I envision the world’s people living there.” Trump’s idea cuts against the longstanding insistence by Israel’s neighbors Egypt and Jordan that Palestinians should not be permanently displaced from their homes in Gaza. Mike Waltz, Trump’s national security advisor, said that Trump spoke with Egyptian President Abdel Al Sisi on Tuesday and that Jordanian King Abdullah would visit the White House next week. Speaking with reporters before Trump’s press conference with Netanyahu, Waltz said that the extent of the damage in Gaza created a particular challenge for those in southern Gaza waiting to return to their land in the north of the strip. He said rebuilding parts of Gaza that were bombed in the war could take more than a decade, as parts are still riddled with explosives and sit on top of a honeycomb of tunnels built by Hamas. “At some point, we have to look realistically, how do you rebuild Gaza? What does that look like? What is the timeline?” Waltz said. “A lot of people were looking at very unrealistic timelines. We’re talking 10 to 15 years.”

On March 9, most people in the U.S. will set their clocks forward an hour, thanks to the start of Daylight Saving Time. But if President Donald Trump acts on what he’s said about the practice, Daylight Saving Time as we know it could change. Daylight Saving Time has long been controversial—most countries don’t participate in it, and many Americans have said they want to stop changing the clocks twice a year. Trump has expressed support for ending the practice, but recent efforts to do so have stalled, and only two states—Hawaii and most of Arizona—don’t participate in Daylight Saving Time. What has Trump said so far about Daylight Saving Time? On Dec. 13, 2024, Trump posted on his social media site, Truth Social, “The Republican Party will use its best efforts to eliminate Daylight Saving Time, which has a small but strong constituency, but shouldn’t! Daylight Saving Time is inconvenient, and very costly to our Nation.” But more than a month into his presidency, Trump has yet to make any moves on the issue since his Truth Social post, and experts are a little unsure as to what changes could be coming. David Prerau, author of Seize the Daylight: The Curious and Contentious Story of Daylight Saving Time and an expert on the topic, says there are three options. The first is to keep the existing system of changing the clocks twice a year; currently, most of America sets the clock forward an hour starting in March for Daylight Saving Time, and sets the clock back an hour starting in November for Standard Time. The second option is to make Daylight Saving Time permanent, and the third is to make Standard Time permanent. “[Trump] said it in a very short sentence without detail so it isn’t clear which of those he meant,” Prerau says. “Most people don’t even realize that there are two other options.” The White House did not immediately respond to a request for comment seeking clarity on Trump’s plans for Daylight Saving Time. What would permanent Daylight Saving Time look like? Daylight Saving Time is meant to allow people to make use of the daylight in the evening during the warmer months. Making Daylight Saving Time permanent would mean advancing the clocks an hour for the entire year, so the sun would appear to rise and set an hour later, not just in the summer, but in the winter too, Prerau says. Lawmakers have tried to do this in the past. A bipartisan bill called the Sunshine Protection Act would have made Daylight Saving Time year-round, but the bill stalled, and was recently reintroduced by Republican Sen. Rick Scott of Florida. Lawmakers who have expressed support for the bill argue that changing the clock twice a year is an inconvenient disruption. “I hear from Americans constantly that they are sick and tired of changing their clocks twice a year—it’s an unnecessary, decades-old practice that’s more of an annoyance to families than benefit to them,” Scott said in a Jan. 8 press release about reintroducing the Sunshine Protection Act. “I’m excited to have President Trump back in the White House and fully on board to LOCK THE CLOCK so we can get this good bill passed and make this common-sense change that will simplify and benefit the lives of American families.” Trump has previously indicated support for such a change, tweeting in 2019, “Making Daylight Saving Time permanent is O.K. with me!” Prerau says the U.S. government made Daylight Saving Time permanent before, in 1974, during an energy crisis. But the change was unpopular because the sun appeared to rise later in the morning, so many people were waking up and going to work or school in the dark. The permanent time change was repealed less than a year later. “We have tried that year-round Daylight Saving Time, and it proved very unpopular nationally,” Prerau says. Dr. David Kuhlmann, a spokesperson for the American Academy of Sleep Medicine (AASM) and a sleep medicine doctor, says that while the AASM supports ending the seasonal time changes, it doesn’t support making Daylight Saving Time permanent. Rather, the academy has been advocating for making Standard Time permanent, arguing that it aligns best with our circadian rhythms and would be better for our health and safety. “[If we had permanent Daylight Saving Time] people would be waking up in darkness, and likely be going to work in darkness … versus being able to get up with the more natural rhythm of the sun,” Kuhlmann says. What would permanent Standard Time look like? Making Standard Time permanent would mean setting the clocks back an hour for the entire year, so the sun would appear to rise and set an hour earlier not just in the winter, but in the summer too. Many health and sleep experts support making Standard Time permanent because they say it would be better for our health. Kuhlmann says that toggling between Daylight Saving Time and Standard Time disrupts our sleep and circadian rhythm, which is associated with negative health effects. He points to studies that have found Daylight Saving Time to be associated with an increased risk of motor vehicle accidents and an increased risk of stroke and hospital admissions, among other impacts. He adds that the effects of the “circadian misalignment” from Daylight Saving Time don't just last for a few days after the clocks change, but for the entire eight months that we use Daylight Saving Time. Generally speaking, making Standard Time permanent would allow us to wake up with the sun year-round, Kuhlmann says, and so would be better aligned with our circadian rhythm and ultimately more beneficial for our health. “From a circadian alignment perspective … it’s really the only choice that’s healthy,” Kuhlmann says. Prerau says the cons of making Standard Time permanent are that, in the summer, many people would likely still be sleeping when the sun appears to rise earlier, and they wouldn’t get to take advantage of the daylight in the evening since the sun would appear to set earlier. Rather than changing the current practice, he suggests that officials improve messaging, such as through public service announcements, to help people better prepare for and anticipate the seasonal time changes. “The current system is really a compromise between those two possibilities and it’s actually, in my opinion, better than either one because you’re getting the best of both,” Prerau says.

