One of the cheapest ways to save a life is going away

Summary

Podcast Summary: "One of the Cheapest Ways to Save a Life is Going Away"

Podcast Information:

• Title: The Indicator from Planet Money
• Host/Author: NPR
• Episode: One of the cheapest ways to save a life is going away
• Release Date: June 25, 2025

---

Introduction to PEPFAR and Its Impact

In the episode titled "One of the Cheapest Ways to Save a Life is Going Away," NPR's The Indicator from Planet Money delves into the profound effects of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). Introduced by Darren Woods at [00:39], PEPFAR was established in 2003 under President George W. Bush with a commitment of $3 billion annually to combat HIV/AIDS in Africa and the Caribbean. Woods highlights the program's remarkable efficiency, stating, "That program is heavily modeled, monitored for its outcomes" ([05:03]), emphasizing its data-driven approach that has saved an estimated 26 million lives by providing antiretroviral therapy to those in need.

PEPFAR's Success Metrics

John Cohen, a senior correspondent for Science magazine, underscores the effectiveness of PEPFAR by outlining its stringent metrics: "95% of people know their status. 95% of those people start treatment. 95% of those people reach undetectable levels" ([05:18]). This triad of targets ensures that the program maintains high standards of accountability and effectiveness, allowing program managers to identify successes and address failures promptly.

Impact of Trump Administration's Funding Cuts

The episode takes a critical turn as Darren Woods discusses the significant funding reductions PEPFAR has faced under the Trump administration. Highlighting the administration's strategy, Woods explains, "The president paused foreign assistance in January. Doge then demolished USAID, which delivered a majority of the program's assistance" ([01:21]). These cuts have threatened the sustainability of PEPFAR's life-saving initiatives, prompting concern among global health communities.

Ground Realities in Southern Africa

John Cohen provides firsthand insights from Southern Africa, specifically focusing on Eswatini and Lesotho, regions with some of the highest HIV prevalence rates in the world. At [07:04], Cohen remarks, "If John hadn't been there and if those children did have HIV, the outcome could have been quite different," illustrating the dire consequences of reduced funding. He narrates the experience at a local clinic where, despite the supply of antiretroviral drugs, the lack of funds hampers essential outreach efforts. Cohen recounts a critical moment:

"I saw a young woman named Tema Langeni Dlamini who came into the clinic for her pregnancy checkup. She tested positive for HIV, so she was swiftly given antiretrovirals." ([07:55])

This instance highlights the program's success in treatment but also exposes the vulnerability in prevention due to funding cuts.

Personal Stories and Human Impact

The episode humanizes the crisis through personal narratives. Cohen describes accompanying an outreach worker to test the contacts of a newly diagnosed individual, leading to the testing of eight children who fortunately tested negative. He reflects on the gravity of the situation:

"At that point, they already would have suffered irreparable damage to their bodies when they grew older. They would probably be stunted if they survived." ([09:16])

Additionally, Cohen cites an analogy from the head of the UNAIDS program in Eswatini:

"It's like pulling someone off a life support machine and just pulling the plug." ([09:34])

This metaphor starkly portrays the abrupt halt in life-saving support due to funding cessation.

Economic Arguments and International Responsibility

Addressing the Trump administration's rationale for the cuts, Woods references White House Budget Director Russ Vought's stance:

"The US is in $37 trillion in debt and at some point the continent of Africa needs to absorb more of the burden of providing this healthcare." ([09:44])

Cohen counters this argument by emphasizing the minimal financial impact relative to the overall U.S. debt:

"To think that this is going to solve our debt problem, I mean, come on, do the math. This is a drop in the ocean." ([10:00])

He further challenges the notion that PEPFAR is merely a charitable endeavor, arguing its broader implications for global stability and health security.

Current Status and Future Projections

Despite the ongoing reductions, a spokesperson from the Department of State maintains that "PEPFAR continues to support life-saving, HIV testing, care and treatment approved by the Secretary of State" ([10:34]). However, other services funded by PEPFAR are under review for alignment with U.S. foreign policy, signaling potential further cuts.

Researchers from the HIV Modelling Consortium have already estimated that these funding reductions have led to the deaths of approximately 70,000 people ([11:34]), underscoring the immediate and severe impact of policy changes on public health.

Conclusion: The High Stakes of Funding Cuts

The episode culminates by reiterating the critical role PEPFAR plays in combating HIV/AIDS in some of the world's most affected regions. As Darren Woods aptly puts it:

"This was an extremely well-run program in its hobbled state. Now though, researchers from the HIV modelling consortium estimated 70,000 people have already died." ([11:34])

The discussion reveals that while antiretroviral drugs continue to save lives, the inability to sustain comprehensive testing and prevention efforts due to funding cuts jeopardizes the program's overall success and threatens the progress made over the past two decades.

---

Notable Quotes:

• Darren Woods [00:39]: "PEPFAR...save a human life for just $4,600."
• John Cohen [05:18]: "95% of people know their status. 95% of those people start treatment. 95% of those people reach undetectable levels."
• John Cohen [09:34]: "It's like pulling someone off a life support machine and just pulling the plug."
• John Cohen [10:00]: "To think that this is going to solve our debt problem, I mean, come on, do the math. This is a drop in the ocean."
• Darren Woods [11:34]: "Researchers...estimated 70,000 people have already died."

