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I have trouble taking the USAID crying seriously. If people really, truly cared about the pullback in aid they would do what they could to fill the gap. The Clintons, Obamas, Pelosis et al have a standard of living most of us can only dream of. Are they sacrificing their luxuries to save these people they are crying about? No. And they'll excuse it by saying a government org can do more blah blah. You know what? When I really care about something, I do what I can about it. I don't throw up my hands and say why bother because I can't do as much as some other way.
It leaves me thinking it's all a bunch of lies. Which is a shame. Because I think some of the programs were good, even if they don't hit my top concerns. So how stupid am I to think the programs were good if people living seriously luxurious lives can't even give up their caviar in order to help fill the gap?
Musk deliberately implemented the cuts in a way which made that almost impossible in the short term. None of the named individual victims identified by Kristof could have been saved by someone taking over funding - they all died because of the chaotic way in which USAID was shut down. If you remember Musk's bragging at the time, the point wasn't just to cut spending - it was to feed the agency into a woodchipper and create psychological distress in the staff. That had consequences, which were intended, and the people who did it are responsible for what they did. (Clearly the number of people who died specifically as a result of Musk's intentional cruelty is much lower than the big numbers being slung around, but Musk continues to insist that it is zero and threaten legal action against people who disagree). I will enjoy the schadenfreude if the screwworms get him. I will not enjoy the schadenfreude if (as is more likely) all they get is a bunch of normie Texas ranchers who voted for the Face-Eating Leopard Party.
The Clinton Foundation is sufficiently notorious that one might suspect bad faith. It wasn't their own personal money, but Bill Clinton spent most of his time since leaving office fundraising and organising charitable work, either through the Clinton Foundation or through his partnership with George HW Bush. The most visible programme the Clinton foundation ran was providing AIDS drugs to kids in Africa - so the Clintons were doing precisely the thing you blithely assume they were not doing.
The Obama's and Pelosi's considerable charitable donations (hundreds of thousands of dollars annually in both cases) are also a matter of public record that I was able to find with 30 seconds googling. Obama focussed on US domestic poverty and providing scholarships for poor kids. (Like most ex-Presidents, Obama moves far more dollars by fundraising than he can donate himself - but that is just being effective in your charitable work). Paul Pelosi focussed on the usual arts and elite universities bougie philanthropy bullshit.
Actual excess deaths appear to be something in the ballpark of zero. This is probably why Nicholas "Dog Rape" Kristoff used anecdotes.
Screwworm has been a growing problem, creeping closer for years, almost certainly linked to the Biden migrant wave. The US under Trump is putting more effort into combatting it, including building a second sterile-male production facility.
That's... not likely. And, conversely, the >100k numbers are not remotely plausible.
PrEP excess deaths didn't happen and couldn't happen yet, in bulk. That's just not how the disease works. The higher-end plausible estimates give between 200k and 400k excess undetected infections, but it takes several years for a healthy adult to progress into full disease, and that's assuming compliance and decision-making that you just don't see in this space: more realistic numbers are <10k. Very young children can get sick fast, but they had the clearest and earliest waiver, and immediately after birth the recommendation is ART, not PrEP.
ART excess deaths could happen. People who are otherwise perfectly healthy who disrupt ART can last some time before having serious medical consequences, though viral load and T-cell function tends to get hit pretty early even there. But people who have other viral diseases (especially tuberculosis) or who had very low T-cell function to start with (eg, due to fairly progressed AIDS before start of treatment) rebound much worse, and much faster. That's a relatively small number of total cases, but it's still a lot of people in absolute numbers. In a perfectly naive frictionless-cow world, the academic number is a 1.6x multiplier on top of the normal death rate, for those people who were disrupted, assuming a three-month freeze; extend this over a year and you get closer to 2x as you start running out of the really-sick people. So find the number disrupted, get an approximate base death rate, multiply, and you've at least got a Fermi-Estimate level answer. Not great, nothing I'd write in stone, but at least reasonable.
The trouble's actually figuring out those values.
The highly-publicized analysis tend to assume some portion of people were wildly disruptive based on multipliers pulled from a hat, or in proportion for what HIV programs that PEPFAR or USAID funded. If you read that carefully, you'll notice a problem: ART isn't the only HIV program PEPFAR/USAID funded, nor was PEPFAR/USAID the only source of those programs, nor was everything disrupted. The worst models just assume that basically everything turned off. Some just assume that there's zero ART initiations during the PEPFAR freeze; others assume that existing ART users would be dropped in proportion to PEPFAR spending.
Neither assumption is remotely plausible across all countries: South Africa in particular needed the least PEPFAR support for its existing ART clinics, but even the worst-impacted locations just didn't end up with degree of disruption that even self-described 'light' or 'moderate' disruption models did. There were substitution effects, there was preservation of funding toward higher-priority focuses, and there were successful detection of new cases. The highest-plausible bounds for the actual disruption period is closer to 40k than 600k; a realistic bound is somewhere between 2k and 20k, and that's including excess mortality since the disruption 'officially' ended.
Kristoff might still be making up the names and events -- he is a putz -- but I don't think there's any plausible model without at least low three-digit excess deaths from the initial freeze to today. That’s separate from the questions of whether it ties to moral culpability or utilitarian analysis
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Given the inaccuracy of African demographic statistics, "something in the ballpark of zero" and "100,000 dead kids across the countries where USAID used to operate" are compatible. The numbers in the millions are not plausible given the lack of a visible macro-demographic effect.
Sure. But that same logic also applies to all positive claims that USAID was doing good.
Exactly. I'm sure that making such a large change probably technically killed >0 people, but I also feel that massive amounts of USAID funding had been commandeered over the years on absolutely massively exaggerated claims of efficacy and 'We cut programs that claimed to keep millions of people alive' =/= 'They were keeping millions of people alive and they instantaneously died'. An organism of that size is going to have a large amount of ineffective altruism (even if it's actually attempting to be Altruistic as opposed to a political slushfund) and the galaxy brain takes that every single dollar that USAID spend was equally effective in saving lives and there was no marginal benefit fall off is inherently silly.
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