As the U.S. government endeavors to trim its spending, no agency has been as pared back as the United States Agency for International Development (USAID). On Feb. 26, after 30 days of what was purported to be a 90-day review, the Trump Administration announced that 90% of the international aid projects the agency was funding were going to be canceled, ending an era of outsize dominance and generosity by the U.S. in foreign aid. These cuts include funding for medical, nutrition, educational and democratic initiatives that were sustaining and protecting millions of people. While foreign aid represented about half a percentage of the U.S. budget, it also represented more than 40% of the world’s foreign aid. The size and speed of the cancellations have reverberated around the world, with many experts suggesting that America’s reputation as a reliable and trustworthy partner has taken a hit simply because of the abruptness of the process. Secretary of State Marco Rubio has said that all foreign-aid projects must make Americans safer, stronger, and more prosperous. Valerie Karr, who has been working in disability rights for two decades, understands that impulse but is aghast at the cost to the people her small business served: disabled children in impoverished countries. For the last six years, Inclusive Development Partners (IDP) has helped implement plans to get children with disabilities around the world into schools and keep them there. IDP was hired by other aid organizations to make sure the work they were doing included people with disabilities. In that way it was occasionally branded as a DEI project, but it was not one informed by identity. If an education program was being established, IDP helped train teachers on how to instruct disabled children. It also helped identify disabled children, who were often kept home, and provided them with the materials they needed to get to school, including wheelchairs and braille books. Now after the termination of its contracts, IDP is struggling to stave off bankruptcy. Karr, who as well as being president of IDP is an associate professor at UMass Boston, spoke to TIME about how this will affect disabled children, what Americans got out of USAID, and what she learned in the weeks since the foreign-aid freeze was implemented. What led you to found your organization? I got to attend the negotiations for the U.N. Convention on the Rights of Persons with Disabilities. I learned the value of the disability community having a voice and advocating for their rights at an international level. In 2018, my co-founder Anne Hayes and I realized that the task was no longer advocating for disability rights; it was, how do we achieve these rights? I’m an academic and she’s a practitioner. Academics aren't good at practice, and development practitioners aren't good at using evidence. So we were meeting in the middle: how do we do quality work, using the evidence base? How can we include kids with disabilities in education around the world? We had a really strong collaboration with USAID. As of Jan. 22 we had 17 programs to include children of all age ranges, from pre-primary all the way through workforce transition. Morning meeting between students at a school and students from a school with disabilities in Western Kenya An inclusive morning meeting between students at a primary school and students from a school with disabilities in Western Kenya in 2018.Courtesy Inclusive Development Partners As the U.S. government endeavors to trim its spending, no agency has been as pared back as the United States Agency for International Development (USAID). On Feb. 26, after 30 days of what was purported to be a 90-day review, the Trump Administration announced that 90% of the international aid projects the agency was funding were going to be canceled, ending an era of outsize dominance and generosity by the U.S. in foreign aid. These cuts include funding for medical, nutrition, educational and democratic initiatives that were sustaining and protecting millions of people. While foreign aid represented about half a percentage of the U.S. budget, it also represented more than 40% of the world’s foreign aid. The size and speed of the cancellations have reverberated around the world, with many experts suggesting that America’s reputation as a reliable and trustworthy partner has taken a hit simply because of the abruptness of the process. Secretary of State Marco Rubio has said that all foreign-aid projects must make Americans safer, stronger, and more prosperous. Valerie Karr, who has been working in disability rights for two decades, understands that impulse but is aghast at the cost to the people her small business served: disabled children in impoverished countries. For the last six years, Inclusive Development Partners (IDP) has helped implement plans to get children with disabilities around the world into schools and keep them there. Read More: Franklin Graham Thinks It's 'Very Good' to Take a Pause on Foreign Aid IDP was hired by other aid organizations to make sure the work they were doing included people with disabilities. In that way it was occasionally branded as a DEI project, but it was not one informed by identity. If an education program was being established, IDP helped train teachers on how to instruct disabled children. It also helped identify disabled children, who were often kept home, and provided them with the materials they needed to get to school, including wheelchairs and braille books. Now after the termination of its contracts, IDP is struggling to stave off bankruptcy. Karr, who as well as being president of IDP is an associate professor at UMass Boston, spoke to TIME about how this will affect disabled children, what Americans got out of USAID, and what she learned in the weeks since the foreign-aid freeze was implemented. What led you to found your organization? I got to attend the negotiations for the U.N. Convention on the Rights of Persons with Disabilities. I learned the value of the disability community having a voice and advocating for their rights at an international level. In 2018, my co-founder Anne Hayes and I realized that the task was no longer advocating for disability rights; it was, how do we achieve these rights? I’m an academic and she’s a practitioner. Academics aren't good at practice, and development practitioners aren't good at using evidence. So we were meeting in the middle: how do we do quality work, using the evidence base? How can we include kids with disabilities in education around the world? We had a really strong collaboration with USAID. As of Jan. 22 we had 17 programs to include children of all age ranges, from pre-primary all the way through workforce transition. What did your work actually look like? In northern Nigeria, we were working with the International Rescue Committee on a USAID activity called Opportunities to Learn. These kids were out of school. We know that children with disabilities are eight to 10 times more likely to be out of school than a child without a disability. We train teachers how to be inclusive and use something called Universal Design for Learning (UDL), which has been found to not only help children with disabilities learn better, but children who are malnourished, children of minority status, and children who have issues with chronic absenteeism due to child labor or having to support farming communities. In Bangladesh, we work with parents and communities on how to reduce stigma towards kids with disabilities, because kids with disabilities don't go to school for a variety of reasons. The classroom is not accessible. But also parents are scared to send their kids because their child is more likely to be hurt or harmed if they leave the household. We work with communities and schools to ensure kids ultimately get the access they need to an education. What kind of disabilities are you dealing with? USAID started more with hearing and vision and physical disabilities, because those are obvious, but over time—because we're using Universal Design for Learning, which meets the needs of all children—we realized we don’t need to know the specific disability a child has. There's also something called a twin-track approach. You can’t just build more inclusive spaces; kids need braille, kids need sign-language literacy, they need glasses or hearing aids. So we were providing both. In Kenya, 70% of children with disabilities are undiagnosed and in the mainstream classroom. We went in with remediation and after-school programs to help, as well specific universal pedagogy. That program, the Kenya Primary Literacy Program, just got canceled. It was in its first year. Teacher training sounds a bit amorphous. It’s hard to know whether the teachers were applying it or not. Do you have a success story that you can say, well, here is an impact that we had? We worked a lot on the fact that there were no numbers, there were no