Would you click a button that led to the deaths of thousands?

DOGE employees keep blocking PEPFAR funding that the Trump White House has approved

Here’s a thought experiment.

Imagine the White House puts you in charge of the largest trolley system in America. Currently, there is a trolley called PEPFAR going down some tracks, and if it continues on those tracks, it will waste a small amount of money, but no one dies. (While your bosses want to save money, they have specifically given you a signed waiver to allow this train to continue on these tracks). Great!

However, if you disobey your bosses in the White House and pull a special lever, the PEPFAR trolley will change its tracks, saving a little bit of money, but then the trolley crashes into and kills thousands of Africans. Terrible!

Would you pull the lever?

Most people would not pull the lever. They would instead say something like, “Hey, I don’t love losing money, but killing people is really bad. Let’s not pull the lever, unless we can somehow get those people to safety first.”

But what if I told you that this lever actually exists, and right now there are two DOGE employees who have pulled that lever? What would your reaction be?

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First, let me explain what I’m talking about.

HIV/AIDS used to kill millions of Africans every decade. But in 2003, George W. Bush launched the President's Emergency Plan for AIDS Relief, or PEPFAR. Christian evangelicals (and Bono) were instrumental in helping this bipartisan program pass Congress. PEPFAR provided advanced medicine that effectively halted the spread of AIDS, and reversed its symptoms. Researchers even called it “The Lazarus Effect” because these drugs brought people who were effectively dead back to life.

Since 2003, PEPFAR basically paused the AIDS epidemic in sub-Saharan Africa and saved 26,000,000 lives, and counting. That’s 26 million lives saved, in just 22 years.

However, PEPFAR relies on a steady, uninterrupted flow of medicine. If a person stops taking AIDS medicine for even a couple months, the virus comes back much stronger and can spread.

Pregnant mothers with AIDS are able to keep their unborn babies from contracting AIDS if they keep taking their medicines; if they miss a few weeks of pills, the babies contract AIDS. Without treatment, half of those babies will die before they turn two years old.

You probably know where I’m going with this. Because PEPFAR is under the umbrella of USAID, it was basically eliminated after Elon Musk threw USAID “into the woodchipper” a couple months ago.

After a quick uproar, Secretary of State Marco Rubio issued a waiver so that PEPFAR and other “life-saving humanitarian assistance” could continue. Many rejoiced-PEPFAR wasn’t dead! The payments for this lifesaving medicine would go through!

That is, until Elon Musk and two of his DOGE employees found out. Their names are Gavin Kliger and Luke Farritor. Those two young men personally blocked the funding for this medicine.

As reported in the Washington Post,

“several times, USAID managers prepared packages of these payments [for lifesaving programs including PEPFAR] and got the agency’s interim leaders to sign off on them with support from the White House. But each time, using their new gatekeeping powers and clearly acting on orders from Musk or one of his lieutenants, Farritor and Kliger would veto the payments—a process that required them to manually check boxes in the payment system one at a time [italics added].”

In other words, Kliger and Farritor have been manually clicking a button that saves a little bit of money,¹ while killing thousands of Africans. And they’ve done it several times.

I can’t get around how evil this is. Farritor and Kliger have an explicit request from the White House to keep on sending funds to keep PEPFAR alive. They have the backing of Congress. They have the force of morality. But each time, they keep clicking the button to halt the payments.

Their actions have already killed people. A lot more people are going to die if these men don’t stop.

One study shows that eliminating PEPFAR for just one single country, South Africa, could kill 601,000 people in the next ten years alone. And that’s not counting the other 55 countries where PEPFAR is active! If PEPFAR saved 26 million lives since 2003, then ending it could kill millions more.

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For weeks, I have felt furious at Farritor, Kliger, and Elon Musk (and Trump). I blamed them for these cuts. I was praying imprecatory psalms and longing for them to experience the “weeping and gnashing of teeth” that God warns will be the end result for those who reject His way.

But then I shared a draft of this article with some friends, and they wisely pointed out that my emotions, while valid, may be a bit misdirected. The actions of Kliger, Farritor, and Musk, while evil, are really just a symptom of much deeper problems in America:

• The truth is, most Americans don’t care that much about helping those who are sick, starving, or refugees, if those people are overseas.

• The truth is, most Americans would prefer to claw back a few bucks of taxes even if it meant thousands of people died in faraway lands.

• The truth is, American most conservatives have allowed their movement to be taken over by America-Firsters who cannot see any value in humanitarian aid, multilateralism, or building international relationships. And similarly, American liberals have allowed social justice warriors to demean all foreign aid programs as mere tools of Western colonialism and imperialism, without seeing that there are also tangible results that are worthwhile.

• The truth is, American churches have allowed the government to take the lead on the most largest, most efficacious international aid programs, diluting our witness and leaving these programs up to the whims of politicians in Washington.

• The truth is, USAID got sloppy with some of its other (non-lifesaving) programs, meaning that it became a target for conservatives eager to slash government spending.

• The truth is, Silicon Valley’s infatuation with efficiency and its passion for “moving fast and breaking things” has spread throughout American culture, including to areas where its values are fundamentally at odds with human dignity.

I’m not sure which of these factors played the biggest role in PEPFAR’s demise, but in sum, they have doomed it. With USAID being shut down last week, and absent a miracle, PEPFAR is close to dead.

If you’re the type who writes editorials or calls your Congressperson, April is probably the last month where those things might make a difference.² Maybe we can lobby to have PEPFAR get restarted under the authority of Marco Rubio’s State Department, or figure out some other way to get the medicine flowing again.³

Because otherwise, by the time May 2025 rolls around, PEPFAR as an institution will likely be completely erased. Perhaps eventually some other charities or nations will step into the gap and rebuild something similar to PEPFAR, but for now, there’s little hope.

PEPFAR was an astounding achievement, one of the best contributions America ever made to the world. Many, including me, will mourn its demise.

1. Instead of starting with cuts in the military which costs the average American $205/month in taxes, Musk started with USAID, which costs the average American $10/month (PEPFAR costs even less).

2. Shoutout to

Bentham's Bulldog

for inspiring me to do both a couple months ago, when the PEPFAR cuts first began. He’s done a lot to rally support for PEPFAR and I’m grateful for that. Shoutout also to

Leah Libresco Sargeant

for her advocacy for PEPFAR in the NYT and in person.

3. Perhaps we can rename PEPFAR after Trump or something—TRUMP-PEP? TRUMPFAR? He loves flattery, so that may be the way to save it. Who knows.