Thanks @Omnizoid for highlighting this important moment. I’ve received a bunch of Whatsapp messages from Ugandan friends who are very very worried about what this might mean not only for patients (the main issue), but also for jobs and the livelihood of many local NGOS.
One small comment is that I think the title might be slightly misleading. If these steps happened (none of which have happened yet), then millions could die. But I think all these steps all happening is pretty unlikely
Congress (edit) does actually stop PEPFAR funding permanently—I think they are just reviewing it at the moment. Medication supplies for ARV drugs are still there for the next 3 months , there’s just a chance they’ll stop it after that period. (Unlikely)
Other countries don’t fill in the funding gap if the US pulls out permanently (Unlikely)
Low income country Governments don’t reprioritise funding and free HIV treatment comes to a halt in some countries (Unlikely) - although there could be a large negative effect on other health services if countries were forced to pull money from other healthcare towards ARV treatmen.
And to reiterate, thanks for the article and its still a very very big deal
I’ve received a bunch of Whatsapp messages from Ugandan friends who are very very worried about what this might mean not only for patients (the main issue), but also for jobs and the livelihood of many local NGOS.
I think it could be pretty effective for your Ugandan friends to record videos interviewing people who have been helped by the program, and post the videos online.
A lot of skepticism of foreign aid is driven by the fear that the aid is being captured somewhere along the way, either here in the US or in the target country. Hearing directly from the aid recipients helps address that fear.
As an American, it feels like good things the US does are taken for granted, and the US will be criticized relentlessly by people in other countries no matter what we do. So I wouldn’t suggest scolding the US for withdrawing funds. And in any case, rewards usually work better than punishments for modifying behavior. I think saying thanks, and talking about what it would mean for the program to continue, would be a lot more powerful than scolding. Even for Americans who aren’t particularly altruistic, this would provide tangible evidence that the program is improving America’s reputation.
One mental model I have is that the US is suffering from something akin to EA burnout, and the solution to both “US burnout” and “EA burnout” is a stronger culture of gratitude. In principle, I could imagine that a really good response to this PEPFAR situation actually ends up motivating the US to fund additional effective aid programs.
Strongly second this—it helps a lot to hear from people on the ground as many details as they can share while respecting patient privacy about who they serve and what it’s like.
That’s a good point about patient privacy. On X, you suggested that PEPFAR has had a sizable macro impact on AIDS in Africa. Maybe Africans who are old enough to remember could talk about what AIDS was like in Africa before and after PEPFAR, as a way to illustrate that macro impact without violating the privacy of any individual patients.
Of course, insofar as individual patients are willing to speak about their experiences, possibly with some light anonymization such as looking away from the camera, that seems really good to me too.
A couple other thoughts:
If access to ARV drugs is interrupted, I imagine that could lead to drug-resistant HIV strains, same way your doctor tells you to take your antibiotics consistently.
This really speaks my mind. I think rather than scolding Trump, we might need to know why the Congress is taking the decision. What if the funding are actually being “captured somewhere along the way”? That might truly be the fear.
Wow that’s interesting! I have no inside information but would have guessed like 70-80 percent chance that funding for HIV meds would continue but maybe I’m way off the mark
To throw some numbers in here, point no2 would need for a lot of countries to all decide it’s not worth it to fill the funding gap even a little. Let’s say there are 50 countries that could (I’d estimate half of them to be in Europe), and they decide not to fund with probability 1−p.
The probability that they all decide not too fund is then (1−p)50. If p is something like half a percent, there’s a 78% risk of no country filling the funding gap. If all three steps have 78% probability then yeah, we do approach 50% of them all happening.
How sure are you on #1? I want to organize US folks to contact their representatives and senators, but want to be specific with the ask. Is it 1) waive the pause or 2) just ensure it comes back at the end of the pause? This link makes me believe that the pause itself is stopping PEPFAR-related work, but it sounds like you think NGOs will have funding to make it through the next month?
My understanding is that #1 is false – PEPFAR funding is authorized by congress, the executive can’t (legally) unilaterally cut it off. However, their funding is currently paused as part of a broader pause on all US foreign aid. Organizing people to call their senators and representatives (especially if these are Republicans) is a great thing to do right now – the ask is to exempt PEPFAR from the foreign aid pause. You might also tell them to say that PEPFAR is a program initiated by a Republican president which has enjoyed widespread bipartisan support for 25 years.
I think this is an OK ask, but the bigger long term issue is that PEPFAR stays funded after the review—that seems to me both a bigger deal and perhaps more tractable than “unpausing” right now. It seems pretty unlikely that decision would be reversed but I don’t know much about the US political system or Trump’s way of operating
It would not be legal for USAID to cancel funding for PEPFAR after the reverse! Their funding comes from congress, executive agencies don’t have the power to do that. It still might happen – such are the times – but it would be definitely flagrantly illegal.
I think we are in uncharted territory here. It’s true that Congress has the power of the purse. But Trump’s pick for Office of Management and Budget Director (Russell Vought) supports impoundment—unilateral action taken by the exectuve branch to delay or cancel appropriations enacted into law.
