A comprehensive study published by The Lancet has found that abrupt and sweeping cuts to United States foreign aid could result in more than 14 million additional deaths worldwide by the end of the decade, including over 4.5 million deaths among children under five.
The peer-reviewed study, released on June 30, analyzed two decades’ worth of data from 133 low- and middle-income countries to evaluate the impact of funding provided by the United States Agency for International Development (USAID).
Researchers concluded that USAID interventions contributed significantly to global reductions in mortality, particularly in poverty-related diseases.
From 2001 to 2021, USAID support is estimated to have prevented over 91 million deaths, with around one-third of those being children under five years old.
The study links higher USAID funding levels with substantial declines in deaths caused by HIV/AIDS (65%), malaria (51%), and neglected tropical diseases (50%). Declines were also observed in tuberculosis, diarrhoeal diseases, maternal conditions, respiratory infections, and malnutrition.
Using dynamic microsimulation models, the study projected mortality rates under two scenarios: continuation of existing USAID funding and the implementation of recently announced cuts.
It found that the current defunding trajectory, triggered by Executive Order 14169 and the cancellation of 83% of USAID programs, could reverse decades of progress in global health.
According to the projections, the total number of excess deaths between 2025 and 2030 could reach over 14 million, with the greatest burden expected to fall on children, women, and populations in sub-Saharan Africa and other high-need regions.
Researchers emphasized that USAID’s health impact extends beyond direct interventions. Investments in water, sanitation, education, and poverty alleviation—such as cash transfers and school infrastructure—also played a crucial role in improving health outcomes and reducing mortality.
The report noted that these social determinants, supported by USAID, contributed to significant public health gains in the poorest countries.
The funding cuts are part of a broader trend among Western donors. The study highlighted reductions in aid budgets by the United Kingdom, France, the Netherlands, and Belgium, warning of a growing crisis in global humanitarian and development financing.
The authors cautioned that the projected death toll stems from a worst-case scenario, yet emphasized the urgent need for political action to prevent widespread and avoidable loss of life.
The study was conducted by researchers from the Federal University of Bahia, ISGlobal, and several global health institutions, with funding from the Spanish Ministry of Science and Innovation, the UK Medical Research Council, and the European Union.
