From dread to action: Tracking the Trump-Musk death toll from cuts to USAID

At the outset of the United States' freeze on billions of dollars in foreign aid, Brooke Nichols thought President Donald Trump would never cut funding to the President's Emergency Plan for AIDS Relief, a $6.5 billion program that supplies most of the HIV treatment drugs in low-income countries across the world. PEPFAR saves too many lives, the global health expert recalled thinking, he couldn't possibly touch it.

But the Trump administration soon did. Dread then set in.

"I immediately knew what the impact was," Nichols, a Boston University associate professor of global health and infectious disease mathematical modeller, told Salon in a video call. "If you don't have that funding, and it just disappears overnight, people die."

Nichols said she wracked her brain over how she could make clear to others just how devastating the cuts to U.S. foreign aid would be for the world. How could she impart how outrageous the Trump administration's decision was — and how outraged everyone should be?

Then an idea came to her during a run: create a model tracking the human impact, including the inevitable increase in HIV/AIDS infection and transmission and the subsequent rise in otherwise preventable deaths. HIV response research was one of her first professional focuses when she got her start in 2008, so the effort came naturally, the Amsterdam-based mathematical modeler said.

The first version of her model, now a web dashboard focused on multiple diseases called the Impact Counter estimating the death tolls caused by the funding freezes, terminations and the effective elimination of the U.S. Agency for International Development, would go live on Jan. 28. The hope, Nichols said, was that it would resonate with others and galvanize them to advocate for the government to change course.

"I hope that people can feel the numbers because I know there's a subset of people that understand and 'feel' numbers, that these are people," she said. "To a lot of people, numbers are just numbers, and without stories around them, it's really hard to engage with what those mean. But because I'm a numbers person, I'm speaking to the numbers people, and I hope that all the people that visit the site or engage with the work can feel the gravity of what's happening."

On the first day of his presidency, Trump signed an executive order establishing a 90-day, program-by-program review of foreign assistance programs to determine which would continue, bringing funding for foreign assistance to a screeching halt. Elon Musk's Department of Government Efficiency also forced out the majority of USAID employees, reducing its staff to just 15 legally required positions and folding it into the State Department as part of the administration's concerted effort to shrink the size of the federal government.

Aid organizations dependent on U.S. funding felt the fallout immediately, including largely successful programs that contained outbreaks of Ebola and saved more than 20 million people through HIV and AIDS treatment. Musk and Trump have both characterized USAID projects as a waste of money that push a liberal agenda.

As of Friday afternoon, the Impact Counter estimates that the funding discontinuation and terminations will result in 70,856 adult deaths and 147,852 child deaths at a combined rate of 103 deaths per hour. The PEPFAR-related counters, which reflect the number of adult and child deaths to date since funding disruption earlier this year, estimate nearly 40,000 additional adult HIV deaths and just over 4,000 additional infant HIV deaths. Those numbers are projected to reach nearly 159,300 and 16,954 deaths, respectively, after one year.

In the face of such anticipated loss at the hands of her native government, Nichols said she's battling a "general feeling of powerlessness" not unlike other Americans, particularly those on the left. But she said creating the Impact Counter is her way of attempting to fight back.

"I found that this is something I can do that I hope has even the tiniest impact on either giving other people the tools that they need to speak about what's happening, [or] even as futile as it might feel, to call their representatives," she said.

Nichols' calculates the estimates from previous research on how changes in policy regarding treatments of infectious diseases or aid distribution affect health outcomes, like deaths or transmissions. A separate tab on the website breaks down the methodology behind the projections for deaths from HIV/AIDS, malaria, tuberculosis, neglected tropical diseases and other categories.

Once Nichols created the initial model estimating the death toll from the PEPFAR funding freeze, she reached out to colleagues, angered by what felt like the impending carnage. One suggested she publish her estimates online so that others could understand the consequences. Nichols then set out to build a website.

After an unsuccessful attempt at HTML coding, she tapped Eric Moakley, a friend and Amsterdam-based product manager, to help her create the dashboard. Nichols' text came in around 4:30 p.m. local time while Moakley was on his regular bike ride home and, with the help of AI, the site went up an hour later.

Moakley told Salon that prior to assisting Nichols with website development, he wasn't familiar with the intricacies of how the U.S. distributes foreign aid and who it helps. In some ways, he was the first non-academic her estimations reached.

"Even with AI helping, there's no way you can stare at the numbers that are on these sites, and not be moved and not be concerned," he said in a video call.

"I just wasn't as informed on that, so for me, I was going about my business, reading the news, reacting," added Moakley, who serves as the site's back-end technical resource. "But for Brooke, it was very real. These are people that she knows. These are causes that she's been driving, so it was nice to be able to help, to try and deliver an outcome for her and clarify it, and also do some good with a cause that I am aligned with but was less informed about the details of."

The 24 hours that followed were a whirlwind. Colleagues at the HIV Modelling Consortium reached out with an offer to rapidly peer-review the estimates and endorse their numbers. The website also saw heavy circulation, snapshots of the counters shared across social media platforms X, BlueSky and LinkedIn, as well as among government officials and workers.

Later on Jan. 28, just hours after the site went live, the State Department announced it would be issuing a waiver on its foreign assistance funding for life-saving medicine, medical services, food and shelter among other categories, a decision Nichols and Moakley want to believe their project played a part in motivating. Former and current USAID officials said earlier this year, however, that the waivers were functionally useless, with response teams dismantled and payments to partner organizations stalled.

The website has since undergone a number of expansions as Nichols' colleagues contributed modeling on estimated deaths from tuberculosis, malaria and other diseases impacted by the funding freezes, and site visitors wrote in with feedback on how to improve the projections or functionality.

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In particular, the PEPFAR tracker has seen more than 200 iterations, from minor changes to large updates. An early version of the site, for example, initially included a tracker of the financial return on PEPFAR funding — estimated at over $380 billion — to translate the value of the aid program into the financial terminology of the president's executive order. But Moakley said they removed that feature to maintain the focus on the human toll of the funding halts.

Impact Counter has received more than 65,000 visitors from nearly 200 different countries since it launched, Moakley said. The reception to the project has also remained largely positive, with Nichols noting that a majority of visitors use their outrage to advocate and others voice their appreciation for their work (though a small share writes in to tell them that they don't believe the numbers).

Months removed from the initial launch, the duo is working on hashing out what the future of their effort will look like. Nichols' has even enlisted a team of graduate student researchers in Amsterdam and postdocs to assist in reviewing the estimates.

More recently, they've developed a model projecting deaths and catastrophic costs from the proposed funding cuts to Medicaid after one year — more than 28,000 and 750,000 respectively — which is an addition Nichols said she hopes will appeal to viewers who may relate better to estimated impacts in the U.S. A group of more than a dozen professors at Boston University is also working with the pair to develop estimates around more domestic changes, with additions to the site expected in the coming weeks and months.

While Moakley said he'd like to strengthen the call to action the site will attempt to mobilize viewers around going forward, Nichols said she wants the initiative to hit home with U.S. officials, who most need to recognize how their actions are affecting people within the nation's borders and globally.

"I would want people to understand — even if they can't understand the gravity of the impact of what's happening abroad — the choices that they are making will ultimately lead to the deaths of their constituents," Nichols said. "They should, at the very least, care about that. And if they don't, they should be brave enough to say it."