Loaded for Bear: 100-plus deaths an hour — the toll of Trump’s gutting of Pepfar and USAid

29 Apr 2025

Pepfar was a game-changer and a lifesaver, which had also boosted Africa’s economic development. Now lives are being cruelly lost because of its termination.

One hundred and three deaths per hour: that is the human toll triggered by the Trump administration’s gutting of the US President’s Emergency Plan for Aids Relief (Pepfar) and USAid, according to an impact dashboard devised by Brooke Nichols, an infectious disease mathematical modeller and health economist at Boston University.

That is 2,472 deaths a day. The elimination of Pepfar and USAid is eliminating African lives.

“This dashboard visualises the human impact of funding changes for aid and support organisations. Each metric represents real people affected by policy decisions,” the dashboard says.

Updated calculations of mortality increases linked to the slashing of US-funded programmes on the tropical health front are provided on this digital platform.

Pepfar – arguably the only noble legacy of the George W Bush administrations – was launched in 2003 with strong bipartisan support and is credited with saving 26 million African lives since its inception.

Pepfar also funded clinics that provide screening and treatment for cervical cancer, which is linked to HIV infections in women. It has been a game-changer and a lifesaver. And now lives are being cruelly lost because of its termination.

“After pausing all foreign aid assistance by executive order on Inauguration Day, the administration permanently cancelled 83% of USAid’s global contracts just weeks later – a decision that public health experts warned would lead to preventable deaths and accelerate disease spread,” Boston University said on its website in late March.

“If this foreign aid is not restored before the end of 2025, more than 176,000 additional adults and children around the world could die from HIV.” A further 62,000 are likely to die of TB.

‘When I get mad, I do math’

Nichols, the professor behind this initiative, was spurred to action by the callous cutting of these lifelines to the poor and vulnerable.

“When I woke up and read the news about the executive order, I was horrified and really mad. And when I get mad, I do math,” Nichols was quoted by Boston University as saying.

There are endless debates about the effectiveness of international aid to Africa, and it is useful to view this wood chipper approach to US health initiatives through that prism.

In 2009, Zambian economist Dambisa Moyo stirred a hornet’s nest with her book, Dead Aid: Why Aid is not Working and how there is Another Way for Africa.

“... has more than $1-trillion in development assistance over the last several decades made African people better off? No,” she wrote in her scathing assessment. “Aid has helped make the poor poorer, and growth slower.”

There are many valid criticisms of aid. These include the culture of dependency it can foster, the distorting of incentives to goad governments to expand their tax base and grow their economies, and the vast amounts that are simply squandered.

How many big, air-conditioned Toyota SUVs are being driven around Africa by aid workers? Answer that question, and you will have an idea of how Japanese aid subsidises Japanese industry.

But that does not mean that all aid is useless, ineffective or a sop to industries in donor countries. As I noted in this column in January, Pepfar has also been a force for good for Africa’s economic development and America’s standing on the continent.

Read more: If Pepfar is cut, the US and Africa will both lose and China may gain

One of the often overlooked reasons for Africa’s economic spurt from about two decades ago was the containment of the HIV/Aids pandemic. In the early 2000s, there were tons of ominous forecasts about its withering impact on consumer demand, the labour force, productivity and economic growth in South Africa and the wider region.

These dystopian forecasts have not come to pass, largely because of initiatives such as Pepfar. Indeed, HIV/Aids in Africa has mostly vanished from the radar screens of news and public discourse in recent years, and not simply because of the emergence of the Covid-19 pandemic.

Africa is almost certainly more prosperous with faster rates of economic growth because of this lifting of a crushing disease burden, which looks set to weigh on its prospects again.

TB is also a drain on development when its caseload reaches critical levels, and it has reclaimed its grim title as the world’s deadliest disease from Covid-19.

According to the World Health Organization, USAid until recently provided 25% of all global funding to address TB.

A cynic might say this elimination of health-focused aid will now force governments in Africa and other developing regions to cough up the funds needed to fill the void.

South Africa is a case in point. The ANC’s obsession with hiking VAT instead of cutting government fat underscores the fact that much wasteful expenditure could be channelled in far more useful and productive ways, including for public health outcomes.

It’s also possible that China might step in to fill the gap and boost its influence in Africa.

This will be a blow to US interests. Pepfar and other health-targeted projects funded by the US have been shining examples of effective aid, which has saved tens of millions of lives while boosting economic development – and American influence.

This is a searing indictment of the US Republican Party and the uncaring and menacing cult it has become under Trump, a man completely devoid of empathy.

The previous Republican president launched an initiative grounded in his evangelical Christian beliefs that prevented tens of millions of deaths. Now, more than 100 people are estimated to be dying every hour from preventable deaths because of the lethal policies unleashed by the current Republican president. DM

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‘When I get mad, I do math’