resources, there was nothing in place at the time we started, so our progress is much more on intermediary goals. We’ve been working to build assessment instruments, so that this type of data would exist. It’s also what my guide for USAID—published in November and now removed from the web—was guiding other orgs to do: measure the impact of inclusion. Our data in Ghana showed that when you trained teachers in UDL, they implemented it and felt more prepared to include learners with disabilities. What would you say to people who say that Nepal and Bangladesh and Nigeria need to look after their own and ask why America should look after the disabled kids of other countries? I’d say we do it to develop ties with communities. If you're a parent of a child with a disability, which my co-founder is, and you meet a parent of a child with a disability in a different country, you immediately have a very strong bond. That is a relationship that we have cultivated and really established. So we know that when we need to call on allies and friends, these countries are our friends. They are advocating for the American people as well. We also know that a more educated population has greater productivity. We know there's better economic outcomes and that we reduce migration. These education programs build resilient communities, they build stable political communities, and they build allies with the United States. And honestly, it's working. Nepal was graduating from a low-income country to a middle-income country in the next year or two, and that's because the investment of USAID has helped stabilize and build a system. And that, to me, is success. Did you see this as Diversity Equity and Inclusion (DEI) work? Disability rights have actually always been politically a left and a right issue. Republicans say if you support people with disabilities while they're young, they can get a job, they can be income earners, and that helps the economy. The left has an equal-rights stance on disability inclusion. Honestly, we really became IDP under Trump's first Administration. Over time, we've benefited from DEI, and we, at our hearts, support everybody being included. For example, in our Nepal equity and inclusion in education program, our role was called the DEIA advisor. So we'd seen DEIA have an influence on disability, but they were really pretty different for a very long time. Have you heard from people who are asking where your service is? The harder, more pressing matter has actually been trying to pay people. So you know, we haven't been paid for some of our December work, and we definitely haven't been paid for most of our January work that we already paid out. So IDP had lost about $350,000 and we now are still owed over $250,000. We’re a woman-owned small business. We've never actually generated profits because we work on grants and contracts, there's not actually profit in them. Every line item is accounted for. So we launched a GoFundMe and raised a little bit over $20,000 to avoid bankruptcy. I have employees with disabilities that need to be paid. We owe them money. But they're like, What do you need? Can I write a letter? Can I call my congressman? So I try to look at it that way, that if USAID has collapsed, it's catastrophic for my country and it's catastrophic for my work, but we're still going to all be pushing for inclusion. How much of your revenue came from USAID? Ninety percent. In hindsight, did you think, Oh, I really should have diversified my clients? Yeah. We were a group of consultants that decided it was better to work together, because when you're a partner, you're able to really build inclusive systems. When you're just a consultant by yourself, it's hard. It was a great business model to create the change we needed to see in these programs. But because the USAID programs went from one to two to four to 18, it was so much work for a very small staff—we're only 14 staff and nine international. It was really hard to keep up that pace and grow our systems; we were just running to catch up. I don't think anyone could see that a whole industry would fall. I kind of relate this to COVID, right, where we all went in the pandemic. In the first days, you just couldn't believe what was happening, that the world would halt. Is there one loss that keeps you awake at night? I'm kept up at night mainly for some of our international team members, because I know people live day to day on their income, and that means that you're very close to poverty immediately from this loss. I have been holding off the grief on what it means to the kids. I'll get too emotional at the thought of 10,000 kids not being able to go to school. I have a moral sense of responsibility and failure that we won't be able to do that. I know education isn't as stark as AIDS medication being stopped, or people starving. To me, it is really striking that the American people are like, Oh, I didn't know. There's a lack of consciousness over the atrocity that is happening here. I had a friend from college contact me after one of my posts about USAID, and the summary of that was that kids in New Hampshire need you too. We ended up having a really good conversation. Politically they want us to fight. They want us to think that because I was working for a child with a disability in Nepal, that I was somehow robbing an opportunity from a child in New Hampshire with a disability. But we all care about kids with disabilities being able to have access. I know that a child in New Hampshire is just as important as a child in Nepal. But the money that is saved from USAID is not going to be given to New Hampshire children. They're cutting just as much out of education and Medicaid. This is not an either/or. This is not a red or blue. Everyone wants their kids to have an education and have opportunity. What is your plan going forward? Our plan is to try and avoid bankruptcy and make sure we can pay out all the people who have to leave, so they have as much money as they can to stabilize their homes for a little bit longer while they search for new jobs. We do have a little bit of U.N. programming and World Bank programming, and if we go bankrupt, we will lose those programs along with it, and that will put those programs in a bind, right? If we can survive, which I think we will, we'll be working on research and programs with other donors and continuing programs, which means we'll have to be small. We'll all go back to being consultants working small and part time and for limited hours, and we'll try and rebuild. We have a hope that the American people will see that aid is valuable, and maybe someday it'll come back, which would be great.

Doug Collins, the Secretary of Veterans Affairs, is reportedly serving as the designated survivor during President Donald Trump's joint congressional address on Tuesday night. The designated survivor is a person in the presidential line of succession—often a low-level Cabinet member—chosen to be kept separate from other executive branch officials when the government is all gathered in one place in the event of a catastrophic event. Collins was revealed to be the designated survivor, according to multiple media reports. The practice ensures that the government can still run even if all those present at a large governmental event are wiped out—which is why some members of Congress also are kept separate to ensure that the legislative branch can continue to function. The practice began during the Cold War, when the idea of nuclear warfare was heavy on the minds of the U.S. government. In the event of a nuclear event wiping out the presidential line of succession in one go, the designated survivor is chosen so that they are eligible to be president, and could take up the mantle to lead the United States if need be. There are very few times in which all of America’s governmental leaders are in the same place, and thus it is rare that the designated survivor must be tapped—only a handful of times during each presidency, usually. The American Presidency Project at the University of California-Santa Barbara keeps a running list of designated survivors dating back to 1984 when Ronald Reagan was president. In Politico Magazine in 2017, Dan Glickman, former United States Secretary of Agriculture under Bill Clinton, wrote about his experience as designated survivor, and spending the State of the Union address at his daughter’s apartment in New York City. “I don’t recall getting any specific instructions on what to do if the doomsday scenario happened. All I knew is that if necessary, I could turn to that military officer accompanying me, holding that 45-pound bag, and trigger a military response, including a nuclear strike,” Glickman wrote of his experience. “It felt like an awesome responsibility to put on one man’s shoulders, even if it was exceedingly unlikely the president—or in this case, the secretary of agriculture—would ever have to use it.”

