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USAID And PEPFAR Cuts Could Lead To Massive Loss Of Life Overseas

USAID And PEPFAR Cuts Could Lead To Massive Loss Of Life Overseas

Forbes8 hours ago
A Lancet paper published in July evaluates data to illustrate the importance of roughly two decades of American humanitarian aid offered through the United States Agency for International Development and the President's Emergency Plan for AIDS Relief. The piece subsequently projects what the future could look like in light of the steep cuts imposed by President Trump to USAID and PEPFAR.
Authors estimate that USAID-funded programs have helped prevent more than 91 million deaths globally in the past 20 years, including 30 million fatalities among children. Projections suggest that ongoing deep funding cuts—combined with the dismantling of the agency—could result in more than 14 million additional deaths by 2030.
On inauguration day, President Trump ordered a sweeping 90-day spending freeze on virtually all U.S. foreign aid, including many forms of health and food assistance. An independent agency, USAID, was largely gutted.
The USAID undertakes a wide range of activities, which include among other things food aid and distribution (often in conflict zones), clean water provision, maternal and infant health support, mass administration of rehydration salts for children suffering from diarrhea, malaria prevention and treatments and polio vaccinations in countries where the disease is still endemic.
The agency was established under President John F. Kennedy in the early 1960s to administer humanitarian aid programs around the world. Congress appropriates funds for USAID's operations. The agency employed roughly 10,000 people, two-thirds of whom worked overseas. In fiscal year 2024, the agency received more than $44 billion in federal funding. Most of that money was spent in Asia, sub-Saharan Africa and Europe (primarily on humanitarian efforts in Ukraine). While a considerable sum, it merely accounts for 0.4% of the entire federal budget.
The Trump administration has slashed 86% of USAID funding. Only a small fraction of aid programs remains in place. The employee head count is now under 500.
As carried out by successive administrations since Bush, including the first Trump administration, PEPFAR represented the largest commitment in history by any nation to address a single disease, HIV/AIDS. But gradually the second Trump administration is unraveling this initiative, too. KFF reported that while PEPFAR received a limited waiver on Feb. 1, allowing it to continue certain 'life-saving HIV services,' the waiver doesn't include essential pre-exposure prophylaxis for anyone other than pregnant and breastfeeding women. The State Department has sought $2.9 billion in funding to continue HIV-AIDS programs in the next fiscal year—considerably lower than PEPFAR's current budget of $4.1 billion. Moreover, USAID was the main agency working on behalf of PEPFAR. Without USAID and its staff, PEPFAR's implementation capacity has been seriously affected.
Going forward, the Trump administration intends to transform PEPFAR from an aid program to one that is aligned with its 'America First' priorities. The plan, as described by the New York Times, outlines the administration's intentions to 'transition' countries off of PEPFAR, in some cases within two years. The program would in essence no longer be involved in aid and saving lives overseas. Rather, it would focus on detecting outbreaks that could threaten the U.S. and at the same time create new markets for American drugs and technologies.
On the ground, journalists are painting a grim picture of the implications of the drastic curtailment in U.S. aid. A story in America Magazine, for example, describes in detail the local impact in Eswatini, a country in Southern Africa, of the gutting of USAID and reductions in PEPFAR. Cuts have severely limited access to HIV treatments and testing in clinics.
During the height of the HIV/AIDS pandemic, the population of Eswatini plummeted, and life expectancy dropped from 61 in 1988 to 44 by 2003. It reverted to 61 in 2023, thanks in large part to USAID and PEPFAR. But now the gains in health outcomes are in jeopardy.
The ramifications of a greatly diminished U.S. presence in health aid, international development and disaster assistance could be profound, specifically around the global humanitarian programs which rely on USAID. In terms of international assistance, the U.S. was by far the world's largest donor. The U.S. spent $68 billion on international aid in 2023.
And the Trump administration's actions are also affecting what is termed the President's Malaria Initiative, an organization also founded by former President Bush. Through the work of this entity, the U.S. had become the global leader in donating to anti-malaria programs and research. According to the New York Times, one of Trump's executive orders has led to two-thirds of the staff being let go from the Malaria Initiative.
And by pulling out of the World Health Organization, Trump further diminishes the critical role the U.S. plays in combating neglected tropical diseases, such as leishmaniasis, river blindness, Dengue fever and trachoma. These preventable and mostly treatable infectious diseases affect millions of people in tropical regions of the world, causing severe health problems, including anemia, blindness, chronic pain, infertility and bodily disfigurement. Historically, despite the large burden imposed by neglected tropical diseases on many people, they've received a relatively small portion of resources for drug development and treatment distribution. U.S. aid agencies had been filling some of the void. Until now.
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Chronic diseases Dementia Getting olderFacebookTweetLink Follow In a major new finding almost a decade in the making, researchers at Harvard Medical School say they've found a key that may unlock many of the mysteries of Alzheimer's disease and brain aging — the humble metal lithium. Lithium is best known to medicine as a mood stabilizer given to people who have bipolar disorder and depression. It was approved by the US Food and Drug Administration in 1970, but it was used by doctors to treat mood disorders for nearly a century beforehand. Now, for the first time, researchers have shown that lithium is naturally present in the body in tiny amounts and that cells require it to function normally — much like vitamin C or iron. It also appears to play a critical role in maintaining brain health. 