There has been a lot going on in the last six weeks to be gentle and it may be hard to see through the dust and tell you what's actually going on.
The government threatened tariffs, retreated, then placed tariffs, and then began carving out tariff exceptions for unconnected constituencies.
We did some flashy military deportation flights and then stopped because they were incredibly expensive. The gust of Trump's executive order tried to end birthright citizenship (the judge put it on hold), and frozen the issuance of passports to transgender Americans (this is slowly resolved as people appeal to their representatives or the media for help). Elon Musk's government efficiency, or Doge, sent an email that the team had significantly reduced federal workers and then hired many people.
One outcome is that it is extremely difficult to communicate as a journalist or learn as a member of the public. This is what continues to do with the harmful things the government is doing and is actually worth pushing back.
But here is the issue of very high wagering. This is clear and still ongoing. Cancellation of overseas programs with the best performance to treat infectious diseases.
My colleague Dylan Matthews has been writing about Pepfer, the underrated star of George W. Bush's ignorant presidency for ten years. PEPFAR helps partner countries provide HIV testing and life-saving treatment on an extraordinary scale. When the administration took office, more than 20 million people had received life-saving antiretrovirus from Pepfar.
No one in Rubio's State Department or clumsy said they wanted to cancel Pepfahl. Rubio actually made repeated remarks in favor of this in the past, but was hit by an order to stop the work. And even after many Pepfer programs issued exemptions, the funds were not retreated, and USAID contacts were fired or placed on leave, and in most cases they were unable to resume.
After that, some PEPFAR programs have been sent termination notifications. The Elizabeth Glaser Pediatric Aids Foundation has received cancellation notices for a program that serves more than 350,000 people to treat pregnant HIV+ women and prevents babies from contracting HIV in the US and abroad.
For people like me who have long been proud of Pepfer, it is painful and frightening to see this life-saving work stopping without justifying its justification or accepting what it is going on. It's brave to know that people are dying for no reason, and it's crazy to hear everyone musk that all legitimate programs have recovered, while MUSK says that contact on the frontline of the fight against HIV is not like that.
So, in response to the Pepfahl turmoil, some economists, engineers and policy experts gathered online for a weekend hackathon last month. We aimed to do a few things. Get independent confirmations of the eye-opening numbers thrown at you about the life saved by Pepfer, creating up-to-date public resources that understand the current situation of the program and explain all this. (The State Department overseeing Pepfar has not returned a request for comment.)
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That weekend, the hackathon team produced independent estimates. Pepfahl saves about 1 million lives a year and is an independent site that explains what we conclude and why. (You can read the report here.)
For Dylan Matthews' report, I had already assumed that Pepfer was a good program, but when I looked up the numbers I was surprised at how strong it was. Pepfar's actual dollar funds peaked in 2009. Since then, each year, the number of patients treated with less funding has increased (when adjusting for inflation).
In many countries, Pepfer successfully takes over responsibility for local governments. In South Africa, for example, the programme only provides 25% of the drugs, so the rest is funded and provided by the South African government.
However, the effectiveness and importance of Pepfer emphasizes the devastation that is unfolding as it is withdrawn. Even just 25% of patients thrown out of the clinic overnight causes massive amounts of confusion and mass deaths as heartbreaking reports emerge of the effects of a sudden Pep-Far closure.
And South Africa is relatively lucky. In some other countries, such as Nigeria, where Pepfar is 90% of HIV funding, there is no viable way for most people to get antiretroviruses once Pepfar is closed.
Some of the 20 million people who abandoned their life-saving medicine will find other sources, but many are not. And every day, 1,400 babies are born with HIV. HIV would not include HIV unless the programme was frozen to help mothers.
The 44-page report summarizes: If Pepfa does not turn around, about a million additional people will die terrible deaths each year for a foreseeable future.
Does activism do anything?
There were many massive protests in the first Trump administration. There are still many protests this time, but there is less energy. I think this is due to the perception that these first-year protests did not actually work. After all, Trump was eventually re-elected with more support than before.
But I don't think “protest work” is too complicated to have the answer “yes” or “no”. Protests can draw attention to the issue. Whether that attention is good or bad depends on whether the public and policy makers are on your side.
Therefore, protests are most useful about half of what is being done by chance or carelessness. Musk claims that USAID Freeze doesn't kill anyone and reapproves all legal programs.
However, the Pepfar clinic is still closed. Senator Lindsey Graham reportedly pressed the government to close Pepfer. Unlike many other things Trump and Musk does, slashing Pepfer doesn't seem like a truly partisan act, and it's not even clear that it's intentional.
As such, many reports from PEPFAR are trying to raise awareness of the PepFAR programme, with prolife groups, effective altruism DC and many involved citizens protesting at the Foggy Bottom Metro Station on Friday.
I didn't take part (not doing so is a Vox policy and even on the wrong coast), but I would like to create an intelligent case for what they're doing. Protesting the Trump administration works best when you can get through the noise and tell people that they didn't know what they were going on, didn't know, they didn't know, they were ongoing, or they didn't know that it was unpopular.
The administration has not defended Pepfer's cuts and in fact claims that Pepfer is still operating and has been exempt. It makes it an unusually good target for public pressure.
When considering protests, I consider other ways to improve the world, and I say “Is it important? Is it easy to handle? Is it ignored?”
Finding all three things, as a product of a policy that most people don't notice, a product of a policy that no one in the government supports and that Republicans oppose along with Democrats, when you find a million unnecessary deaths in a year – even in the horrifying roar of noise, the defining feature of this moment, it's worth making some noise.
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