The Houston public school classroom might have looked like any other, if not for an unusual feature on the whiteboard: A countdown timer. The teacher leading the English lesson allowed her fourth graders “10 more seconds to log in” for tech problems. Then she asked the class to read a passage to determine the author’s motivations, set the timer to one minute, and called out at the 25- and 15-second marks. Students took 30 seconds to share answers with a partner before their daily 10-minute quiz. The regimented structure is part of a strict new schooling model that nearly half of the 274 schools in the Houston Independent School District have adopted. Educators are required to adhere closely to the curriculum. District officials visit schools several times a week to observe classes and ensure that teachers are following the new protocols. Strict behavior policies are enforced. At one point, students were required sometimes to carry orange traffic cones to the bathroom, instead of the traditional hall passes, as part of an effort to prevent disorder. Advertisement SKIP ADVERTISEMENT These ideas are not all new, but the scale, pace and force of change in Houston stands among the starkest in modern American education.Halfway through the second school year that the new model has been in use, officials argue that it is paying off. The number of schools in Houston that were rated D or F by the state dropped to 41 from 121. Math and reading scores on state standardized tests have risen. The overall gains were “largest single-year growth in the district’s history,” district officials said. The Houston schools did not make overall gains in reading last year on a federal exam that is considered the gold standard — but it did avoid the national slide in achievement in the subject. Still, the overhaul has also been deeply polarizing, infuriating many people in a district where more than 80 percent of the students are Black or Hispanic. A fierce movement of parents and teachers argue that the new model’s emphasis on test preparation damages students’ desire to learn. They have criticized the removal of novels from English lessons, and have complained that the closure of libraries is harmful to disadvantaged children. Advertisement SKIP ADVERTISEMENT Houston’s experience recalls previous efforts to overhaul struggling school systems in other cities: A hard-charging, high-octane leader arrives demanding change, and residents accuse the new leader of bulldozing beloved programs and shrugging off criticism. But the situation in Houston also stands apart from other cities. The school system has been taken over by the state, which appointed all new leadership. As a result, the transformation of classroom life is overlaid with a political tug of war between the conservative Republicans who run the state and the Democratic city leaders fighting for local control.In November, voters rejected a new bond to pay for improvements to Houston school facilities after Democrats, who usually support such measures, framed the vote as a referendum on the state-imposed school leadership. At the center of the changes and the controversy is Mike Miles, an unyielding superintendent installed by the Republican administration of Gov. Greg Abbott. Advertisement SKIP ADVERTISEMENT Mr. Miles, a former Army Ranger, short-time Dallas superintendent and founder of a charter school network, has become a lightning rod in Houston. He described the school system he took over as antiquated and backward, and argued that “incremental, piecemeal reform” would fail to meet the moment.“People talk about equity all the time, and then don’t do a damn thing about it,” Mr. Miles said. “One year doesn’t make a trend. But we’ve shown that the model already works, especially for kids who are behind.” Onlookers and local residents say that for all his ambition, the superintendent has built up too much animosity to keep the momentum going — and that his model is doomed to flame out, as others have before. “This is not an education,” said Liz Silva, whose third-grade son attends an arts magnet school in Houston under the new model. “My kid’s miserable.” A ‘New Education System’ The model, now in use at 130 schools in Houston, uses a fixed structure for students in grades three through 12. It was first introduced at a small number of schools that were performing poorly; more schools were added later or joined voluntarily.The curriculum was designed by the district. Math and English teachers spend about 45 minutes on instruction for each lesson, followed by a quiz. Students find out immediately how they did on the quiz, and then are split into two groups. Those who score well leave the classroom for independent or paired work, under the eyes of uncertified learning coaches. The rest stay behind to go over the concepts they missed. The district calls it the “New Education System.” During visits to two schools this winter, hallways and classrooms were almost always orderly; disruptive students are removed from the classroom. Posters with school test score data hung on the walls. Mr. Miles regularly visits schools himself to observe teachers. On one visit, Mr. Miles asked frequently for more student participation, telling a principal, “I would’ve liked to see a little bit more of that pair and share.” The superintendent even offered a note on the air temperature in classrooms: It was a little chilly, he said.At Hilliard Elementary School, where the timed English lesson took place, more than 97 percent of students come from economically disadvantaged households. Under the new system, the state rating for the school jumped to A from F in a single year. The principal, Erika Kimble, called the progress “mind-blowing,” but she worries about maintaining it. “As tough as last year was, it’s easier to get there and harder to stay there,” she said. There have been stumbles. At another school, Thompson Elementary, fourth grade students pointed out that a district-made slide included an incorrect solution for a math problem. Teachers and administrators appeared to still be adapting to the demands for efficiency. One of Mr. Miles’s top deputies, for example, noticed that a math teacher moved to giving students their daily quiz five minutes early, when she “could have done two more problems” in that time instead. At Hilliard, when two fifth graders reached the same right math answer by different methods, their teacher reminded students that geometry problems can often be solved in several ways. Then she quickly moved on, in an effort to stay on schedule. Amy Poerschke, a district official who supervises Ms. Kimble and watched the lesson, later suggested that the teacher might have paused to explore the idea. “That could have turned into a ‘Turn and talk to your neighbor: Why are they both right?’” Dr. Poerschke said. Ms. Kimble replied that the new system’s time strictures sometimes made it tough to do that: “What does that wiggle room look like?” ‘At what cost?’ The New Education System is all the more contentious because of how the takeover came about. In 2015, a local lawmaker, Harold V. Dutton Jr., spearheaded passage of a new law allowing the state to wrest control of school districts from local officials based on consistently poor performance at a single school. Mr. Dutton hoped the law would lead to changes at struggling Houston public schools like Wheatley High, where he was once a student. Its consistent F ratings from the state eventually led to the takeover. Though a Republican-led state government now runs the schools in the state’s largest Democratic stronghold, Mr. Dutton — a Democrat — said he had no regrets. The shake-up, he argued, was just what the district needed to force improvements in schools that had languished for too long. “The biggest thing that’s working, which people are complaining about, is just change itself,” he said in an interview. Advertisement SKIP ADVERTISEMENT The backlash was immediate. There were legal challenges to the takeover. Large protests assembled at the district’s headquarters. Yard signs popped up, and can still be seen around Houston, with the message “Go Away Miles.” State officials removed dozens of school administrators and hundreds of educators; many more left voluntarily. The district is also in the process of adopting a pay-for-performance system for teachers and principals, a contentious practice to reward them financially for improving student achievement, among other things, rather than on the basis of seniority. Houston’s would be the largest public school system in the country to do so. It is part of a playbook for Mr. Miles, who has brought similar salary systems — and his militarylike approach — to other districts. He oversaw a sustained rise in test scores in a small Colorado district, but his short stint in Dallas led to mixed results and a large jump in teacher turnover. Education experts see strengths in elements of Mr. Miles’s Houston plan, like adding new aides to help manage classrooms. Some experts said that uncomfortable conversations about how to evaluate, compensate and retain effective teachers are essential for school improvement.Toni Templeton, a senior research scientist at the University of Houston’s Education Research Center, said she was concerned that the long-term gains may be limited to a small cohort of lower-performing children. And she cautioned that state and district-level changes to testing practices could complicate the picture of progress. “I expect to see some improvement,” Dr. Templeton said. “‘At what cost?’ is my question.” Other state takeovers of school districts have rarely led to long-term gains in achievement. One longtime high school teacher in Houston said she had never faced a more taxing school year, including during the pandemic. A middle-school English teacher said she was so convinced that the new practices would hurt children that she felt compelled to resign. Several parents in interviews lamented the lost time in the school day for building social and emotional skills. “Children are saying that school is a prison,” said Michelle Williams, president of the Houston Education Association, a teacher’s union with about 200 members. “They hate it,” she said. Local anger was evident on Election Day, when voters were asked to approve a much-needed $4.4 billion bond to improve the crumbling infrastructure at many local schools. The measure failed by 58 percent to 42 percent.“Our schools need investment,” said Molly Cook, a Democratic state senator from Houston. “But if we can’t trust the leadership, then we simply cannot trust them with $4.4 billion.” Some teachers and parents are concerned that the overhaul will drive families away from the public schools. The district’s enrollment has been on the decline since 2016, but schools in the New Education System saw larger drops last year than others did. Seen from the outside, Houston is “one of the most fascinating stories in education,” said Jonathan Collins, an assistant professor at Teachers College who studied another state takeover, in Providence. But if the new school leaders underestimate the importance of community buy-in, he added, Houston’s effort end up like others that ultimately fell apart Even the Houston superintendent acknowledged that the success of the New Education System will not hinge on test results alone. “It has to have people who want to keep it,” Mr. Miles said.

