“It’s unacceptable”: Boston University mathematician tracks how many deaths may result from USAID, Medicaid cuts

It was 5 am, and Brooke Nichols was out for a jog, her mind reeling from reading about the Trump administration dismantling the United States Agency for International Development (USAID). As a mathematician who is also an infectious diseases modeler, her concerns went straight to the numbers: How many people will die because of this decision? 

For decades, USAID provided the largest source of international assistance to over 120 countries, with tangible benefits like hunger relief, food programs, and infectious disease outbreak responses. With a background in calculating the impacts of infectious diseases around the world, Nichols set her mind to determining the immediate effects of one of the many programs on the chopping block: the President’s Emergency Plan for AIDS Relief (PEPFAR), an HIV prevention program that has operated through USAID since 2003. It provides critical drugs to adults and children with HIV and has saved an estimated 26 million lives. The program was terminated in late February and had immediate consequences in some of the world’s poorest nations. 

“My brain jumps to math, and I was reading the news and getting mad, and thinking, what does this actually mean? How many people are going to die?” says Nichols, a Boston University School of Public Health associate professor of global health. By the time she returned from her run, she began to tackle the problem in front of her. She sent her initial calculations to a few colleagues, and she was soon encouraged to share the findings publicly. By 5 pm the same evening, the results were live on a website made by a friend. 

And the numbers are startling.

Because of the PEPFAR funding freeze, she found that an adult life will be lost every 3 minutes and a child will die every 31 minutes. As of writing this article, over 23,000 adults and more than 2,400 infants would have died, because of the elimination of PEPFAR, according to Nichols’ findings. The numbers are published on a live updating impact tracker. 

Nichols and her colleagues also created a second tracking system to estimate how many lives will be lost from cutting USAID’s tuberculosis (TB) prevention and response programs. TB is one of the world’s deadliest infectious diseases; according to the World Health Organization, the USAID programs averted about 3.65 million deaths in the last year alone. With help from the United Nations Stop TB Partnership organization and Avenir Health, Nichols showed that there will be an additional death from TB every seven minutes. As of writing this article, the team estimates that over 10,000 people have died because of the USAID funding cuts (the TB impact tracker also updates live as the minutes go by). 

“I want these numbers to be shared with policymakers and people that are trying to advocate from within the government, and for them to have these numbers to be able to say why funding should not stop,” says Nichols, also a BU Center on Emerging Infectious Diseases (CEID) core faculty member. “I want people to cite it and use it to be outraged.” 

The impact trackers are all available on the Impact Counter dashboard website, and the mathematical models have been applied to track the impact of other diseases and conditions, including malaria, malnutrition, and more. As trackers become available on the website, Nichols continues to communicate with numerous colleagues to help peer-review her initial back-of-the-envelope calculations. “Now, the trackers are reflective of about a dozen modelers that all agree this is about as accurate an assumption as we can come up with,” she says. 

Nichols also is in the process of finalizing an impact tracker, specially for people living in the US, to estimate how many deaths would result from the US government cutting Medicaid. 

The US House of Representatives passed a bill proposing an overhaul to Medicaid, “and since it hasn’t passed the Senate, there’s still an opportunity to show the ramifications. If this passes, many Americans are going to die every year,” Nichols says. According to her Medicaid Cuts Impact Counter, the proposed cuts could lead to an estimated 28,785 excess deaths in the first year after such a policy took effect. This translates to one additional death every 18.3 minutes.  

Her efforts are now focused on keeping the tracking systems up-to-date and following the news to see if any adjustments need to be made based on policy and court decisions. President Trump and White House advisor Elon Musk have said that USAID wastes government money. A US district court judge recently wrote that the dismantling of USAID likely violated the Constitution in multiple ways, but the future of the agency remains in limbo. 

“I’m keeping my eyes open for other major consequential policy choices,” says Nichols. “So far, this work has been shared widely and is being used to express outrage, which was my goal. My goal is to display something that is as close to reality as we can estimate—these estimates are inherently outrageous given the extent of the impact. It’s unacceptable.”

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