A groundbreaking new study published in The Lancet has sounded an alarm on the profound global health implications of recent reductions in U.S. foreign aid. Spearheaded by an international team of researchers from the Barcelona Institute for Global Health (ISGlobal), alongside collaborators from the Federal University of Bahia, UCLA, and the Manhiça Centre for Health Research (CISM), the research presents the first comprehensive evaluation of two decades of funding by the United States Agency for International Development (USAID). This large-scale funding mechanism, historically the world’s foremost supporter of humanitarian and developmental initiatives, has played a critical role in saving millions of lives. However, data now reveal that steep funding cuts enacted in 2025 could catastrophically reverse these health gains, potentially resulting in more than 14 million additional deaths by 2030, including over 4.5 million deaths among children under the age of five.
This extensive investigation documents the profound impact USAID programs have had on health outcomes within low- and middle-income countries (LMICs). By integrating retrospective statistical analysis with advanced microsimulation forecasting models, the study spans 133 countries and scrutinizes mortality trends from 2001 through 2021, while projecting forward through 2030. The researchers meticulously accounted for demographic variables, socio-economic factors, and healthcare infrastructures to isolate the effects directly attributable to USAID support. Their findings highlight a remarkable 15% reduction in all-cause mortality associated with USAID funding, and even more strikingly, a 32% decrease in mortality among vulnerable children under five, underscoring the agency’s pivotal role in improving child health on a global scale.
One of the cardinal revelations of the study is the quantification of lives saved: approximately 91 million deaths were prevented during the two-decade period thanks to USAID interventions. Of these, a staggering 30 million were children whose survival was directly influenced by targeted programs. These gains were particularly pronounced in countries receiving substantial funding, where disease-specific mortality reductions were profound. For instance, mortality from HIV/AIDS plummeted by 74%, malaria deaths decreased by 53%, and deaths from neglected tropical diseases declined by 51%. The study also reports significant improvements in combating tuberculosis, nutritional deficiencies, diarrheal diseases, lower respiratory infections, as well as maternal and perinatal conditions – areas historically plagued by high mortality in resource-constrained settings.
The investigative team underscores that the mechanisms through which USAID funding achieves these outcomes extend beyond direct medical interventions. In addition to strengthening health systems and enhancing service delivery, the funding has bolstered critical social determinants of health including education, nutrition, access to clean water, sanitation, and economic resilience. These cross-sectoral benefits are essential for sustainable development and long-term health improvements, illustrating the interconnectedness of humanitarian aid and structural social progress. The study warns, with stark clarity, that the abrupt withdrawal or reduction of such support threatens to unravel decades of cumulative gains.
Forecasting future scenarios, the study employs rigorous microsimulation models to project mortality outcomes under two contrasting funding trajectories: one maintaining 2023 funding levels, and another reflecting the announced 83% cut to USAID’s budget starting in early 2025. The latter scenario paints a dire picture, with projections indicating an excess of 14 million deaths by 2030, of which 4.5 million would be children under five. This shock equates to an estimated additional 700,000 child deaths annually. The model integrates complex variables to approximate how cuts will compromise health service accessibility and quality, disrupt nutritional programs, and degrade infrastructure for water and sanitation, all of which are vital to population health.
Experts involved in the study emphasize that this potential reversal is not only a tragedy in human terms but also destabilizes fragile health systems at a critical juncture. Davide Rasella, the study coordinator and ICREA Research Professor at ISGlobal, highlights the immense risk posed by current funding trajectories, likening the potential mortality shock to the scale of a global pandemic or a major armed conflict. This comparison underscores the catastrophic nature of the impending health crisis should USAID defunding persist unabated, especially in the world’s most vulnerable regions where institutional resilience is limited.
From a ground-level perspective, the consequences of diminished USAID funding extend into the erosion of local health infrastructures painstakingly built over decades. Francisco Saúte, General Director at CISM and co-author, reflects on how prior investments have reinforced local capacities to combat formidable diseases such as HIV, malaria, and tuberculosis. The study signals that halting these investments now would jeopardize not only lives but also the very backbone of health systems that facilitate disease surveillance, treatment delivery, and emergency response in LMICs.
The ramifications extend beyond USAID itself, precipitating a broader domino effect in global health financing. The United States has historically accounted for over 40% of global humanitarian aid; reductions on this scale may prompt other international donors, including prominent agencies within the European Union, to scale back their commitments. Such a cascading reduction in aid threatens to exacerbate service delivery failures, deepen health inequities, and leave millions ever more exposed to preventable conditions. Caterina Monti, an ISGlobal predoctoral researcher and study contributor, warns that the compounding effect of simultaneous budget cuts across international actors could lead to plummeting health outcomes worldwide.
Importantly, these budgetary reductions stand in stark contrast to global commitments to achieve the Sustainable Development Goals (SDGs), specifically those targets related to health and well-being. The study highlights the critical timing of its findings in the context of the 4th International Conference on Financing for Development (FFD4) held in Seville, Spain. This gathering represents a vital opportunity for policymakers to recalibrate funding priorities and maintain, or ideally expand, investments proven to yield life-saving results. The authors collectively stress that scaling back aid now undermines global progress and the long-term vision of health equity.
The economic dimension underpinning USAID’s impact is likewise noteworthy. Despite the lifesaving power of the aid, the average U.S. citizen contributes merely about 17 cents daily to USAID programs, totaling roughly $64 annually. James Macinko, co-author and UCLA professor, argues that this modest individual investment yields outsized returns in lives saved, a fact not widely recognized among the public. Raising awareness about the profound efficiency of even minimal funding could galvanize broader support for sustaining aid budgets and amplify public pressure on decision-makers.
Methodologically, the study integrates diverse data sources and cutting-edge statistical approaches. By employing retrospective data analysis combined with forecasting techniques, the research captures both the historical impact and future risks associated with USAID funding changes. The use of microsimulation enables exploration of “what if” scenarios, reflecting realistic policy and funding shifts alongside their projected health outcomes. This rigorous approach provides a robust evidence base for international stakeholders contemplating the consequences of aid investment decisions.
In conclusion, this landmark study offers a clarion call to the global community at a pivotal juncture. The cumulative gains of over two decades in reducing mortality across multiple diseases and age groups are at imminent risk due to sweeping budget cuts to USAID’s programs. The projected loss of millions of lives, particularly among children, demands urgent policy interventions. Reaffirming the essential role of comprehensive foreign aid in fostering resilient health systems and addressing social determinants, the findings advocate for the restoration and amplification of funding. This is a decisive moment where scientific evidence must translate into decisive action to avert a looming public health crisis on an unprecedented scale.
Subject of Research: People
Article Title: Evaluating the Comprehensive Impact of Two Decades of USAID Interventions and Forecasting the Effects of Defunding on Mortality up to 2030.
News Publication Date: 30-Jun-2025
Web References:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01186-9/fulltext
http://dx.doi.org/10.1016/S0140-6736(25)01186-9
References: The Lancet, 2025; data/statistical analysis of USAID funding impact on mortality in LMICs (2001-2021), microsimulation projections through 2030.
Keywords: Health equity, Economics