On Jan. 22, a 17-year-old in the Antioch neighborhood of Nashville entered his high school’s lunchroom and shot two other students before fatally turning the gun on himself. One of the students escaped with a graze wound. The other, Josselin Corea Escalante, 16, died. Antioch High School was fitted with multiple safety measures intended to thwart school shootings: shatter-resistant glass, security cameras with software designed to detect a brandished weapon, two school resource officers stationed on campus. Reportedly radicalized by far-right propaganda online, the assailant was active on sites that valorized school shooters. He was suspended in the fall for threatening a student with a box cutter. One teacher called him a “walking red flag.” But none of what was known about the gunman and none of the safety measures enacted by the school were enough to save Josselin Corea Escalante. WPLN, Nashville’s NPR affiliate, put eight journalists on the story, breaking into national newscasts with live updates throughout the day of the shooting. In most other ways, response to the tragedy in Antioch, which lies southeast of downtown, has been muted — very different from the city’s passionate response to a shooting less than two years ago at the Covenant School, a private Christian academy on Nashville’s southwest side. The Covenant shooting took the lives of three 9-year-olds and three staff members, including the school principal. Advertisement SKIP ADVERTISEMENT Tennessee has one of the highest rates of firearm deaths in the country. A lot of us thought the Covenant shooting might shift the hopes-and-prayers contingent toward reason, if only in modest ways. Covenant’s principal was a close friend of Maria Lee, the wife of Gov. Bill Lee. Covenant offers a Christian education that aligns with what Republicans want for the state’s public schools. For them, the tragedy was personal.The protests that followed the Covenant shooting engendered several nonpartisan organizations whose explicit goal was to force the General Assembly to pass the common-sense gun legislation that a majority of Tennesseans favor. Red-flag laws. Background checks. Waiting periods. Safe gun storage. Legislators passed no such laws, so the governor hauled them back to finish the job in a special legislative session. I have harbored many fruitless hopes in my life, but I have never been more flagrantly, hideously wrong than I was in holding out hope for meaningful, reasonable action on guns from Republicans. Everybody wants to know how the underage Antioch shooter got his hands on a deadly weapon, but tracing the provenance of a gun in Tennessee is “a fool’s errand,” according to WPLN’s Paige Pfleger, whose joint investigative reporting with ProPublica has tracked the deadly ramifications of Tennessee’s lax gun laws. “State laws have made it really, really easy to possess guns here without any permitting process,” she said last week on “This Is Nashville.” “Background checks are not required for private sales, including sales online or at gun shows. That’s not to mention the ubiquity of guns — guns stolen from cars, and that’s very common.” Down here, school shootings inspire weaker gun laws. In the wake of the Sandy Hook massacre in 2012, when other states were tightening gun laws, Tennessee invited gun manufacturers to come on down. After a gunman killed four people at a Waffle House in Nashville in 2018, legislators proposed an open-carry law that was opposed by parents, physicians, pastors, police officers, public-health officials — just about everybody. It passed anyway. Whatever flickers of hope that Governor Lee’s call for a special session on gun safety may have stirred in 2023, the special session he convened last week inspired no such illusions. Outside the statehouse, as before, hundreds of students were chanting “Not one more!” and “Students, united, will never be divided!” But this time the governor was in lock step with his hard-line supermajority. Progress was never even an option. This special session was also concerned with schools, but not to make them safer. This time the governor wasn’t urging legislators to pass a red-flag law. This time he was cravenly using the urgent need to pass disaster relief for East Tennesseans affected by Hurricane Helene as a way to ram through the kind of school-choice and immigration legislation favored by President Trump. Equally horrible bills are being considered by statehouses across the South. Tennessee legislators allocated $447 million to get the voucher program up and running this year, but the program is designed to grow. At least one Republican legislator, Representative Jody Barrett, expects costs to balloon to $1 billion a year within a decade, even though most students currently enrolled in a voucher pilot program did not perform as well as students in public schools did. Little wonder, then, that vouchers in general don’t enjoy wide public support. Last year Kentucky voters — who, unlike Tennesseans, were given a chance to weigh in — soundly defeated a voucher measure in their state. Here in Tennessee, Governor Lee failed to corral enough Republican legislators to pass a voucher bill just last year. But political intimidation and heavy spending by out-of-state special interest groups changed the outcome this time. In a state where public schools are chronically underfunded, Tennessee is about to spend nearly half a billion public dollars to launch a program that will benefit mainly students already enrolled in private schools. The State House minority leader, John Ray Clemmons, a Nashville Democrat, called the voucher law “the best scam that money can buy.” Representative Bo Mitchell, also a Nashville Democrat, referred to it as the “Gov. Bill Lee Private School Voucher Bribery Scam Subsidy Act.” The special session’s new immigration legislation, meanwhile, is almost certainly unconstitutional: By making it a felony for local elected officials to vote in favor of “sanctuary” policies for immigrants, the law will make it harder for Tennesseans of conscience to protect diverse communities like Antioch, which has a larger Latino population than any other Nashville neighborhood. Think about that for just a minute: This law will turn elected officials into felons, and will remove them from office, when they merely vote for a policy that Republicans oppose, never mind that their own constituents elected them to do that very thing. The American Civil Liberties Union has already vowed to challenge the law in court. The Tennessee General Assembly has never cared whether its constituents support the laws it passes, and it doesn’t care now. We are on our own. With no legislative help in keeping guns out of the hands of dangerous people, the Nashville school system is piloting a new weapons-detection system at Antioch High School. We can only pray it’s more effective than the earlier system was. But it will not bring back Josselin Corea Escalante. Josselin, who celebrated her quinceañera in 2023; Josselin, who played soccer and made good grades and loved her family; Josselin, whose parents sought asylum in this country to keep her safe from violence, is gone. A GoFundMe page notes that her family will send her body back to Guatemala, “where she can rest in peace surrounded by loved ones.”

