It is true that fewer people die. It is also true that more poor people are still at risk than richer people. It is also true that population is in decline in places with choice. (that a good thing!) Clean water is still a HUGE issue in some parts of the world. Inequality drives women to have to haul water, even if she does have six plus kids. You are right that if we stopped with vax and medicine, we would have die offs. However, people need to see themselves as good. They are more likely to want to sell meds in order to save lives and see themselves as non-monstrous.