---

This comprehensive summary encapsulates the critical discussions and insights presented in the episode, providing a clear understanding of PEPFAR's achievements, the risks posed by recent funding cuts, and the profound human and economic implications of these policy changes.

Transcript

[Narrator]

This message comes from Square. You probably know Square from your favorite local spots, but you might not know that there's a lot more to square than meets the eye. What started as a little white card reader is now being used to rapidly scale, build loyal followings, cover cash flow gaps and expand to new locations. Wherever your business is growing, Square meets you there. Go to square.com go NPR to learn more.

[NPR Station ID]

NPR.

[Darren Woods]

In rich countries like the U.S. we spend millions of dollars to save a life. People with health insurance enjoy befuddlingly expensive surgeries and medication regimens. Governments shell out for highway improvements to reduce crashes. But there's a program that has been saving millions of lives for a fraction of that cost, just $4,600 to save a human life. That program is called PEPFAR, the U.S. president's Emergency Plan for AIDS Relief. Ladies and gentlemen, George W. Bush started it in 2003.

[John Cohen]

Seldom has history offered a greater opportunity to do so much for so many.

[Darren Woods]

At the State of the Union, President Bush asked Congress to commit $3 billion a year to fight AIDS in Africa and the Caribbean. It's now Given an estimated 26 million people another chance at life by preventing and treating HIV and aids. Under President Trump, that program is being gutted. The president paused foreign assistance in January. Doge then demolished usaid, which delivered a majority of the program's assistance. And now there's a bill going through Congress that would codify much of these cuts. So what's happening on the ground? Journalist John Cohen went to Southern Africa to find out.

[John Cohen]

They're reeling, they're dizzy, they're like, what? What? This is our trusted partner, the United States government. How can they be doing this?

[Darren Woods]

This is the indicator from Planet Money. I'm Darren Woods. Today on the show, HIV AIDS prevention under Trump and a trip to an African clinic to learn about the cost of these cuts.

[Narrator]

This message comes from Schwab. Everyone has moments when they could have done better. Same goes for where you invest. Level up and invest smarter with Schwab. Get market insights, education and human help when you need it. Support for NPR and the following message come from Edward Jones. What does it mean to live a rich life? Maybe it's full of brave first leaps, tearful goodbyes and everything in between. And with over 100 years of experience, your Edward Jones financial advisor can help. EDWARD Jones Member, SIPC this message is from Spectrum Business.

[NPR Station ID]

From independently owned storefronts just open for business, to established professional services run from large offices, Spectrum is committed to delivering connectivity solutions for any size business. Create a plan made for your business with fast, reliable Internet, TV packages, phone mobile services and more. All backed by the Spectrum commitment. From one employee to thousands, Spectrum keeps your business connected.

[Narrator]

Learn [e-mail] business this message is sponsored by Udemy. Not sure if you have the experience to start your dream job? Good news these days it's skills that count. Udemy can help you get those in demand. Skills Want to be an AI mastermind? Learn with Udemy Game developer. They've got you covered. AWS Certified Cloud Practitioner Udemy can help you prep. You'll learn from real world experts who love what they do so that you can love what you do. Go to udemy.com for the skills to get you started and get set for your dream job.

[Darren Woods]

Not everyone remembers this acutely, but in the 1990s, AIDS was one of the leading causes of death, including in the U.S. and then came game changing drugs to treat HIV, the virus that causes AIDS. These drugs were what's called antiretroviral therapy. John Cohen is a senior correspondent for Science magazine and has been covering public health for over 30 years.

[John Cohen]

They could basically allow people who had HIV to live normal lifespans.

[Darren Woods]

Antiretroviral therapy saved millions of lives in wealthy countries.

[John Cohen]

Well, that wasn't available to most people living with HIV in the world because the drugs were so incredibly expensive. About 15,000 a year per person.

[Darren Woods]

So that's manageable in a rich country, but just completely inaccessible for people from low income countries.

[John Cohen]

Great in the United States, Europe, Australia, Japan had no meaning for most of sub Saharan Africa, for most of Asia. And that's where most people who have HIV infections live.

[Darren Woods]

There were still millions of deaths a year across those countries. And that's what impelled George W. Bush to start pepfar. And what's made PEPFAR successful is that the program is heavily modeled, monitored for its outcomes.

[John Cohen]

The metrics that we're talking about here are 95% of people know their status. 95% of those people start treatment. 95% of those people reach undetectable levels.

[Darren Woods]

959595 program managers can look at a country and see where it's succeeding, where it's failing, and what could be changed. And even some of the countries hardest hit by AIDS have reached these targets.

[John Cohen]

To date, the program has spent over $120 billion and has saved an estimated 26 million lives. It's a phenomenally successful program.

