As the lead U.S. agency for international development and humanitarian assistance, USAID has played a key role in the United States’ international efforts to prevent and respond to the COVID-19 pandemic and mitigate its profound public health, economic, social, and development effects. One of USAID’s main interventions in the fight against COVID-19 has been the provision of ventilators to over 40 countries at an obligated amount of approximately $204 million. Prior to the start of the ventilator donation program in April 2020, USAID followed its customary practices in determining how it would respond to COVID-19 in accordance with the State Department-USAID joint strategy. However, the ventilator donation program significantly differed from USAID’s customary practices for responding to public health emergencies. Specifically, the decisions for donating ventilators abroad—including National Security Council decisions for determining recipient countries, how many ventilators to send, and which suppliers and models to use—did not align with the Agency’s initial COVID-19 response planning. We are making no recommendations because the ventilator donation program has been completed and there are no current plans to donate more ventilators abroad.