"Sketching Ballpark Figures for Major Disease Areas
A lot of the projects mentioned in the article revolve around a few top causes of death in low-income settings—particularly HIV, TB, and malaria—plus maternal/child health, polio immunization, neglected tropical diseases, and acute malnutrition relief. Let’s look at the big three first:
A. HIV/AIDS
Programs at stake:
350,000 people receiving antiretroviral therapy (ART) in Lesotho, Tanzania, and Eswatini (Elizabeth Glaser Pediatric AIDS Foundation programs).
2.5 million monthly treatments in Kenya.
46,000 in Uganda (Baylor College of Medicine).
Plus smaller programs in other countries.
It’s easy to see that over 3 million people on ART might lose reliable access if these terminations truly go through.
Impact of losing ART:
Historically, before widespread ART scale-up, HIV mortality in sub-Saharan Africa could be 5–10% per year for people with untreated late-stage HIV.
Not all 3 million are on the brink of advanced disease, but a large fraction would see significantly higher morbidity and mortality within months to a couple of years of treatment interruption.
Deaths per year:
If even ~5% of these 3 million lost access and died within the year, that’s ~150,000 deaths.
It could be significantly higher depending on how advanced their disease is, how quickly they can find alternative sources, etc.
B. Tuberculosis
Projects at stake:
3 million people receiving TB medications via the Global Drug Facility.
The main USAID-funded TB research consortium (Smart4TB).
Additional TB/HIV co-treatment programs.
Mortality if untreated:
Globally, the case-fatality rate for untreated active TB can reach 30–50% in high-burden, resource-poor settings. Even partially treated or interrupted regimens have high mortality risk.
Conservatively, if ~3 million lose consistent access to TB meds, you could be looking at hundreds of thousands of additional TB deaths over a year or two.
C. Malaria
Projects at stake:
$90 million bed net and treatment contract covering 53 million people.
Additional programs (e.g. Evolve) that do indoor residual spraying for 12.5 million.
REACH Malaria (PATH) for ~20 million.
Mortality if these interventions vanish:
Globally, roughly 600,000+ people (mostly children) die of malaria each year (WHO estimate for recent years).
Bed nets and spraying are a major reason malaria deaths have fallen since ~2000. Various sources (including GiveWell) estimate a cost of a few thousand dollars per life saved (varies, but often on the order of $3,000–$7,000 for top charities).
The U.S. is a key donor to a large chunk of those protective interventions. It’s not crazy to think tens of thousands—possibly 100,000+—extra malaria deaths could occur annually if those nets and sprays simply are not replaced."
Pretty late to the party, but here are some thoughts.
I think one point that Amia might be making is a criticism of EA's culture. Amia seems to think that EA has a pro-political-status-quo culture. While EA people seem to share a number of basic assumptions about the world, an account of 'how power works' (that Amia would find acceptable) is not one of them. There is no prevailing attitude that capitalist political institutions are the root cause of a number of the world's most serious problems. Given Amia's political commitments, I think her view is that a prerequisite to driving morally valuable systemic change is the epistemic task of accepting a world view that has been advocated by socialist, feminist, and anti-racist scholars. It is not that EA should place a greater focus on systematic change. Rather, EA doesn't seem to take the epistemic task seriously enough.
If this is right, then it represents an opportunity for improvement. A closely related argument has been made by Kissel (2017). (https://www.semanticscholar.org/paper/Effective-Altruism-and-Anti-Capitalism%3A-An-Attempt-Kissel/1bf6ec429a11ce12deee337e3e7a3c7eb38375f3). He writes: "... I think Effective Altruism will be less effective in realizing its own ends insofar as it fails to recognize that capitalism restricts the good we can do... I first argue that Effective Altruism and anti-capitalism are compatible in principle by looking at similarities between Effective Altruist theory and some Marxist writing. I then go on to show that the theoretic compatibility can be mirrored in practice... I conclude by suggesting that their reconciliation would lead to better outcomes from the perspective of a proponent of either view. In short, an “Anti-Capitalist Effective Altruism” is not just possible, it’s preferable."