Over the last few months, University of California officials have boasted that they have admitted the most racially diverse class ever to their sprawling system. They have managed to do this, they say, despite a 28-year-old state ban on considering race in college admissions, known as Proposition 209. But a lawsuit filed on Monday by a newly formed group takes aim at the university’s efforts, accusing the California system of cheating by secretly restoring race-conscious admissions in defiance of the state law. The group, Students Against Racial Discrimination, was organized by a persistent critic of affirmative action. The lawsuit accuses the California system of harming all students by gradually bringing back racial preferences in recent years to stem public outrage over the low number of Black and Hispanic students at the state’s top universities. Stett Holbrook, a spokesman for the University of California system, said the university had not yet been served with the legal papers, so it could not reply directly to the lawsuit. But he said that after the ban, it had adjusted its admissions practices to comply with the law, and it collected undergraduate students’ race and ethnicity for statistical purposes only, not for admission. Students Against Racial Discrimination was founded last fall by a group that includes researchers and Asian American anti-affirmative action activists. Among them is Richard Sander, a law professor at the University of California, Los Angeles, who has made something of a crusade of fighting affirmative action. The group’s approach emulates the strategy of Students for Fair Admissions, the organization that defeated Harvard and the University of North Carolina in the landmark 2023 Supreme Court ruling that rejected affirmative action in college admissions nationwide. The lawsuit accuses the University of California system of violating protections against racial discrimination in Title VI of federal civil rights law and the Equal Protection clause of the 14th Amendment. It asks the court to order the U.C. system to select students “in a color-blind manner” and to appoint a court monitor to oversee admissions decisions, to “eliminate the corrupt and unlawful race and sex preferences that subordinate academic merit to so-called diversity considerations.” Last month, the U.C. system reported that Black undergraduate enrollment was up by 4.6 percent and Latino enrollment by 3.1 percent across the 10 campuses. It contrasted those increases with the many other universities that have struggled to maintain Black and Hispanic enrollment in the wake of the Supreme Court decision.Over nearly a decade, the data show a steady but small rise in African American freshman admissions systemwide — to 7,139, or 5 percent, for the fall of 2024 from 4,358, or 4 percent, in 2016. The percentage of Hispanic students has also risen slightly, from a much bigger base. (About 6 percent of Californians are Black and 40 percent are Latino.) The university said it had increased undergraduate enrollment overall and the diversity of the incoming class last fall by capping out-of-state enrollment and through funding support from the state, especially at the most in-demand campuses. It also targeted recruitment and college preparatory courses at disadvantaged students and eliminated the SAT and ACT testing requirement. John Aubrey Douglass, a senior research fellow at the Center for Studies in Higher Education at Berkeley, said that while he was not an insider on admissions practices, “my sense is that admissions is highly regulated and careful to stay clear of Prop 209 restrictions, and the Supreme Court’s ruling on affirmative action.” Much of the increase in enrollment can be explained by the demographic pool of applicants, and their growing readiness for college as they take required courses and as their high school graduation rates increase, he added. California voters adopted Proposition 209, which banned the use of race in admissions at public universities in the state in 1996, becoming the first of nine states to take similar action.The first class at Berkeley’s law school after Proposition 209 was approved had only one Black student, and he had been admitted before the referendum. The situation at Berkeley was so dire that it became the topic of a “Doonesbury” cartoon, in which Joanie Caucus, a Berkeley law graduate, arrives at her reunion to be told that not much has changed except, “Well, we no longer admit Black people.” Dr. Sander said in an interview that he believes that Berkeley reverted to race-conscious admissions almost immediately. If so, the impact has been small. The number of African American freshmen admitted to Berkeley has risen to 683, or 5 percent, in the fall of 2024 from 464, or 3 percent, in 2016. Janet Gilmore, a spokeswoman for the system’s flagship, the University of California, Berkeley, said the institution was complying with the law. “U.C. Berkeley is committed to admitting and enrolling the best and the brightest students and we do so in compliance with all state, federal and university policies and laws,” she said. In the fall of 2006, a decade after the passing of Proposition 209, only 96 of the 4,800 freshmen expected to enroll at U.C.L.A. were Black, the lowest figure since 1973. Twenty of those were athletes, according to a front-page article at the time in The Los Angeles Times. The Black students became known as “the infamous 96,” and administrators blamed the situation on the ballot measure. (Four more Black students were admitted on appeal.) U.C.L.A. also buckled to public outrage, the complaint says. U.C.L.A. referred questions about the case and its admissions to the larger university system. In the lawsuit filed on Monday, the complaint cites Tim Groseclose, a member of a faculty oversight committee for U.C.L.A. admissions during that period, who said U.C.L.A.’s chancellor had made admissions more subjective. Dr. Groseclose, now a professor of economics at George Mason University, believed that “this new policy became a subterfuge for reactivating racial preferences in admissions,” the complaint says. Dr. Sander argues that affirmative action is detrimental to Black and Latino students who are less prepared and struggle academically. His theory, known as “mismatch,” argues that students will do better on measures like grades, persistence in science and math and graduation rates at a college that better matches their preparation. The complaint says that the system has become more and more guarded about such data, shutting down websites that provided it. But many experts have disputed the mismatch theory, especially after Justice Antonin Scalia commented in 2015, during oral arguments in an affirmative action case at the Supreme Court, that Black students might be better off going to “slower-track” colleges where they could succeed. Matthew Chingos, then a vice president of the Urban Institute, challenged Justice Scalia’s comments at the time. Research has shown that students with similar credentials who attend different colleges are more likely to graduate from the more selective colleges, Dr. Chingos noted. And his analysis found that the mismatch conclusions were based on “at best very weak evidence for this claim and no evidence of any connection to affirmative action policies.” The complaint filed on Monday allows that “the effects of Proposition 209 upon U.C. and its students were complex and are still debated by academics.” And the evidence it offers is sometimes contradictory. To bolster the point that the system is cheating, the complaint says statistical analysis shows an improbable parity between the Black and Hispanic admission rates and the overall admission rate. And it says that Dr. Sander’s analysis of publicly available U.C. law school data shows that Black students with relatively low LSAT scores and grade point averages have 10 times as good a chance to be admitted as a white or Asian American student with similar credentials. But the complaint also notes that Black and Latino graduation rates across the system were “much higher” in 2006 than in 1998. It argues that is because students “cascaded” down to lesser colleges where they could compete. And it concedes that there were other factors at play that could explain the increase in Black and Hispanic students — not that they were being favored in the admissions office, but that more were applying and getting in as the university system responded to Proposition 209 by putting more resources into helping them.