When asked about Trump’s funding freeze the other day, Rep. Tom Cole, Chairman of the House Appropriations Committee, said “Appropriations is not a law, it’s the directive of Congress.”
Some Republican members of Congress may not push back on illegal actions without pressure from their constituents.
Ok thanks, that matches my prior belief. However, I don’t know if receiving organizations have the funding runway to keep programs running during the pause. Do we have good (back of the envelope) calculations about the effects of the full 90 day pause (even if it is reinstated)?
I really doubt we have the info yet even for a BOTEC. The situation will vary wildly from org to org and country to country. The best place people to comment here might be staff in USAID conduits like Chemonics and ABT associates, who would know the financial situation at scale for USAID funded orgs in low income countries.
Many implementing partners will not be able to make it the full 90 days. Several are under a communications gag order as part of the stop work order and can’t speak freely about the impacts. This Devex article quotes heads of NGOs (who spoke under condition of anonymity to reduce the risk of retribution): “I don’t think anyone can survive for 90 days”: Aid’s grim new reality (1/30/25).
Almost every contractor is already furloughing or laying off staff. On 1/31/25, The CEO of DT Global said that most firms are furloughing +80% of their staff with up to 3,000 in the DC area losing jobs by next week.
Those who have announced furloughs include:
Chemonics (100% of global health division)
DT global
MSH (HQ staff on leave 1-2 weeks, layoff imminent)
Those who have announced layoffs include:
Credence (95% of staff—this is where the majority of the Institutional Support Contractors (ISCs) who staffed the Global Health Bureau worked)
You’re right that the funding has stopped, although there will be a bunch of dedicated money in foreign accounts which will keep paying many people. There will be chaos though. For example we have 3 nursing staff under a contract paid by USAID and I’d be very surprised if they just don’t get paid now (I’ll tell you in a week).
What I mean by 1 (sorry I phrased it wrong at first, is that HIV meds in Uganda are still available and probably in other supported countries for the next few months. Its only after the pause that the shit will really hit the fan if USAID decides to permanently stop funding.
My ask would be to ensure PEPFAR funding continues after the pause.
I agree that a permanent stop is worse. Thanks for clarifying the situation during the pause; that sounds reassuring. Please keep the EA community updated!
Thanks @Omnizoid for highlighting this important moment. I’ve received a bunch of Whatsapp messages from Ugandan friends who are very very worried about what this might mean not only for patients (the main issue), but also for jobs and the livelihood of many local NGOS.
One small comment is that I think the title might be slightly misleading. If these steps happened (none of which have happened yet), then millions could die. But I think all these steps all happening is pretty unlikely
Congress (edit) does actually stop PEPFAR funding permanently—I think they are just reviewing it at the moment. Medication supplies for ARV drugs are still there for the next 3 months , there’s just a chance they’ll stop it after that period. (Unlikely)
Other countries don’t fill in the funding gap if the US pulls out permanently (Unlikely)
Low income country Governments don’t reprioritise funding and free HIV treatment comes to a halt in some countries (Unlikely) - although there could be a large negative effect on other health services if countries were forced to pull money from other healthcare towards ARV treatmen.
And to reiterate, thanks for the article and its still a very very big deal
I think it could be pretty effective for your Ugandan friends to record videos interviewing people who have been helped by the program, and post the videos online.
A lot of skepticism of foreign aid is driven by the fear that the aid is being captured somewhere along the way, either here in the US or in the target country. Hearing directly from the aid recipients helps address that fear.
As an American, it feels like good things the US does are taken for granted, and the US will be criticized relentlessly by people in other countries no matter what we do. So I wouldn’t suggest scolding the US for withdrawing funds. And in any case, rewards usually work better than punishments for modifying behavior. I think saying thanks, and talking about what it would mean for the program to continue, would be a lot more powerful than scolding. Even for Americans who aren’t particularly altruistic, this would provide tangible evidence that the program is improving America’s reputation.
One mental model I have is that the US is suffering from something akin to EA burnout, and the solution to both “US burnout” and “EA burnout” is a stronger culture of gratitude. In principle, I could imagine that a really good response to this PEPFAR situation actually ends up motivating the US to fund additional effective aid programs.
Strongly second this—it helps a lot to hear from people on the ground as many details as they can share while respecting patient privacy about who they serve and what it’s like.
That’s a good point about patient privacy. On X, you suggested that PEPFAR has had a sizable macro impact on AIDS in Africa. Maybe Africans who are old enough to remember could talk about what AIDS was like in Africa before and after PEPFAR, as a way to illustrate that macro impact without violating the privacy of any individual patients.
Of course, insofar as individual patients are willing to speak about their experiences, possibly with some light anonymization such as looking away from the camera, that seems really good to me too.
A couple other thoughts:
If access to ARV drugs is interrupted, I imagine that could lead to drug-resistant HIV strains, same way your doctor tells you to take your antibiotics consistently.