Relevant NYT article detailing the cuts: https://www.nytimes.com/2025/02/27/health/usaid-contract-terminations.html?smid=nytcore-android-share
Had O1 pro estimate the death toll of these cuts:
"Sketching Ballpark Figures for Major Disease Areas
A lot of the projects mentioned in the article revolve around a few top causes of death in low-income settings—particularly HIV, TB, and malaria—plus maternal/child health, polio immunization, neglected tropical diseases, and acute malnutrition relief. Let’s look at the big three first:
A. HIV/AIDS
Programs at stake:
350,000 people receiving antiretroviral therapy (ART) in Lesotho, Tanzania, and Eswatini (Elizabeth Glaser Pediatric AIDS Foundation programs).
2.5 million monthly treatments in Kenya.
46,000 in Uganda (Baylor College of Medicine).
Plus smaller programs in other countries.
It’s easy to see that over 3 million people on ART might lose reliable access if these terminations truly go through.
Impact of losing ART:
Historically, before widespread ART scale-up, HIV mortality in sub-Saharan Africa could be 5–10% per year for people with untreated late-stage HIV.
Not all 3 million are on the brink of advanced disease, but a large fraction would see significantly higher morbidity and mortality within months to a couple of years of treatment interruption.
Deaths per year:
If even ~5% of these 3 million lost access and died within the year, that’s ~150,000 deaths.
It could be significantly higher depending on how advanced their disease is, how quickly they can find alternative sources, etc.
B. Tuberculosis
Projects at stake:
3 million people receiving TB medications via the Global Drug Facility.
The main USAID-funded TB research consortium (Smart4TB).
Additional TB/HIV co-treatment programs.
Mortality if untreated:
Globally, the case-fatality rate for untreated active TB can reach 30–50% in high-burden, resource-poor settings. Even partially treated or interrupted regimens have high mortality risk.
Conservatively, if ~3 million lose consistent access to TB meds, you could be looking at hundreds of thousands of additional TB deaths over a year or two.
C. Malaria
Projects at stake:
$90 million bed net and treatment contract covering 53 million people.
Additional programs (e.g. Evolve) that do indoor residual spraying for 12.5 million.
REACH Malaria (PATH) for ~20 million.
Mortality if these interventions vanish:
Globally, roughly 600,000+ people (mostly children) die of malaria each year (WHO estimate for recent years).
Bed nets and spraying are a major reason malaria deaths have fallen since ~2000. Various sources (including GiveWell) estimate a cost of a few thousand dollars per life saved (varies, but often on the order of $3,000–$7,000 for top charities).
The U.S. is a key donor to a large chunk of those protective interventions. It’s not crazy to think tens of thousands—possibly 100,000+—extra malaria deaths could occur annually if those nets and sprays simply are not replaced."
Pretty late to the party, but here are some thoughts.
I think one point that Amia might be making is a criticism of EA's culture. Amia seems to think that EA has a pro-political-status-quo culture. While EA people seem to share a number of basic assumptions about the world, an account of 'how power works' (that Amia would find acceptable) is not one of them. There is no prevailing attitude that capitalist political institutions are the root cause of a number of the world's most serious problems. Given Amia's political commitments, I think her view is that a prerequisite to driving morally valuable systemic change is the epistemic task of accepting a world view that has been advocated by socialist, feminist, and anti-racist scholars. It is not that EA should place a greater focus on systematic change. Rather, EA doesn't seem to take the epistemic task seriously enough.
If this is right, then it represents an opportunity for improvement. A closely related argument has been made by Kissel (2017). (https://www.semanticscholar.org/paper/Effective-Altruism-and-Anti-Capitalism%3A-An-Attempt-Kissel/1bf6ec429a11ce12deee337e3e7a3c7eb38375f3). He writes: "... I think Effective Altruism will be less effective in realizing its own ends insofar as it fails to recognize that capitalism restricts the good we can do... I first argue that Effective Altruism and anti-capitalism are compatible in principle by looking at similarities between Effective Altruist theory and some Marxist writing. I then go on to show that the theoretic compatibility can be mirrored in practice... I conclude by suggesting that their reconciliation would lead to better outcomes from the perspective of a proponent of either view. In short, an “Anti-Capitalist Effective Altruism” is not just possible, it’s preferable."