Sweeping cuts to the U.S. Agency for International Development (USAID) could result in more than 14 million additional deaths globally by 2030, reversing decades of progress in the fight against deadly diseases such as HIV/AIDS, malaria, and respiratory infections, according to new research published in The Lancet.
The study, conducted by researchers at the Barcelona Institute for Global Health and others, paints a stark picture of the human cost of the U.S.’s dramatic retreat from global health leadership. If the defunding continues as projected, an estimated 4.5 million children under five could die from preventable causes, the researchers warned.
“This structural defunding could represent one of the most significant setbacks to global health in decades,” said Davide Rasella, co-author of the study and professor at the Barcelona Institute for Global Health. “It risks causing millions of preventable deaths, particularly among the most vulnerable, and reversing progress in health and socio-economic development.”
The paper used mortality data from 133 countries spanning 2001 to 2021 to estimate the historic impact of USAID’s global health interventions. It found that USAID-funded programs prevented approximately 91.8 million deaths during that period, including a two-thirds reduction in HIV/AIDS fatalities—saving roughly 25.5 million lives. Programs targeting malaria, diarrhoeal diseases, neglected tropical diseases, and respiratory infections saved an additional 31 million lives.
Based on current trends and planned funding reductions, the researchers project 1.78 million to 2.5 million excess deaths annually from 2025 to 2030.
The study comes amid a fundamental shift in U.S. foreign aid strategy. In March, Secretary of State Marco Rubio announced that 83% of USAID programs would be cancelled, with remaining efforts absorbed by the State Department. USAID’s budget for 2023 stood at $42.4 billion, but long-term funding projections remain unclear as some cuts face legal challenges.
Adding to the blow, U.S. Health Secretary Robert F. Kennedy Jr. announced last week that the U.S. would halt contributions to the Gavi vaccine alliance, which received $300 million via USAID in 2024. The decision aligns with the administration’s broader pivot away from international health partnerships. The U.S. has also formally notified the World Health Organization of its intent to withdraw membership by early 2026.
Former presidential adviser Elon Musk previously boasted about “feeding [USAID] into the wood chipper,” drawing sharp criticism from global health experts who say the implications of such rhetoric are now becoming dangerously real.
“Whether [the estimates] are out by 2 percent or 20 percent shouldn’t detract from the central fact that USAID was a colossal funder of essential health services in the world’s poorest countries,” said Luke Allen, co-director of global primary care at the University of Oxford and a consultant to the WHO.
Experts acknowledged some limitations in the data and modelling methods, noting that projections inherently involve uncertainty. Still, the overarching message is clear: the abrupt withdrawal of U.S. global health funding poses a deadly threat to millions.
“The new U.S. approach to international collaborations and partnerships has and will cost lives,” said Michael Head, a senior research fellow in global health at the University of Southampton. “Few people would argue against reform, but even fewer would support slashing aid without a viable replacement.”
The U.S. State Department did not respond to requests for comment.