On his first day back in office, President Trump ordered a sweeping 90-day spending freeze on almost all U.S. foreign aid, initially making exceptions only for military funding to Egypt and Israel and emergency food aid. The “stop-work order” in the directive had immediate consequences for people’s health and wellbeing. HIV clinics around the world funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), a highly successful aid program launched by George W. Bush that has saved more than 25 million lives, had to cancel appointments and turn patients away. Two-thirds of the staff of the President’s Malaria Initiative—the world’s largest funder of malaria control programs, also founded by George W. Bush—have been fired. Humanitarian assistance programs in Gaza, Sudan, and Syria that provide services like clean water and cholera treatment were halted. Oxygen supplies are no longer reaching health facilities in some low-income countries. Funding was frozen for critical disease control programs that prevent and treat a range of deadly infectious diseases, including malaria, Marburg virus, mpox, and tuberculosis. In Zambia, distribution of life-saving medical supplies to treat childhood diarrhea and bleeding in pregnant women came to a stop. At one U.S.-funded hospital in the Mae La refugee camp on the Thai-Myanmar border, 60 patients were sent home. “It feels like one easy decision by the U.S. president is quietly killing so many lives,” one of these patients, who has tuberculosis, told the New York Times. He was sent home with only one week’s supply of medicine and has no other way to get treatment when the supply runs out. Read More: I’m a Veteran. Trump’s Trans Military Ban Betrays Our Troops Restoring a city’s charm Branded Content Restoring a city’s charm By China Daily Last week, the distressing reports of people being denied their HIV medicines led Secretary of State Marco Rubio, who oversees U.S. aid, to issue an emergency temporary waiver that—in theory, at least—allowed U.S. aid to be used to pay for HIV antiretroviral medications. But there was a huge amount of uncertainty about what this waiver covered. Colleagues in low- and middle-income countries who provide HIV services funded by PEPFAR say that they were instructed to stop work and that the language of Secretary Rubio’s waiver was too vague to have any meaningful impact. Facing pressure to clarify the confusion, on Feb. 1, 2025, the Department of State issued a memo saying that the waiver covers HIV treatment as well as services for preventing transmission of HIV from mother to children—but not other kinds of preventive services. While these waivers are welcome, they are narrow in scope and temporary, and they do not do enough to overcome the confusion, disruption, and paralysis in U.S.-funded health programs worldwide. It is true that many low- and middle-income countries are working towards increasing their own domestic spending on health so that they become less aid dependent, and that aid donors, including the U.S., have signaled their support for such a transition out of aid. PEPFAR, for example, in its latest 5-year strategy, commits to helping countries mobilize domestic financing and gradually increase country ownership and management of their national HIV control programs. But the key word here is “gradually.” Sudden shocks, like freezing aid overnight, do not accelerate the transition process; they blow it up and can cause disease resurgence. Read More: A Study Retracted 15 Years Ago Continues to Threaten Childhood Vaccines There is now a wealth of research evidence and real-world experience on how best low- and middle-income countries can transition out of aid and take over the funding of their disease control programs in a way that is careful, safe, well-planned, and unhurried. The process typically takes around a decade or more, during which countries spend an increasing amount of their own domestic resources on these programs, year on year, so that they don’t face a sudden spending cliff when the donor exits. Managing donor exits well is critical in order to maintain the remarkable gains that have been made by countries, with the support of aid donors, in controlling deadly infectious diseases over the last few decades. These gains are fragile; in places where there is still ongoing transmission of an infectious disease, disease control programs must be maintained and never interrupted. The reason that transition is done slowly and carefully is that countries need adequate time to get their health delivery systems and their finances strong enough to fully take over these programs. Sudden, chaotic withdrawal of aid is the worst kind of interruption—one that puts lives on the line. To see what happens when aid donors withdraw their support precipitously, we only need to look at what happened in Romania when two donors exited simultaneously. In 2010, the Global Fund for AIDS, Tuberculosis and Malaria—the world’s largest multilateral donor to HIV programs—rapidly departed from Romania, with no plan put in place for the Romanian government to fund or take over HIV prevention services. Romania was a so-called “first wave” transition country; it was in the group of countries that first lost support from the Global Fund. As we noted in our study on donor transitions from HIV services, withdrawal of the Global Fund from Romania “left a significant gap in financing for HIV prevention activities that was not covered by the government.” The Global Fund’s exit was compounded by the simultaneous withdrawal of funding from the United Nations Office on Drugs and Crime, an aid donor that had previously supported HIV-prevention efforts among people who inject drugs, such as needle and syringe exchange programs. The double whammy of two donors withdrawing their aid was catastrophic. HIV prevention and treatment services in Romania for vulnerable populations—sex workers, men who have sex with men, and people who inject drugs—collapsed, and the HIV prevalence shot up quickly. For example, among people who inject drugs, HIV prevalence rose from 1.1% in 2009 to 6.9% three years later; by 2013, 53% of this population had HIV. Read More: Why We Need to Remember the Physical Effects of Polio We can also look to see what happens when funding for malaria control programs is halted in places where there is still ongoing transmission. In a study we published in 2012, we looked back through history to identify all episodes of malaria resurgence. We found 75 resurgence events in 61 countries that occurred from the 1930s through the 2000s. The most important finding of our study was that almost all of the resurgence events—68 out of 75—were due at least in part to weakening of the malaria control program. The most common reason for this weakening was a disruption in funding. The message is clear. Trump’s sudden disruption to funding disease control programs worldwide will wreak havoc. When people stop taking HIV medicines, they don’t just become sick; their HIV viral load also rises, which can drive disease transmission. The New York Times reports that in Uganda, aid workers estimate that about “40 newborns contracted HIV per day when the U.S. stopped funding for antiretroviral drugs.” Sudden treatment interruptions can also cause the rise of drug-resistant HIV strains. If a patient develops a resistant strain, then they will not be able to go back on the same HIV drugs as before. They will need different, more costly second-line medicines. Make no mistake: freezing U.S. health aid is the opposite of a well-managed, careful transition out of aid. It puts people at risk of illness and death and risks diseases raging out of control.

