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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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