It’s been one year since the Trump administration dismantled the US Agency for International Development (USAID), with aid cuts leading to the closure of HIV clinics in South Africa, the termination of medical programmes in Afghanistan, and the end of numerous programmes tackling malnutrition and preventable diseases around the world.
The slashing of US foreign assistance was followed by cuts by the United Kingdom, Germany, Canada and other developed nations, due to take effect this year and next year, compounding the impact, reports CNN.
Now, a study published in The Lancet aims to quantify the human toll of those budget decisions – projecting that global aid cuts could lead to at least 9.4m additional deaths by 2030, if the current funding trend continues. About 2.5m of are projected to be children under five.
The peer-reviewed study, conducted by the Barcelona Institute for Global Health (ISGlobal) with funding from the Spanish Government and the Rockefeller Foundation, modelled the outcome if aid cuts continue in line with recent averages and compared those figures with the deaths that would have occurred if aid had been maintained at 2023 levels.
It drew on data from 93 low-income and middle-income countries that receive overseas development aid.
Researchers also modelled what could happen if funding cuts deepen further through to the end of the decade, projecting that the number of additional deaths could reach 22.6m.
“Our analyses show that development assistance is among the most effective global health interventions available. Over the past two decades, it has saved an extraordinary number of lives and strengthened fragile welfare states and healthcare systems,” said the study’s co-ordinator Davide Rasella, a research Professor at ISGlobal and the Brazilian Institute of Collective Health.
“Withdrawing this support now would not only reverse hard-won progress but would translate directly into millions of preventable adult and child deaths in the coming years.”
The study also highlighted some of the achievements attributed to overseas development aid over the past two decades. Between 2002 and 2021, global aid helped reduce child mortality by 39% for under-fives. It also contributed to massive mortality declines for several major communicable diseases – including drops of 70% for HIV/Aids and 56% for malaria – while deaths from nutritional deficiencies were reduced by 56%, researchers found.
The new research comes roughly one year after the Trump administration began its dismantling of USAID and ended funding for large numbers of aid programmes around the world, including those that had been engaged in lifesaving work.
The US funded around 47% of the global humanitarian appeal in 2024, according to UN officials, making it the largest provider of humanitarian assistance globally (a position it still holds). Foreign aid has historically accounted for about 1% of the US federal budget.
Asked about the study, a senior US State Department Official called The Lancet a “failed journal” and said: “Some recent ‘studies’ are rooted in outdated thinking, insisting that the 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 global culture of dependency, compounded by significant inefficiency and waste. This has prompted development donors everywhere – not just the United States – to reconsider their approach to foreign aid,” he added.
‘People are dying already’
Experts in the field of humanitarian and development aid told CNN there are limitations to mathematical models of projected death tolls. But the impact of the aid cuts is already being felt, even as it remains unclear how exactly the cuts will play out and how recipient countries will respond.
“What we can say with confidence is these cuts are already killing people. The scale of that is still hard to fully compile, in part because the aid cuts themselves have made it harder to do so,” said Jeremy Konyndyk, president of Refugees International.
For example, health clinics that used to compile mortality data in many communities have now closed.
“Places are not collecting data. We’re flying blind. But we see evidence that people are dying already. We see evidence that systems which we know save lives are breaking down,” Konyndyk told CNN. “If the current trends are sustained, it’s primed to get a lot worse over the next few years.”
Lee Crawfurd, a senior research fellow at the Centre for Global Development think tank, who was not affiliated with the Lancet study, told CNN that death toll projection models can vary, “and we should take the precise numbers with caution, but I think the overall conclusion is likely to be correct – people will die in large numbers”.
The Centre for Global Development’s own analysis of the USAID cuts alone found that the decline in current spending may have led to between 500 000 and 1 000 000 lives lost in 2025 compared with previous years. The decline in future spending commitments is projected to lead to 670 000 and 1 600 000 lives lost annually.
“The cuts over the past year have been big,” Crawfurd said. “Many of those announced by European countries haven’t yet been implemented but are planned for this year and next year, so there is more bad news to come.”
He noted, however, that the Lancet study did not model philanthropic efforts or the responses from governments of developing countries that “have helped to mitigate some of the worst harms”.
Several countries, including Kenya, Rwanda and Nigeria, have signed bilateral agreements on health policy with the US, which involve funnelling aid through their governments rather than through international aid partners and organisations, as part of the Trump administration’s new “America First Global Health Strategy”.
But health policy experts have warned the new strategy carries risks for corruption and missing the most vulnerable people. Experts also criticised the strategy’s narrow scope, as it focuses mainly on HIV/Aids, malaria, TB and infectious disease outbreaks, while lacking a focus on other key areas like maternal and child health and nutrition.
Meanwhile, the UN has responded to funding pressures with an austerity process, working to cut bureaucracy and reshuffle donations to the most life-saving measures.
Konyndyk argued that mortality data won’t reflect many adverse outcomes of the aid cuts, because humanitarians and aid recipients are frantically reallocating funds; for example, taking money away from education to put it towards food.
He also said Refugees International has witnessed vulnerable people adopting near-term survival strategies, which will have adverse impacts in the long term, like selling their assets, taking on unsustainable debt and pulling children out of school.
“The corresponding cost of that is fewer people finding jobs, people being more dependent on aid in the future, poverty rising,” he added. “The idea from the administration that you can knock the guts out of global aid financing and then somehow find efficiencies to completely offset that is a pipe dream.”
See more from MedicalBrief archives:
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Washington launches billion-dollar health pacts in Africa – with provisos
US aid cuts could mean millions of TB deaths – global analysis