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> Brooke Nichols, the Boston University epidemiologist and mathematical modeller, has maintained a respected tracker of current impact. The model is conservative, assuming, for example, that the State Department will fully sustain the programs that remain. As of November 5th, it estimated that U.S.A.I.D.’s dismantling has already caused the deaths of six hundred thousand people, two-thirds of them children.
Which links to Impact Counter [0], if you want to read more on how they reached those figures.
I think it's fair to say with absolute certainty that thousands of people have died as a direct result of dismantling USAID, but that we aren't certain of the exact magnitude. One model estimated it's around 600 thousand, but we don't have exact figures because of the disruptions.
Do you think there's a way this could be communicated more clearly? I'm not trying to be deceptive in how I present this information, and I could be persuaded to re-evaluate the exact figure if presented with a better analysis.
[0] https://www.impactcounter.com/dashboard?view=table&sort=inte...
> Based on the budget for the 2024 financial year, USAID's nutrition program was allocated $168 million dollars [3]:. It is estimated that the cost of treating a child for severe malnutrition, while varied by context, is between $100-$200 [4]:. Assuming: a similar budget of $160 million dollars in 2025, that this budget is utilized for treatment of severe acute malnutrition in children and that on average treatment per child costs $150 (midpoint of range), approximately 1.12 million children with severe malnutrition would remain untreated as a result of USAID funding freeze and discontinuation in 2025.
> This would result in approximately 168,000 (112,000 – 224,000) annual deaths in children under 5. Additionally, children who survive but do not receive treatment will love with long-term morbidity. One element of this is compromised immune systems, leaving them vulnerable to other infections like diarrheal disease and pneumonia. These estimates do not capture that morbidity.
If you look at the papers that are being cited, these programs are incredibly effective:
> A total of 328 patient cards/records of children treated in the programs were reviewed; out of which 306 (157 CTC and 149 TFC) were traced back to their households to interview their caretakers. The cure rate in TFC was 95.36% compared to 94.30% in CTC. The death rate in TFC was 0% and in CTC 1.2%. The mean cost per child treated was $284.56 in TFC and $134.88 in CTC.
https://link.springer.com/article/10.1186/1478-7547-10-4
If you look at what they mean by CTC program, it's ongoing support in addition to the treatment for acute malnutrition, so it's not just throwing a child back into the same environment:
> CTC programs use decentralized networks of outpatient treatment sites (usually located at existing primary health-care facilities), small inpatient units (usually located in existing local hospital facilities), and large numbers of community-based volunteers to provide case detection and some follow-up of patients in their home environments. Patients with severe malnutrition, with good appetite, and without medical complications are treated in an outpatient therapeutic program (OTP) that provides ready-to-use therapeutic food (RUTF) and medicines to treat simple medical conditions. The food and medicines are taken at home, and the patient attends an OTP site weekly or fortnightly for monitoring and resupply.
In terms of overhead, the overhead for the organization providing care is already accounted for in the $100-200 figure, including the costs of managing the program from the capital. Presumably Save The Children takes a chunk of the grant for its own overhead but I believe these costs are typically capped by the US government at something like 10%. Similarly, USAID has its own costs but I'm not sure if those are accounted for in the $168m line item or if they're accounted for elsewhere.
So, sure, Nichols' paper is using a cost estimate that's based on specific types of programs and generalizing that. Given the number of countries and organizations involved, I'm not sure how much more accurate you could get.
But your cynicism is also pretty unfounded. The sources take into account the organization's overhead, the logistics of reaching remote areas (the Ethiopia paper points out that much of the overhead goes to vehicle rental and gives a distribution of patients by how far they have to walk to get to the treatment center). It accounts for ongoing vs acute care.
So I wouldn't take 168,000 number especially seriously - and I would note that the author adds some very large error bars - but I also wouldn't dismiss it as a complete fiction.
“Thousands of people” covers at least 3 orders of magnitude, depending how loose you get with the language… I don’t see the contradiction in “the error bands are wider without the high-fidelity surveillance, but even from fuzzier sources, the absolute minimum is definitely in the thousands.”
[ETA: A June study in the Lancet estimates the cuts to USAID (if sustained) will result in 14 million deaths by 2030: https://www.thelancet.com/journals/lancet/article/PIIS0140-6... ]