If you've tried to schedule a doctor’s appointment recently, you might have had to flip your calendar to a different season. There simply aren’t enough physicians in the U.S.: By 2037, the deficit is expected to reach 187,130 doctors, including more than 8,000 cardiologists and 4,000 nephrologists. That means patients routinely wait a long time—an average of 38 days, according to some data—before they’re able to snag an appointment with a doctor they really need to see. “People are constantly trying to get in to see doctors,” says Dr. Gerda Maissel, a physician in New York’s Hudson Valley who works as a patient advocate and helps people navigate the health care system. She once worked with a man who wanted to see a specialist at a major academic center about his worsening neurological disease. After he accepted an appointment 10 months down the road, “he and his wife were just beside themselves,” she recalls. “He had a tremendous need, and the academic center was just like, ‘Yeah, sorry, everybody wants [that specialist].’” Thousands of different versions of that story unfold every single day for patients across the country, she says. Long waits for necessary care can add emotional distress during an already stressful time—plus, of course, open the door to symptoms that aren’t caught or treated in time. Fortunately, patients can sometimes take steps to get in sooner. We asked experts to share their favorite hacks to see a specialist as soon as possible. Find out if the office has multiple locations Many doctors see patients in a variety of locations—some of which are busier than others. Always ask for the wait time at alternative locations, advises Sara Mathew, associate director of research and operations administration at Weill Cornell Medicine, where she leads the surgery department. Mathew thinks about health-care wait times constantly, both as an administrator and as a patient, and has found traveling slightly farther away can be helpful. When she recently tried to schedule an OB-GYN appointment in Manhattan, for example, she was told the next available slot was a year out. So she asked if there was anything available sooner—and the doctor’s office told her that if she was willing to travel to the Upper West Side instead of the East Side, she could be seen in two months. Flexibility is your friend when you’re in a hurry to see a doctor. Make sure you’re on the cancellation list Not every medical office automatically adds patients to the cancellation list. If you want to be notified if an earlier appointment opens up, let the receptionist know—and make it a point to flag that you could drop everything and be there with little notice, if that's in fact the case, says Christina Robertson, a regional director for Reproductive Medicine Associations, where she oversees the patient scheduling team. “Ask their percentage of cancelled appointments,” she suggests, as well as whether those cancellations usually happen the same day or a few days in advance. That information can help set your expectations. Read More: 8 Symptoms Doctors Often Dismiss As Anxiety If the office where you’re trying to get an appointment doesn't have a cancellation list, call and check in frequently. “I knew somebody who called every day,” Maissel says. You run the risk of annoying the scheduler, she acknowledges, but you’ll also stay front of mind. “It’s communicating what you would like, and if you're not quite getting it, then nicely popping up again and asking for it.” Ask your referring doctor to call on your behalf Depending on the severity of your situation, your primary care physician or other referring doctor could make a call on your behalf. Sometimes, that extra step will encourage the specialist’s staff to squeeze you into the schedule, which might mean before or after typical clinic hours, Mathew says. “I wouldn’t abuse that for every kind of diagnosis,” she says. “But if you went for a routine GI checkup and they noticed something on your gallbladder or colon, and there’s a possibility it could be cancer, find every way to get in faster. You definitely want to know if you have something like that sooner, so you can be treated faster.” Make a personal plea Nicoletta Sozansky’s daughter was born needing life-saving surgery, which she received in Florida. When the family returned to their home in New Jersey, they wanted their daughter to see a pediatrician who specialized in complex care. None of the doctors they shortlisted were accepting new patients—or, they had impossibly long wait lists. So Sozansky, a patient advocate and founder of the concierge health care navigation company Healthcare Redefined, called each doctor’s office and requested to speak to a practice manager. These staffers tend to be empathetic, she’s found, and are more inclined to offer empty slots to people they’ve connected with on a personal level. Read More: Long Dismissed, Chronic Lyme Disease Is Finally Getting Its Moment After introducing herself, Sozansky asked if she could write an email to the specialist, explaining her daughter's medical history and making the case for an appointment that wouldn't require waiting many months. It worked: “This letter opened the door to every pediatrician we reached out to,” she says. “From what I've experienced, doctors who are treating complex cases like your stories. They like a challenge.” Be clear about your needs When you’re trying to schedule an appointment, clearly state whether you’re seeking a new diagnosis or already have one and are looking for treatment or a second opinion. Diagnostic appointments tend to be more time-consuming, Sozansky says, so it might be easier to grab an appointment if you simply need to start a treatment plan. It took her years to be diagnosed with mast cell activation syndrome, for example, but once she knew what she was dealing with, appointments became much shorter and more readily available. “When I was switching from one doctor to another, the helpful thing was that I already had the diagnosis, and I could say, 'Hey, I would love to get on the schedule,’” she says. “It’s much easier to convince the front desk.” Consider providers who aren’t doctors Keep an open mind about whether you’re willing to see another type of provider—like a nurse practitioner or physician's assistant—who typically has greater availability. Every office works a little differently, Maissel says: In some, these providers are “very much like an extension of the physician,” she says. They’ll collaborate closely with the doctor to figure out how to best treat you. In other offices, they operate more independently. Read More: What to Do If Your Doctor Doesn’t Take Your Symptoms Seriously “In general, if I have to choose between waiting six months or seeing the NP next week, I’m going to see the NP next week,” she says. “And then I’m in the practice, and if I make friends with that NP, I can say, 'I'm really worried about this thing that you've told me you're not sure about. How do I get in to see Dr. Jones?’” The nurse works with the doctor every day, she points out, and has insights into their schedule—which means they could help facilitate more rapid care. Plus, providers like physician’s assistants can get crucial testing started, Maissel adds, and often have more time than physicians to spend addressing your needs. Ask the receptionist for their ideas If the next available appointment requires an unbearably long wait, politely tell the scheduler instead of hanging up the phone and grumbling, Maissel advises. “It’s fine to say, ‘Oh, gosh, that’s too far out,’” she says—but be mindful of your tone: “It’s not exactly what you say; it’s how you say it.” Barking at the scheduling team won’t do you any favors. But if you make it clear that you know the lack of appointments isn't their fault, you might find they're willing to brainstorm with you. Ask them if they have any suggestions, she suggests, and perhaps they’ll recommend calling a different office or will identify another doctor with more availability. “Most people want to be helpful,” Maissel says. “Most people in health care are there because it’s a mission-driven thing to do.” Be nice Not being able to see a doctor as quickly as you want to—or need to—can feel maddening. But it’s essential to not let your emotions get the best of you when you're trying to schedule an appointment. “Be nice to the scheduler,” Maissel urges. “Despite what they say, they may have a little bit of discretion—so you want them to know, like, and think of you.” Asking how their day is going, and remaining positive while you talk, can go a long way. And remember: Physicians are typically doing their best to see as many patients as possible, as quickly as possible. Some are simply so specialized that they’re in impossibly high demand. “It is truly hard to accommodate," Mathew says. “I rarely see any of our surgeons sitting. They don't end up taking lunch, and they see as many patients as they can. Just be mindful, and explore the possibilities.”