Edited to add: about eight hours after this post was written, Marco Rubio issued a waiver for programs providing “core lifesaving medicine, medical services”, allowing them to continue operating. This presumably includes PEPFAR, but this has yet to be confirmed (at time of writing, 9:16 AM GMT 1/29/25).
The Trump administration has paused all foreign aid. This includes PEPFAR, President's Emergency Plan for AIDS Relief.
This program was started by (Republican) President George W. Bush and in the last 23 years, has saved around 25 million lives. Over that 23 year period, it has cost about $110 billion dollars,1 or about $4400 per life saved. Currently, about 20 million people are on PEPFAR-provided anti-retroviral drugs.
Overnight, this has stopped. This is not just a pause on new drugs; clinics cannot disburse the drugs even if the drugs have already been obtained and are sitting in local clinics. People are going to clinics even now and being turned away.
As of last year, PEPFAR provided HIV treatment to about 750,000 pregnant women living with HIV. Perhaps 187,000 women that were being treated by PEPFAR are due to give birth during the three-month pause.
25%-40% of those women will give HIV to their baby.2 Since PEPFAR is paused for three months, those babies will not get treatment either. 35% of those babies will die within the first year, perhaps half of those within the first three months.
Let’s do the math here. At the low end, the three-month PEPFAR pause will result in around 4,100 babies dying.3 At the high end, it will result in 6,500 babies dying a completely preventable death.4
I can make all the national security arguments - that of course, the parents of these children will be much easier to radicalize5 against the US if they blame the US for their child’s death. But I don’t want to. It should be enough to say that many babies will die completely preventable deaths.
Those will not be the only PEPFAR deaths, of course. This doesn’t include all the recently born tiny babies, who can now get HIV from their mother’s breastmilk.6 Many of them will die, too.
Other adults - who aren’t pregnant or breastfeeding - won’t get their HIV drugs; some of them, too, will die. There will be thousands of new HIV cases, because people who are not being treated for HIV can now spread the disease.
There will be a last person that dies of AIDS - but every day PEPFAR is paused, that day is further in the future.
Or less than 0.1% of the federal budget. I’m relatively high income, so I pay a reasonable amount in taxes. A quick calculation suggests that I pay about… $40 a year for PEPFAR.
This may differ somewhat for mothers that have recently stopped HIV treatment, depending on how long it takes for viral load to rebound after cessation of treatment. Charles Kenny points that this period seems relatively short in HIV, around 20 days.
Assuming the distribution of births is flat over time and the average birth occurs 1.5 months into the pause.
An earlier version of this post had slightly higher numbers (5k-8k), but Charles Kenny pointed out an arithmetic error.
Many PEPFAR focus countries have active Islamist movements, such as Boko Haram in Nigeria and al Shabaab in Kenya.
Risk of transmission from breastfeeding is relatively high.