The Trump administration’s abrupt decision to dismantle most of the U.S. Agency for International Development (USAID) is poised to trigger a humanitarian catastrophe, according to a peer-reviewed study published Monday in The Lancet. Modeling two budget scenarios through the year 2030, an international team of scientists found that reducing USAID’s work by the 83 percent announced in March could lead to more than 14 million additional deaths, including 4.5 million children under the age of five.
The projections land just months after Secretary of State Marco Rubio declared that “83 percent of the programs at USAID” were being canceled and thanked the Department of Government Efficiency (DOGE) for carrying out the overhaul. DOGE is led by billionaire Elon Musk, whose mandate from President Donald Trump has been to shrink or scrap federal agencies viewed as inconsistent with the administration’s “America First” agenda.
Researchers from the Barcelona Institute for Global Health, the Institute of Collective Health of Brazil’s Federal University of Bahia, the University of California Los Angeles, and the Manhiça Centre for Health Research compared two futures: one in which USAID funding holds at 2023 levels and another in which the announced reductions take full effect. In the high-cut scenario, progress made since the early 2000s in maternal health, childhood vaccination, HIV treatment, and malaria prevention unravels with startling speed.
“Our 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 over the past two decades,” said Daniella Cavalcanti, a postdoctoral researcher at the Institute of Collective Health and a co-author of the report. Between 2001 and 2021, the study estimates, USAID-supported programs prevented roughly 91 million deaths in low- and middle-income countries.
Davide Rasella, the study’s coordinator, warned that the planned cuts would have consequences comparable to the outbreak of a global pandemic. He explained, “our projections indicate that these cuts could lead to a sharp increase in preventable deaths, particularly in the most fragile countries. They risk abruptly halting—and even reversing—two decades of progress in health among vulnerable populations. For many low- and middle-income countries, the resulting shock would be comparable in scale to a global pandemic or a major armed conflict.”
The early effects of shrinking U.S. assistance are already visible. The Washington Post reported Monday that hospitals in war-torn Sudan are running out of medical supplies just as hunger spreads, a situation aid workers attribute to evaporating donor funds. United Nations officials say food rations in Kenyan refugee camps have fallen to their lowest levels ever recorded. “There’s a largely unspoken and growing death toll of non-American lives thanks to MAGA,” columnist Ishaan Tharoor wrote after reviewing the Sudan dispatch.
Journalist Jeff Jarvis distilled his reaction to the death-toll projections into a single word on X: “murder.” Mother Jones reporter David Corn was equally blunt, writing, “In a less imperfect world, Musk and [President Donald] Trump would be forever cast as killers of children, and this would be front-page news for months and the subject of Sunday sermons in every church.”
Founded in 1961, USAID has grown into the largest bilateral aid agency in the world, spending $68 billion in 2023 across more than 60 countries, mostly through non-profit and private-sector contractors. Programs range from distributing insecticide-treated bed nets in sub-Saharan Africa to financing maternal-mortality reduction initiatives in South Asia. That network, researchers argue, cannot be replicated quickly by other donors; instead, abrupt U.S. withdrawal risks creating a funding vacuum at the precise moment multiple countries face conflict, climate-driven disasters, and economic shocks.
Rasella’s team noted that Washington’s pullback has emboldened other wealthy nations to trim their own aid budgets. The United Kingdom, France, and Germany each announced reductions within weeks of Rubio’s statement, amplifying the overall resource gap. Last month the United Nations described the situation as “the deepest funding cuts ever to hit the international humanitarian sector.”
Yet the United States chose not to send a delegation to this week’s United Nations-led development-financing summit in Seville, Spain—the largest aid conference in a decade—leaving diplomats from other countries scrambling to fill a leadership void traditionally occupied by USAID officials.
Inside the United States, the administration frames the rollback as fiscal discipline. DOGE officials say eliminating duplicative or “inefficient” programs will save taxpayers money and streamline foreign-policy goals. Critics counter that the long-term economic fallout of widespread disease, hunger, and instability far exceeds any near-term budget savings.
Public-health scholars draw parallels to the early 2000s, when bipartisan support for the President’s Emergency Plan for AIDS Relief (PEPFAR) helped curb the HIV epidemic. By contrast, the current cuts, they warn, may restore diseases once in retreat and destabilize fragile governments that rely on American assistance for basic health services.
At a hospital in Kakuma, a refugee settlement in northwestern Kenya, a BBC crew recently filmed an infant so malnourished that parts of her skin appeared wrinkled and peeling. Doctors said the child’s condition reflected dwindling food supplies linked to the USAID freeze. Such snapshots, researchers argue, foreshadow the broader mortality surge The Lancet study projects if funding is not restored.
Congressional appropriators will confront the aid shortfall when drafting the fiscal-year 2026 budget, but immediate relief seems unlikely. The administration can reallocate money within the State Department, yet the 83 percent reduction Rubio touted leaves little flexibility. Humanitarian organizations are appealing to private donors and multilateral banks, but those sources historically cannot match USAID’s scale.
As policymakers debate the future of American engagement abroad, the numbers in The Lancet provide a stark baseline: without intervention, 14 million people—roughly the population of Illinois—may die needlessly in just five years. Whether that projection becomes reality will depend on decisions made in Washington long before the decade’s end.
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