It’s been a year since the Trump administration dismantled the United States Agency for International Development (USAID), with aid cuts that led to the closure of an HIV clinic in South Africa, the end of a medical program in Afghanistan, and the end of numerous programs tackling malnutrition and preventable diseases around the world.
The U.S. foreign aid cuts were followed by cuts by Britain, Germany, Canada and other developed countries, set to take effect this year and next, adding to the impact.
A new study published in the medical journal The Lancet aims to quantify the human cost of these budget decisions, predicting that if current funding trends continue, global aid cuts could lead to at least 9.4 million new deaths by 2030. Approximately 2.5 million of these are expected to be children under the age of five.
The peer-reviewed study, conducted by the Barcelona Institute for Global Health (ISGlobal) with funding from the Spanish government and the Rockefeller Foundation, modeled the outcome if aid cuts continued in line with recent averages and compared that figure to the number of deaths that would have occurred if aid had remained at 2023 levels. We used data from 93 low- and middle-income countries receiving overseas development assistance.
The researchers also modeled what would happen if funding cuts were deeper towards the end of the decade, predicting that the additional deaths could reach 22.6 million.
“Our analysis shows that development aid is one of the most effective global health interventions available. Over the past two decades, development aid has saved countless lives and strengthened fragile welfare states and health systems,” said study coordinator Davide Racera, research professor at IS Global and the Brazilian Population Health Institute.
“Withdrawing this support now would not only reverse hard-won progress, but would also lead directly to millions of preventable adult and child deaths in the future,” Racera said in a statement.
The study also highlighted some of the gains attributed to overseas development assistance over the past two decades. From 2002 to 2021, global aid helped reduce under-five mortality by 39%. It also contributed to significant reductions in mortality rates from several major infectious diseases, including a 70% reduction in HIV/AIDS, a 56% reduction in malaria, and a 56% reduction in deaths due to nutritional deficiencies, the researchers found.
The new study comes about a year after the Trump administration began dismantling USAID and ending funding for numerous aid programs around the world, including programs that were engaged in lifesaving operations.
The United States will finance about 47% of the world’s humanitarian efforts in 2024, making it the world’s largest provider of humanitarian aid (a position it still holds), according to U.N. officials. Foreign aid has historically accounted for about 1% of the U.S. federal budget.
Asked about the study, a senior US State Department official called The Lancet a “failed magazine” and said: “Some recent ‘studies’ are rooted in outdated thinking, claiming that an old and inefficient global development system is the only solution to human suffering. This is simply not true.”
“Rather than helping recipient countries help themselves, the old system created a culture of global dependency, compounding significant inefficiencies and waste. This is prompting development donors everywhere, not just the United States, to rethink their approach to foreign aid,” the official added. Last July, Secretary of State Marco Rubio described the new approach as “prioritizing trade over aid, opportunity over dependence, and investment over aid.”
Experts in the field of humanitarian aid and development aid told CNN that mathematical models for predicting death tolls have limitations. However, the effects of aid cuts are already being felt, although it remains unclear how exactly they will play out and how recipient countries will respond.
“What we can say with confidence is that these cuts are already killing people. The full scale is still difficult to tally, partly because the aid cuts themselves make it difficult to implement them,” said Jeremy Konyndyk, president of Refugees International. For example, clinics that collected mortality data in many communities are now closed. “The locations aren’t collecting data. We’re flying blind.”
“But we’re already seeing evidence that people are dying. We’re seeing evidence that the systems that we know are saving lives are breaking down,” Konyndyk told CNN. “If current trends hold, it is likely to get even worse in the coming years.”
Lee Crawford, a senior researcher at the Center for World Development think tank who was not involved in the Lancet study, told CNN that models predicting the number of deaths may differ and that “the exact numbers need to be taken with caution, but I think the overall conclusion is probably correct: people are going to die in large numbers.”
The World Development Center’s own analysis of USAID cuts alone found that between 500,000 and 1 million more lives could be lost in 2025 compared to the previous year due to lower recurrent spending. The reduction in future spending commitments is projected to cost 670,000 and 1.6 million lives a year.
“The cuts last year were significant,” Crawford told CNN. “Many of the cuts announced by European countries have not yet been implemented, but are planned for this year and next, and more bad news awaits.”
But he noted that the Lancet study was not modeled on philanthropy or the responses of governments in developing countries, which “have helped to alleviate some of the worst damage.”
Several countries, including Kenya, Rwanda and Nigeria, have entered into bilateral health policy agreements with the United States that involve funneling aid through their governments rather than through international donor partners and organizations as part of the Trump administration’s new “America First Global Health Strategy.” But health policy experts warn that the new strategy risks corruption and overlooking the most vulnerable. Experts also criticized the strategy’s narrow scope, as it primarily focuses on epidemics such as HIV/AIDS, malaria, tuberculosis and infectious diseases, and not other important areas such as maternal and child health and nutrition.
Meanwhile, the United Nations has responded to funding pressures with an austerity process, cutting bureaucracy and working to shift contributions to the most life-saving measures.
Konyndyk argued that mortality data did not reflect the many negative consequences of aid cuts, as humanitarians and aid recipients were desperately reallocating funds. For example, taking money away from education and putting it toward food. He said he was witnessing vulnerable people adopting short-term survival strategies that would have negative long-term effects, such as selling assets, taking on unsustainable debt or withdrawing children from school.
“The trade-off is that fewer people will find work, people will be more dependent on aid in the future, and poverty will increase,” he added. “The administration’s idea that it can somehow find efficiencies to completely offset global aid funding by gutting it is a pipe dream.”
CNN’s Jennifer Hansler contributed reporting.
