These estimates reflect excess deaths resulting from the US federal government’s discontinuation of USAID funding. Brooke Nichols’ impact trackers suggest that these deaths will continue to rise if USAID funding is not restored. Credit: Impact Counter.

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Tracking Anticipated Deaths from USAID Funding Cuts 

Brooke Nichols has launched online tracking tools that capture estimated increases in mortality and disease spread for HIV/AIDS, tuberculosis, malaria, and other diseases as a result of the near-total freeze in US foreign aid funding and programming. 

Over the last two months, the Trump administration’s slashing of US foreign aid and systematic dismantling of the US Agency for International Development (USAID) have severely disrupted the lives of populations abroad who rely on this funding for disease detection and treatment, nutrition assistance, and other vital public health services.

After pausing all foreign aid assistance by executive order on Inauguration Day, the administration permanently cancelled 83 percent of USAID’s global contracts just weeks later—a decision that public health experts warned would lead to preventable deaths and accelerate disease spread. 

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, according to excess death estimates from a new digital tracking initiative by Brooke Nichols, associate professor of global health. Her tracker also indicates that at least 62,000 additional people could die from tuberculosis (TB)—roughly one death every 7.7 minutes—if foreign aid does not resume by the end of the year, and these figures are steadily increasing.

These estimates are listed on Impact Counter, a real-time digital tracking website that Nichols utilizes to quantify the real-world human impact of the recent US policy changes on humanitarian aid. On the site’s dashboard, Nichols provides up-to-date calculations of increases in mortality, disease spread, and healthcare costs for HIV/AIDS, TB, malaria, pneumonia, diarrhea, neglected tropical diseases, and malnutrition. 

“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,” says Nichols, an infectious disease mathematical modeler and health economist whose research spans transmission dynamics, implementation modeling, and resource allocation, with a focus on infectious diseases and pathogens of pandemic potential. “I wanted to know the true cost of all of these actions. It’s human lives. This is not for political gain, this is about the lives of actual mothers, fathers, sisters, brothers, and kids.”

After receiving initial feedback from colleagues, Nichols consulted with Eric Moakley, a product development expert, to develop the tracking systems. They launched the PEPFAR tracker on January 28, just four days after the Trump administration announced a pause on all foreign aid. PhD students and postdoctoral researchers, including Joshua Chevalier (SPH’22), a graduate of the MPH program, then helped calculate the expected impact of several other diseases that USAID targets. Nichols discusses the project’s methodology in a recent commentary published in the Journal of the International AIDS Society. 

The Impact Counter platform links to individual tracking pages of the team’s estimates of increased mortality from TB and HIV/AIDS, the latter of which reflects drastic funding cuts to President’s Emergency Plan for AIDS Relief (PEPFAR), the bipartisan US global initiative that facilitates HIV testing, treatment, and preventive services in 50 countries. The program has been credited with saving more than 26 million lives since it launched under President George W. Bush in 2003. 

Meanwhile, TB has reclaimed its spot as the world’s deadliest disease (temporarily knocked down by COVID-19 in the last few years), and until recently, USAID had provided about a quarter of international donor funding to support TB services across the globe, according to the World Health Organization. 

Nichols and colleagues are also developing an impact tracker to highlight the human cost of possible funding cuts to Medicaid, as Congressional Republicans remain split on whether they should overhaul the major safety-net health insurance program to help pay for President Trump’s tax cuts and other proposals. Chillingly, Nichols’ modeling suggests that if Congress does restrict funding to Medicaid, an American will die every 18 minutes. 

All of the team’s modeling and calculations used within Impact Counter have been independently peer-reviewed. As there is likely a one-month lag between the beginning of the funding freeze and when additional deaths begin to occur, the excess mortality estimates reflect the net current impact of excess mortality, as well as the total excess deaths by year’s end should the disruption in aid continue.

Nichols hopes these trackers serve as a tool for both government officials and the general public to understand the devastating toll these foreign aid cuts will have on actual lives. “I hope that politicians and other people will continue to use these numbers to advocate for the funding freeze to stop,” she says. “If foreign aid is restored and these programs resume, we’ll stop the counters. 

“But in the meantime, I want outrage and action. Because this is awful.”

The PEPFAR impact counter actually launched just hours before US Secretary of State Marco Rubio issued waivers for life-saving humanitarian programs that would not be subject to the funding freeze and stop-work orders, including a subsequent limited waiver for PEPFAR to resume “urgent life-saving HIV treatment services” on February 1. But many USAID officials, aid groups, advocates, and even federal judges, claim that the administration has not adhered to these waivers, and has ignored multiple court orders to restore funding to these programs. In the latest court ruling, on March 17, a US district court judge ruled that the Trump administration likely violated the Constitution by withholding Congressional funding for USAID programs. While he declined to reinstate the thousands of canceled USAID contracts, the judge ordered the administration to cease any additional efforts to disband USAID, pay contractors for past work, and restore email access and other electronic systems to the remaining USAID staff and contractors, pending the final ruling.

With President Trump also vowing to appeal the March 17 ruling, it remains to be seen whether the judge’s order will have any measurable influence in restoring both the aid and regular operations abroad. Full restoration of programming may also be cumbersome, as many non-governmental organizations, clinics, and other international aid groups have already laid off most of their staff, or ended treatment for clinical trial participants and general community members due to the near-complete loss of funding. 

And beyond individual lives, gutting US foreign aid and support also shatters trust between the US and USAID staff, as well as the local contractors and organizations operating in these countries, Nichols notes. “It’s hard to turn the tap back on once you’ve turned it off, especially if there is no staff to turn it on.”

It’s also difficult to predict exactly how this disruption will affect each country, she adds, as USAID funding comprises different percentages of countries’ total healthcare budgets. 

“If USAID funds 50 percent of a country’s total budget for HIV prevention and treatment, for example, that doesn’t mean that half of the HIV programs continue running, or that half of the people can continue receiving treatment with this freeze,” says Nichols. “That funding could have supported the IT systems or staff members for the entire program.”