[Darren Woods]

That success is now under grave threat. The hope had been that American assistance could start phasing down around 2030, but some Republican lawmakers didn't like that. Some money was targeting higher risk groups like sex workers and LGBT people. So that gl the glide path has now turned more into a crash landing. Earlier this year, many HIV AIDS organizations in places like Africa received emails terminating their contracts with the usaid. The emails were signed off. God bless America. So in May, John went to two African countries to find out what the reality was. At the hospital door, he flew to Eswatini and Lesotho. These are two countries within South Africa.

[John Cohen]

They're small, one to two million people each. They have the highest prevalence of HIV anywhere in the world.

[Darren Woods]

About one in four adults in eSwatini and Lesotho have HIV. Believe it or not, that is a major improvement from a decade ago.

[John Cohen]

I'm not sure the countries would exist today had these medications not arrived there when they did.

[Darren Woods]

In some places in Southern Africa, entire villages have been run by orphans. In Eswatiti, John spoke to a nurse at a clinic in a brick building. Cetabile Dlamin. The pet fire cuts were starting to bite scale.

[John Cohen]

How serious is the situation?

[Darren Woods]

This is really serious.

[John Cohen]

Is this a five alarm fire? This is really serious and it's worrisome.

[Darren Woods]

Now the Trump administration has said it is allowing life saving treatments to still be funded. And yes, the clinic still has the antiretroviral drugs, but they don't have the funds to promote HIV testing to know who needs those drugs. John saw a young woman named Tema Langeni Dlamini who came into the clinic for her pregnancy checkup. She tested positive for hiv, so she was swiftly given antiretrovirals.

[John Cohen]

So when I went to the clinic, I was talking to them and said, well, that's great, you know, the system's working. And this outreach worker there said, no, it's not. We need to now go test the contacts in her home. And typically we would drive out to her home and do the testing.

[Darren Woods]

Timolengeni has two children plus more in the home. It would be important to make sure they were being tested too. Without testing, a child with HIV would probably only be seen once it had progressed to aids. And with the cuts, the clinic didn't have the means to send anyone over to test those children. This time though, there was kind of an unusual solution.

[John Cohen]

I said, well, we have a car. How about if we took you, would you want to do that? And the outreach worker said, yeah, I'd love to do that. So we went out to the home and the woman tested eight children and you know, my heart was in my throat. You know, I really. It's crushing to see positive tests come up, especially in children. And here were eight children being tested and they all came out negative, which was just wonderful.

[Darren Woods]

If John hadn't been there and if those children did have hiv, the outcome could have been quite different, especially once it's progressed to aids.

[John Cohen]

At that point, they already would have suffered irreparable damage to their bodies when they grew older. They would probably be stunted if they survived. That's what's happening. It's a little harder to see than hey, are there drugs on a pharmacy shelf? But that's the reality of what these cuts are doing. As the head of the UNAIDS program said to me in Eswatini is like pulling someone off a life support machine and just pulling the plug.

[Darren Woods]

White House Budget director Russ voight said the US is in $37 trillion in debt and at some point the continent of Africa needs to absorb more of the burden of providing this healthcare. So could African countries find HIV AIDS treatment and prevention themselves?

[John Cohen]

Sure, and they want to and they're moving toward that. But to think that this is going to solve our debt problem, I mean, come on, do the math. This is a drop in the ocean. Now you can argue that, hey, it's a charity, as Marco Rubio has said, and it's not our job to be a charity. Well, this is more than simply being a charity. It's more than simply soft diplomacy. It's creating a stable world where you don't have military conflicts, you don't have countries falling apart because of health.

[Darren Woods]

We reached out to the Department of State asking if its leadership was concerned. A spokesperson said PEPFAR continues to support life saving, HIV testing, care and treatment approved by the Secretary of State. But they also said that other PEPFAR funded services are currently being reviewed for efficiency and consistency with US foreign policy. John says like any large system, there were always wrinkles, like leadership in Washington pushing too hard for those metrics sometimes, or debates over abstinence promotion. But overall, he says, this was an extremely well run program in its hobbled state. Now though, researchers from the HIV modelling consortium estimated 70,000 people have already died. This episode was produced by Julia Ritchie and Cooper Katz McKim with engineering by Senator Lofredo. Fact checked by Cira Juarez. Cake and Canon edits the show and the indicator is a production of npr.

[Narrator]

This message comes from Meta AI. Meta AI is the personal AI to help you with whatever you need. Not only is Meta AI now an app, but it's also on the apps you already love, Facebook, Instagram, WhatsApp and Messenger, plus the Ray Ban Meta glasses. It's easy to access wherever you are throughout the day. Experience Meta's newest AI that's tailored to you by downloading the Meta AI app. Try the Meta AI app today on the Apple App Store and Google Play.

[NPR Station ID]

Support for this program comes from Texas Mutual Insurance Co. A workers comp carrier dedicated to handling claims proactively to help injured employees get back on the job and policyholders get back to business. [e-mail] claims this message comes from US.

[Narrator]

Bank Simplify how you do business with Business Essentials, a powerful combination of no monthly maintenance fee, checking and card payment processing. Deposit products are offered by U.S. bank National association member FDIC.