The first 100 days of Donald Trump’s second administration ended this week. Many, including me, have written about the devastation these few months have caused to important programs across the federal government, and the ways that science and public health have been undermined in both word and deed.

These attacks have not gone unanswered. There has been a flurry of lawsuits to stop the cuts at NIH, NSF, CDC, and other agencies. Universities are standing up to the administration, and thousands are organizing to defend America’s health and the health of people around the globe. But the wreckage is still vast.

As the scope of the damage the president has done becomes clear, scientists are also starting to document and estimate the toll of death and suffering that will now be a part of Trump’s legacy. Several new papers have underscored what is at stake.

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In a paper in one of The Lancet’s family of journals, Jan Hontelez, from Erasmus University Medical College in Rotterdam, and colleagues from around the world estimated the short-term effects of a 90-day interruption in funding for the US’s flagship global HIV/AIDS program, the President’s Emergency Plan for AIDS Relief (PEPFAR). Three months might not seem like a long time, but it’s enough to cause tremendous harm. The excess deaths the study predicts under various scenarios in seven sub-Saharan African countries range from 64,000 to 70,000 over the next five years. Given that most PEPFAR sites are now in limbo, we will soon be able to put these predictions to the test.

Longer-term estimates of the effects of the cessation of PEPFAR funding are even more grim. Debra ten Brink at the Burnet Institute in Australia and colleagues in The Lancet HIV suggest that anticipated international aid reductions, including the cessation of PEPFAR funding, may lead to 4.4 million to 10.8 million additional new HIV infections by 2030 and between 770,000 to 2.9 million HIV-related deaths in children and adults by 2030.

These estimates are for HIV only. The impact on tuberculosis, malaria, and other health conditions is similarly grisly. Mathematical modeler Brooke Nichols from Boston University has estimates for these additional effects of Trump’s policies at impactcounter.com.

Back here in the US, Robert F. Kennedy Jr., Trump’s secretary of health and human services, continues to play fast and loose with the science of infectious disease and vaccination, undermining key immunization programs and tapping key anti-vaxxers to do his bidding. Most recently, he named David Geier—who does not have a medical degree and has been practicing medicine without a license—to lead a study on vaccines and autism, a supposed relationship that has already been exhaustively debunked. This is in the midst of a large set of measles outbreaks in Texas, Oklahoma, Kansas, New Mexico, Pennsylvania, Ohio, Michigan, and Indiana, totaling 819 cases, with another 97 isolated cases in other states across the country.

The implications of the administration’s anti-vaxx agenda could not be more worrying. Last week, a paper Mathew Kiang from Stanford and colleagues published in JAMA warned that even with current vaccination rates, measles is likely to become endemic again, with 851,300 cases of measles occurring over the next 25 years, and with cases of other disease rising as well—such as 190 new cases of rubella, 18 of polio, and eight of diphtheria.

In their study, Kiang and colleagues projected 851 cases of post-measles neurological complications, 170,200 hospitalizations, and 2,550 deaths. This is the status quo. With further reductions in vaccination rates, cases would rise even higher. For instance, a 10 percent reduction in MMR vaccination could lead to 11.1 million new cases of measles. More substantial decreases in vaccination rates risk pushing other childhood infections, such as rubella and polio, back to endemicity. These are diseases we conquered decades ago in this country. Now, we are inviting them back, not through some failure of science or medicine ut through willful mendacity and neglect.

Trump and his henchmen—Secretary Kennedy, Secretary of State Marco Rubio (who oversees PEPFAR), Elon Musk, and Project 2025 mastermind and current Office of Management and Budget chief Russell Vought—have blood on their hands. There is a direct line from their decisions to the deaths of men, women, and children by the tens of thousands, and likely into the millions as they continue their long march through the institutions.

The late Bob Rafsky, a comrade from ACT UP, once said this at a political funeral for Mark Fisher, who died of AIDS in 1992. I’ve quoted his words before, and they are, once again, better than those I can muster:

[W]hen the living can no longer speak, the dead may speak for them. Mark’s voice is here with us, as is the voice of Pericles, who two millennia ago mourned the Athenian soldiers who didn’t have to die and in whose death he was complicit, but who had the nobility to say that their memorial was the whole earth.

Let the whole earth hear us now: We beg, we pray, we DEMAND that this epidemic END.

Not just so that we may live, but so that Mark’s soul may rest in peace at last.

In anger and in grief, this fight is not over ‘til all of us are safe.

As I write this, I am thinking of Bob, of Mark, of the dead I have mourned over the years. The thousands, the millions who will die because of this administration’s policies have lives; they have names; they have friends and family who love them. Let them not just be figures in scientific papers—let their memorial be the whole earth.