Impact of USAID Defunding on Mortality

A new study in The Lancet warns of dire global health consequences from recent U.S. foreign aid cuts, projecting millions of preventable deaths if current reductions continue.

Led by researchers from the Barcelona Institute for Global Health (ISGlobal), alongside the Institute of Collective Health at the Federal University of Bahia (ISC-UFBA), UCLA, and the Manhiça Health Research Centre (CISM), the study estimates that USAID-supported programmes prevented 91 million deaths in low- and middle-income countries (LMICs) between 2001 and 2021. However, recent U.S. aid cuts could reverse these gains, leading to more than 14 million additional deaths by 2030, including over 4.5 million among children under five.

The team analysed data from 133 countries, combining retrospective evaluation (2001–2021) with forecasting models through 2030. Using statistical models accounting for income, education, health systems, and demographics, they estimated USAID’s impact on mortality across age groups and causes of death. They also applied microsimulation to forecast additional deaths if funding cuts continue.

USAID programmes were associated with a 15% reduction in all-cause mortality and a 32% reduction in under-five mortality in supported countries. The most significant declines were seen in priority disease areas, with HIV/AIDS mortality reduced by 74%, malaria by 53%, and neglected tropical diseases by 51% in high-support countries compared to those with low or no USAID funding. The study also found notable reductions in deaths from tuberculosis, nutritional deficiencies, diarrhoeal diseases, respiratory infections, and maternal and perinatal conditions.

The analysis shows that USAID funding has been an essential force in saving lives and improving health outcomes in some of the world’s most vulnerable regions.

To estimate future impacts, the team modelled two scenarios: maintaining 2023-level funding or implementing the sharp cuts announced in early 2025, amounting to an 83% reduction in USAID programmes. The analysis projects over 14 million additional deaths by 2030 if cuts proceed, including more than 4.5 million child deaths, or roughly 700,000 extra under-five deaths annually. The projected toll reflects not only halted health services but also cuts to nutrition, education, water and sanitation, and humanitarian assistance.

The projections indicate these cuts could lead to a sharp increase in preventable deaths, particularly in fragile countries. The resulting shock would be comparable in scale to a global pandemic or major armed conflict.

The study warns that the impact of U.S. cuts could extend beyond USAID’s programmes. As the U.S. previously provided over 40% of global humanitarian funding, reductions may trigger a ripple effect among other donors, further weakening services in aid-dependent countries. Other international donors, primarily in the EU, have also announced substantial aid cuts, which could lead to even more preventable deaths.  

Beyond direct healthcare, USAID-supported initiatives have strengthened food security, clean water access, education, and economic resilience—critical social determinants of health. Reducing this support risks undermining long-term stability and development across LMICs.

This study is the first to comprehensively assess the total mortality impact of USAID funding across LMICs over two decades. The projections represent the most probable scenario based on current data and policies but could shift depending on future government and institutional decisions.

As world leaders gather for the 4th International Conference on Financing for Development (FFD4) in Seville, the study underscores an important choice: continue proven life-saving investments or risk reversing two decades of health gains for the world’s most vulnerable populations.

Source: The Lancet

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