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Close examination of human and animal brain tissues, along with genetic investigations in the study, found the mechanism that appears to be at play: Beta amyloid plaques — the sticky deposits that gum up the brains of Alzheimer's patients — bind to lithium and hold it, including the type that's normally present in the body, as well as the commonly prescribed form. This binding depletes lithium available for nearby cells, including important scavengers known as microglia. When the brain is healthy and functioning normally, microglia are waste managers, clearing away beta amyloid before it can accumulate and can cause harm. In the team's experiments, microglia from the brains of lithium-deficient mice showed a reduced ability to sweep away and break down beta amyloid. Yankner believes this creates a downward spiral. The accumulation of beta amyloid soaks up more and more lithium, further crippling the brain's ability to clear it away. He and his colleagues tested different lithium compounds and found one — lithium orotate — that doesn't bind to amyloid beta. When they gave lithium orotate to mice with signs of Alzheimer's in their brains, these changes reversed: Beta amyloid plaques and tangles of tau that were choking the memory centers of the brain were reduced. Mice treated with lithium were once again able to navigate mazes and learn to identify new objects, whereas those who got placebos showed no change in their memory and thinking deficits. In its natural form, lithium is an element, a soft, silvery-white metal that readily combines with other elements to form compounds and salts. It's naturally present in the environment, including in food and water. Scientists have never fully known how it works to improve mood — only that it does. The original formula for 7Up soda included lithium — it was called 7Up Lithiated Lemon Soda — and touted as a hangover cure and mood lifter 'for hospital or home use.' Some hot springs known to contain mineral water brimming with lithium became sought out wellness destinations for their curative powers. Still, people who take prescription doses of lithium — which were much higher than the doses used in the new study — can sometimes develop thyroid or kidney toxicity. Tests of the mice given low doses of lithium orotate showed no signs of damage. That's encouraging, Yankner said, but it doesn't mean people should try to take lithium supplements on their own. 'A mouse is not a human. Nobody should take anything based just on mouse studies,' Yankner said. 'The lithium treatment data we have is in mice, and it needs to be replicated in humans. We need to find the right dose in humans,' he added. The normal amounts of lithium in our bodies, and the concentrations given to the mice, are small — about 1,000 times lower than doses given to treat bipolar disorder, Yankner notes. Yankner said he hoped toxicity trials of lithium salts would start soon. Neither he nor any of his co-authors have a financial interest in the outcome of the research, he said. The National Institutes of Health was the major funder of the study, along with grants from private foundations. 'NIH support was absolutely critical for this work,' Yankner said. The new research corroborates earlier studies hinting that lithium might be important for Alzheimer's. A large Danish study published in 2017 found people with higher levels of lithium in their drinking water were less likely to be diagnosed with dementia compared with those whose tap water contained naturally lower lithium levels. Another large study published in 2022 from the United Kingdom found that people prescribed lithium were about half as likely has those in a control group to be diagnosed with Alzheimer's, suggesting a protective effect of the drug. But lithium's use in psychiatry caused it to become type cast as therapeutic, Yankner said. No one realized it might be important to the body's normal physiology. That happened in part because the amounts of lithium that typically circulate in the body are so small, they couldn't be quantified until recently. Yankner and his team had to adapt new technology to measure it. In the first stage of the research, the scientists tested the brain tissue and blood of older patients collected by the brain bank at Rush University for trace levels of 27 metals. Some of the patients had no history of memory trouble, while others had early memory decline and pronounced Alzheimer's. While there was no change in the levels of most metals they measured, lithium was an exception. Lithium levels were consistently lower in patients with mild cognitive impairment or Alzheimer's compared to those with normal brain function. The brains of patients Alzheimer's disease also showed increased levels of zinc and decreased levels of copper, something scientists had observed before. Consistently finding lower lithium levels in the brains of people with memory loss amounted to a smoking gun, Yankner said. 'At first, frankly, we were skeptical of the result because it wasn't expected,' said Yankner. But it held up even when they checked samples from other brain banks at Massachusetts General Hospital, Duke and Washington universities. 'We wanted to know whether this drop in lithium was biologically meaningful, so we devised an experimental protocol where we could take lithium selectively out of the diet of mice and see what happens,' Yankner said. When they fed the mice a low-lithium diet, simply dropping their natural levels by 50%, their brains rapidly developed features of Alzheimer's. 'The neurons started to degenerate. The immune cells in the brain went wild in terms of increased inflammation and worse maintenance function of the neurons around them, and it looked more like an advanced Alzheimer patient,' Yankner said. The team also found the gene expression profiles of lithium-deficient mice and people who had Alzheimer's disease looked very similar. The researchers then started to look at how this drop in lithium might occur. Yankner said in the earliest stages there's a decrease in the uptake of lithium in the brain from the blood. They don't yet know exactly how or why it happens, but it's likely to be from a variety of things including reduced dietary intake, as well as genetic and environmental factors. The major source of lithium for most people is their diet. Some of the foods that have the most lithium are leafy green vegetables, nuts, legumes and some spices like turmeric and cumin. Some mineral waters are also rich sources. In other words, Yankner said, a lot of the foods that have already proven to be healthy and reduce a person's risk of dementia may be beneficial because of their lithium content. 'You know, oftentimes one finds in science that things may have an effect, and you think you know exactly why, but then subsequently turn out to be completely wrong about why,' he said.

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