Good morning, Hank, it's Tuesday.

This is a graph of child mortality since 2000, the year I graduated from college; This is a graph of tuberculosis deaths over the same period; This is a graph of HIV deaths. All these graphs bring good news, but, unfortunately, we're about to see this progress stop and even be reversed because of the global pullback in health funding currently headquartered in the United States. One recent estimate holds that, instead of losing 1.3 million people a year to tuberculosis within 5 years, we'll be losing 2 million people per year, and child mortality will get worse as well.

So overall, premature mortality has declined dramatically in the last 25 years, but you can see here that it actually goes up when it comes to HIV/AIDS before it goes down, and that is because, until the mid-2000s, anti-retroviral therapy wasn't widely available in impoverished communities, but then came PEPFAR. PEPFAR is a U.S.-led program to reduce the burden of HIV globally, and it has been hugely effective saving tens of millions of lives, and it has long had bipartisan support. In fact, several Republican senators have recently said that they support PEPFAR and that cutting it would be a "red line," and yet, PEPFAR is in real danger.

Now, Hank, the thing about graphs is that of course they are a terrible way to communicate the meaning of needless suffering and death, but I don't know how else to tell millions of stories at once. But, like, what's happening now is truly horrific. One reporter recently told me, "These young doctors have never seen people die of AIDS. They only know AIDS as a manageable chronic illness. But now they are seeing it." Meanwhile, tuberculosis testing is "in a coma" as one article recently put it with millions of people going undiagnosed, which also means millions of people going untreated.

So the U.S. Congress is currently deciding whether to codify $400 million in cuts to PEPAR and $500 million in cuts to other U.S. health aid. And if these cuts are codified in U.S. law, it's not an exaggeration to say that millions of people will die. These cuts would represent about $3 in savings per American. It's less than 1/10,000th of our federal budget, and yet that $3 per person does so much good. And worse still, at the same time all of this is happening, The Global Fund to Fight Malaria, HIV, and Tuberculosis is under threat. The Global Fund provides treatment and diagnostics to fight the world's deadliest infectious diseases, and I am genuinely terrified to imagine a world without it. The most recent budget proposal by the Trump administration would cut U.S. funding for the Global Fund by 50%, but just as problematically, it would also change how that funding works.

Currently, the U.S. spends $1 on the Global Fund for every $2 raised by other partners, but they wanna change that to $1 for every $4 raised, which everyone knows will just absolutely gut the Global Fund. We know this because the UK and the EU are also pulling back on their global health spending, and will see this 1-to-4 match as an excuse to pull back further. This catastrophe will be the greatest setback in human health in a generation, but I really believe we might be able to stop it.

So I was in a meeting with a Republican member of Congress recently, and he said, "Look, I don't disagree with you. It's just my constituents don't care about this." It was that simple to him. He saw himself as the voice of his people and his people don't care if a million more children die every year. But, respectfully, I just think he's wrong. I think a lot of his constituents care. He's just not hearing from them. Now you may believe, as I long did, that reaching out to your elected representatives is a waste of time or whatever but I know that it's not. I know it because even in this, uh, challenging political climate, I've seen programs get reinstated. And I know it because I've seen TB fighters get bipartisan support for anti-tuberculosis efforts. But now, the rubber meets the road and the promises need to be kept, and if someone like Susan Collins says that she will always stand up for PEPAR and the Global Fund, it is time to stand up for PEPFAR and the Global Fund.

The most important thing your representatives need to hear, and I'm going to curse for the first time in 18 years on vlogbrothers, is that you give a shit about PEPAR and the Global Fund. You care that that $400 million cut will lead to hundreds of thousands of babies being needlessly born with HIV; You care about the Global Fund and its 23 years of work reducing malaria, TB, and HIV; You care about this graph and wanna see it continue to show good news.

So we'd like to see the Global Fund receive about $2 billion in U.S. federal spending, which is about $6 per American per year. Add that to the full budget of PEPAR, and we're talking about 20 bucks a year per American to do some incredibly good work in this world. In the last 20 years, the Global Fund helped save 65 million lives. PEPFAR has saved 26 million lives. I don't know how to value the lives of 91 million human beings, but I know that 20 bucks a year is a great deal. Now I want to restate that the U.S. is not the only challenge here, like, 43% of the Global Fund's money comes from the UK and the EU, and they are also pulling back on global health spending, so if you live there, please also reach out to your representatives. But the U.S. just matters a lot, and its chaotic and massive spending cuts are the main reason why hundreds of thousands of people have seen their TB treatment interrupted and millions living with HIV have been imperiled.

TB fighters in our community are organizing call-a-thons every day this week. These are fun events where you can make friends and also do something worthwhile. Or you can just call right now. Staffers are friendly and these leaders desperately need to hear from you. You can find links to scripts from PIH in the doobly-doo or you can just make it clear in your own words that the world needs PEPAR and the Global Fund. I know it's a small thing. I'm sure it feels insignificant, but when tens of thousands of people do something insignificant together, it becomes very significant.

Oh man, the puff is out of control, but to be fair stress levels are also out of control. One more thing that I'll say: I live in a red state which weirdly makes me unusually powerful in this situation. Like, if you live in Indiana or South Carolina or Texas or Maine, you are weirdly important right now. If your congressional representative is Tom Cole or Mario Díaz-Balart, you matter so incredibly much right now. Like, yes, please call, but also make your parents call. Make your weird aunt who disagrees with you about everything but is willing to spend $20 a year to save millions of children's lives. Make her call.

So I have a friend in Sierra Leone with HIV, and because of funding cuts, his medication has been rationed and when he told me about this, I wrote back and said, "Listen you have nothing to worry about. Sarah and I will make sure that you can afford to buy medication on the private market." And he responded, "Thank you. What about everyone else?" What about everyone else. Private philanthropy simply cannot step up and fill in these gaps. And unless we want to go back to a world where millions are dying every year of HIV, a world where hundreds of thousands of babies are being born annually with a disease that we don't know how to cure, but do know how to prevent, we have to stand up for that everyone else.

We do that not just with our voices and our votes, but those are essential tools, so please, if you are lucky enough to have a say in your governance, reach out to your elected representatives and let them know that $20 a year per American to save millions upon millions of lives is the bargain of a lifetime.

Hank, I'll see you on Friday.