Having a big population of immunocompromised people in Africa seems bad in terms of mutation speed for future pandemics. Here’s a paper I just found on Google, about COVID variants which are thought to have arisen from immunocompromised patients.
This really speaks my mind. I think rather than scolding Trump, we might need to know why the Congress is taking the decision. What if the funding are actually being “captured somewhere along the way”? That might truly be the fear.
Hmm, I guess none of those happening seems decently likely to me—around 50% probability.
Wow that’s interesting! I have no inside information but would have guessed like 70-80 percent chance that funding for HIV meds would continue but maybe I’m way off the mark
To throw some numbers in here, point no2 would need for a lot of countries to all decide it’s not worth it to fill the funding gap even a little. Let’s say there are 50 countries that could (I’d estimate half of them to be in Europe), and they decide not to fund with probability 1−p.
The probability that they all decide not too fund is then (1−p)50. If p is something like half a percent, there’s a 78% risk of no country filling the funding gap. If all three steps have 78% probability then yeah, we do approach 50% of them all happening.
How sure are you on #1? I want to organize US folks to contact their representatives and senators, but want to be specific with the ask. Is it 1) waive the pause or 2) just ensure it comes back at the end of the pause? This link makes me believe that the pause itself is stopping PEPFAR-related work, but it sounds like you think NGOs will have funding to make it through the next month?
My understanding is that #1 is false – PEPFAR funding is authorized by congress, the executive can’t (legally) unilaterally cut it off. However, their funding is currently paused as part of a broader pause on all US foreign aid. Organizing people to call their senators and representatives (especially if these are Republicans) is a great thing to do right now – the ask is to exempt PEPFAR from the foreign aid pause. You might also tell them to say that PEPFAR is a program initiated by a Republican president which has enjoyed widespread bipartisan support for 25 years.
I think this is an OK ask, but the bigger long term issue is that PEPFAR stays funded after the review—that seems to me both a bigger deal and perhaps more tractable than “unpausing” right now. It seems pretty unlikely that decision would be reversed but I don’t know much about the US political system or Trump’s way of operating
It would not be legal for USAID to cancel funding for PEPFAR after the reverse! Their funding comes from congress, executive agencies don’t have the power to do that. It still might happen – such are the times – but it would be definitely flagrantly illegal.
Sorry I wasn’t talking specifics of agencies, I just meant congress cutting their funding, will edit thanks!
I think we are in uncharted territory here. It’s true that Congress has the power of the purse. But Trump’s pick for Office of Management and Budget Director (Russell Vought) supports impoundment—unilateral action taken by the exectuve branch to delay or cancel appropriations enacted into law.
When asked about Trump’s funding freeze the other day, Rep. Tom Cole, Chairman of the House Appropriations Committee, said “Appropriations is not a law, it’s the directive of Congress.”
Some Republican members of Congress may not push back on illegal actions without pressure from their constituents.
Ok thanks, that matches my prior belief. However, I don’t know if receiving organizations have the funding runway to keep programs running during the pause. Do we have good (back of the envelope) calculations about the effects of the full 90 day pause (even if it is reinstated)?
I really doubt we have the info yet even for a BOTEC. The situation will vary wildly from org to org and country to country. The best place people to comment here might be staff in USAID conduits like Chemonics and ABT associates, who would know the financial situation at scale for USAID funded orgs in low income countries.
Thanks for the pointers!
Many implementing partners will not be able to make it the full 90 days. Several are under a communications gag order as part of the stop work order and can’t speak freely about the impacts. This Devex article quotes heads of NGOs (who spoke under condition of anonymity to reduce the risk of retribution): “I don’t think anyone can survive for 90 days”: Aid’s grim new reality (1/30/25).
Almost every contractor is already furloughing or laying off staff. On 1/31/25, The CEO of DT Global said that most firms are furloughing +80% of their staff with up to 3,000 in the DC area losing jobs by next week.
Those who have announced furloughs include:
Chemonics (100% of global health division)
DT global
MSH (HQ staff on leave 1-2 weeks, layoff imminent)
Those who have announced layoffs include:
Credence (95% of staff—this is where the majority of the Institutional Support Contractors (ISCs) who staffed the Global Health Bureau worked)
Jefferson consulting (100% of ISCs)
ABT associates
FHI
Jhpiego
Feed the Children
You’re right that the funding has stopped, although there will be a bunch of dedicated money in foreign accounts which will keep paying many people. There will be chaos though. For example we have 3 nursing staff under a contract paid by USAID and I’d be very surprised if they just don’t get paid now (I’ll tell you in a week).
What I mean by 1 (sorry I phrased it wrong at first, is that HIV meds in Uganda are still available and probably in other supported countries for the next few months. Its only after the pause that the shit will really hit the fan if USAID decides to permanently stop funding.
My ask would be to ensure PEPFAR funding continues after the pause.
I agree that a permanent stop is worse. Thanks for clarifying the situation during the pause; that sounds reassuring. Please keep the EA community updated!