A new study models the impact of the implosion of U.S.-funded disease treatment and prevention in the developing world — and suggests that Elon Musk and Marco Rubio will go down as among history’s greatest monsters if funding and effective administration are not restored. In short: Tens of millions will die, millions of them children. The second Trump administration began by driving a stake through the heart of America’s foreign aid programs. Led by Musk, and enabled by Secretary of State Rubio, the U.S. Agency for International Development (USAID) has been shuttered, and its life-saving programs in global health either defunded or thrown into disarray. The new paper is not yet finalized or peer-reviewed; it was published as part of a project called Preprints with The Lancet. But it offers a first glimpse of the potential impact of the Trump administration’s cut-and-run approach to foreign aid — fueled by lies and red-pill conspiracy theories promoted by Musk about USAID being a “radical left” and “criminal” organization that deserved to be sent through the “wood chipper.” The study models the collapse of nearly $13 billion in U.S. funding for health programs in developing countries, including for the treatment and prevention of HIV and tuberculosis; family planning; and maternal and child health. It forecasts the increase in global death and suffering through 2040 if this funding — which accounts for nearly a quarter of global donor investment — is zeroed out. The findings shock the conscience. Cessation of U.S. aid will lead to people in poor countries dying, in genocidal proportions, of preventable and treatable diseases. That includes more than 15 million additional deaths from HIV/AIDS, more than 2 million additional casualties from tuberculosis, and nearly 8 million additional children dead of other maladies. The impact on family planning is similarly stark — with tens of millions of new unplanned pregnancies (ranging between 40-55 million). Counter to the administration’s stated “pro-life” agenda, the collapse of American aid is projected to lead to as many as 16 million “unsafe abortions.” According to the study, this mass suffering would be avoided by continuing U.S. funding on a “status quo” level from 2024 commitments. (Current funding for these programs represents about 0.2 percent of America’s $6.75 trillion in annual federal spending.) The deadliest projected impact comes from the hobbling of PEPFAR, or the President’s Emergency Plan for AIDS Relief — an enormous humanitarian accomplishment of the George W. Bush presidency that has made anti-retroviral medication widely available in the developing world, particularly in African countries hardest hit by HIV. The program has been credited with saving tens of millions of lives and preventing HIV transmission to nearly 8 million children since 2023. The GOP-led Congress shares blame here, too. PEPFAR’s authorization expired in March, and the current Congress has provided funding only through September — throwing the entire program’s future into doubt. Regardless of appropriated funds, however, the chaotic governance of Trump, Musk, and Rubio has monkey-wrenched the program on the ground. PEPFAR was supposed to be exempt from a 90-day funding “pause” the administration imposed on most foreign aid, but USAID administered a majority of PEPFAR aid and the agency now no longer exists, with its chipped remains being swept into the State Department. International partners on the ground in places like South Africa have likened the Trump-Musk era to being “pushed off a cliff.” The George W. Bush Presidential Center has blasted the new administration for having “gravely undermined PEPFAR.” The future of U.S. funding to prevent and treat tuberculosis, as well child and maternal health programs, is similarly uncertain. (By one estimate, a Trump freeze on TB funding has already killed 11,000 people.) This gutting of medical aid comes atop the deadly havoc caused by the suspension of food aid to relieve famine in the world’s poorest countries. The authors of the preprint paper are stark in their warning about the impact of continued cuts, insisting that a U.S. withdrawal from its 2024 commitments “would reverse decades of progress in global health” and send levels of deaths and disease soaring to levels not seen since the 1990s.