At the start of the United States' freeze on billions of dollars in foreign aid, Brooke Nichols, a prominent expert in global health, initially believed that President Donald Trump would never cut funding to the President's Emergency Plan for AIDS Relief (PEPFAR). This $6.5 billion program is essential for providing the majority of HIV treatment drugs to low-income countries worldwide. Nichols, an associate professor at Boston University specializing in infectious disease mathematical modeling, recalled her thoughts: "PEPFAR saves too many lives; he couldn't possibly touch it." However, the Trump administration soon proved her wrong, leading Nichols to feel a profound sense of dread.
“I immediately knew what the impact was,” Nichols told Salon during a video call. “If you don’t have that funding, and it just disappears overnight, people die.” Faced with the reality of these funding cuts, Nichols struggled to convey the potential devastation to others. She pondered how to express the gravity of the Trump administration's decisions and the outrage that should follow. An idea struck her during a run: to create a model that tracks the human impact of the cuts, including the anticipated rise in HIV/AIDS infections and the resulting preventable deaths.
HIV response research has been a focus of Nichols' career since she began her work in 2008, making the project a natural progression for her. The initial version of her model, now known as the Impact Counter, serves as a web dashboard that estimates death tolls resulting from funding freezes, terminations, and the practical elimination of the U.S. Agency for International Development (USAID). The Impact Counter is set to launch on January 28, with the hope that it will resonate with others and encourage advocacy for a change in government policy.
“I hope that people can feel the numbers,” Nichols expressed. “To a lot of people, numbers are just numbers, and without stories around them, it’s really hard to engage with what those mean.” As a numbers person, Nichols aims to reach others who understand the gravity of statistics, hoping that visitors to the site will grasp the impact of the funding cuts on human lives.
On his first day in office, Trump signed an executive order that mandated a 90-day review of foreign assistance programs, effectively halting funding. This drastic decision had immediate ramifications for aid organizations reliant on U.S. support, including numerous successful programs that tackled outbreaks of Ebola and provided treatment for over 20 million people suffering from HIV/AIDS. The administration's efforts to downsize USAID, including the forced exit of most employees and the reduction of staff to legally required positions, have only exacerbated the situation.
As of the latest estimates from the Impact Counter, the funding cuts will lead to approximately 70,856 adult deaths and 147,852 child deaths—translating to a staggering rate of 103 deaths per hour. The PEPFAR-related estimates indicate nearly 40,000 additional adult deaths and over 4,000 infant deaths due to HIV, with projections suggesting these figures could soar to nearly 159,300 adult deaths and 16,954 child deaths within a year.
Confronted with such alarming anticipated losses, Nichols expressed a feeling of powerlessness that resonates with many Americans, particularly those on the left. Nevertheless, she views the creation of the Impact Counter as a means of resistance. “I found that this is something I can do that I hope will have even the tiniest impact,” she said, emphasizing the importance of equipping others with the tools needed to speak out or contact their representatives.
The estimates presented on the Impact Counter are derived from previous research that analyzes how shifts in policy regarding infectious disease treatments or aid distribution can significantly affect health outcomes, such as mortality rates or transmission rates. The website also features a separate tab detailing the methodology used to project deaths from HIV/AIDS, malaria, tuberculosis, and other neglected tropical diseases.
Once Nichols developed the initial model quantifying the death toll from the PEPFAR funding freeze, she reached out to colleagues who were equally outraged by the situation. One colleague suggested publishing her estimates online to raise awareness of the consequences. After a challenging attempt at HTML coding, Nichols enlisted the help of Eric Moakley, a product manager based in Amsterdam, to assist in creating the dashboard.
The website quickly gained traction, with the Impact Counter going live just an hour after Moakley helped finalize it. The response was overwhelming, with colleagues from the HIV Modelling Consortium offering to peer-review the estimates and endorse the findings. The site attracted significant attention, with snapshots of the counters shared widely across social media platforms like X, BlueSky, and LinkedIn, as well as among government officials.
Shortly after the launch of the website, the State Department announced a waiver for foreign assistance funding aimed at life-saving medicines and services. While Nichols and Moakley hope their project played a role in this decision, former and current USAID officials have criticized the waivers as ineffective due to dismantled response teams and stalled payments.
Since its inception, the Impact Counter has evolved, with colleagues contributing models estimating deaths from various diseases impacted by funding cuts. The site has welcomed over 65,000 visitors from nearly 200 countries, with most feedback being positive. Visitors have expressed outrage and appreciation for the work being done, even as a small fraction has questioned the accuracy of the numbers.
As Nichols and Moakley contemplate the future of their initiative, they have enlisted a team of graduate researchers and postdocs to assist in refining the estimates. They have even begun modeling projected deaths and costs associated with proposed cuts to Medicaid, which may appeal to viewers more familiar with domestic impacts. A group of professors at Boston University is also collaborating to develop estimates related to domestic policy changes, with plans for further site enhancements in the coming weeks and months.
Moakley aims to strengthen the site's call to action, while Nichols emphasizes the importance of making U.S. officials aware of how their decisions impact both national and global communities. “I want people to understand,” she said, “that the choices they are making will ultimately lead to the deaths of their constituents. They should care about that. And if they don’t, they should be brave enough to say it.”
