By Raji Krishna
Colombo, July 2 – Scrapping USAID and similar other cost cutting exercises by US President Donal Trump will soon cripple critical international development institutions including the World Bank and IMF, the British medical journal Lancet warns.
On Jan 20 this year, the Donald Trump administration issued Executive Order 14169, re-evaluating and realigning US foreign aid, which suspended existing foreign aid programmes, except for emergency food assistance and military aid. And on March 10, it was announced that 83% of the programmes run by USAID would be cancelled.
These cuts are being challenged in court. But assuming that the cancellations stand, it could include a potential 88% cut in support to maternal and child health aid, 87% cut to epidemics and emerging diseases surveillance, and 94% cut to programming for family planning and reproductive health.
In its latest issue, the British medical journal Lancet has published the findings of an evaluation of the impact of USAID funding, including all areas of its humanitarian and development assistance, on mortality, both overall and disaggregated by age and cause, over the past two decades and with projections to 2030.
Scrapping USAID will lead to steep spike in mortality world-wide, says Lancet and if President Trump continues on such a destructive path, a number of critical international development institutions including the World Bank and IMF will also be under threat, the journal warns.
Benefits of USAID Funding
The study found that USAID-supported efforts have helped prevent more than 91 million deaths across all age groups, including 30 million deaths among children.
High levels of USAID funding were associated with a 65% reduction in mortality from HIV/AIDS, a 51% reduction from malaria, and a 50% reduction from neglected tropical diseases.
Substantial decreases were also observed in mortality from tuberculosis, nutritional deficiencies, diarrhoeal diseases, lower respiratory infections, and maternal and perinatal conditions.
By age group, the most pronounced reductions were seen in children younger than 5 years (32%).
The study found that the current steep funding cuts, coupled with the potential dissolution of the agency, could lead to more than 14 million additional deaths by 2030, averaging more than 2·4 million deaths per year. These deaths include 4·5 million among children younger than 5 years, or more than 700?000 deaths annually.
Emphasis has Varied
Since the 1990s, the health sector has received the most substantial funding from USAID. However, in 2022, humanitarian assistance emerged as the highest-funded sector because of the escalation of global humanitarian crises, in which USAID was responsible for 57·2% of nutrition interventions, 50·0% of food distribution, 54·4% of agricultural interventions, and 41·9% of clean water, sanitation, and hygiene projects.
In 2023, governance became the most funded sector, but humanitarian assistance returned to the top position in 2024, followed by health and governance. In the same period, education, agriculture, infrastructure, and economic growth also received relevant USAID investments.
Therefore, the impact of USAID on health and mortality reduction extends beyond its direct funding of health programmes and interventions.
Social Support Projects
A substantial part of USAID’s influence stems from improvements in the social determinants of health, particularly among the poorest populations. In particular, USAID’s support for poverty alleviation, education, and water and sanitation interventions, among many others, might have had a substantial effect on health outcomes, also considering the broader spill over effects these interventions can have on entire communities.
Poverty alleviation interventions alone have demonstrated important effects on reducing both adult and child mortality. For example, cash transfer programmes have been shown to reduce adult female mortality by 20% and child mortality by 8% in the Lower Middle Income Countries (LMIC) with even greater reductions observed in specific contexts such as an 18% reduction in under-five mortality in Brazil and a 24% reduction across Latin America.
Education and Nutrition
Education is another crucial determinant of health. A recent global analysis found that each additional year of education reduces adult mortality risk by 1·9%. Moreover, mothers who complete secondary education can reduce the mortality risk of their children younger than 5 years by as much as 31%.
Nutritional interventions, especially those targeting malnourished children, have also demonstrated profound effects, significantly lowering child mortality risk.
In addition, interventions aimed at improving access to safe drinking water, sanitation, and hygiene have been shown to reduce child mortality by 17%.
USAID also contributes substantially through its support for targeted health promotion, prevention, and treatment initiatives. These initiatives include disease-specific programmes such as the President’s Emergency Plan for Aid Relief (PEPFAR), the President’s Malaria Institute (PMI), which rely heavily on USAID for implementation, and partnerships such as the Global Alliance for Vaccines and Immunizations (GAVI).
Earlier Studies
Previous studies evaluating the effect of USAID interventions in the past decades had showed reduction of mortality among women of reproductive age, estimated at 1·3 million over the past two decades, and child mortality, with a reduction of 29 deaths per 1000 live births from 2000 to 2016.
By 2024, PEPFAR was estimated to have saved more than 25 million lives by supporting access to antiretroviral treatments and enabling 7·8 million babies to be born HIV free.
It has been estimated that, together with its partners, PMI has helped to save 11·7 million lives and prevent 1·1 billion malaria cases since 2000.
Some estimates suggest that USAID can prevent approximately 3·3 million all-cause, all-age deaths annually. 1·6 million deaths due to HIV/AIDS can be prevented. The estimate for TB is 305,997. Humanitarian relief can prevent 548?951 deaths and vaccination 501,037 deaths.
It is estimated that funding discontinuation caused 62,?557 adult deaths and 130,535 child deaths until mid-April 2025, with an average of 103 deaths per hour. Moving forward, it could account for almost 1 million deaths per year.
A modelling study for HIV/AIDS estimated that HIV-related international aid reductions plus discontinued PEPFAR support could cause 4·43 to 10·75 million new HIV infections and 0·77 to 2·93 million HIV-related deaths between 2025 and 2030.
Regarding nutritional interventions, some estimates indicate that US-based disbursement for nutrition had prevented approximately 600?000 child deaths in 2023 in the Lower Middle Income Countries, while others estimates suggest that its reduction will cause acute malnutrition in the case of millions of children, potentially causing 163?500 child deaths yearly. Thanks to funding, between 2000 and 2023, the number of global under-five deaths had decreased from 10·1 million to 4·8 million.
A modelling study assessing the potential effect of reductions in USAID’s disease-specific and health condition-specific programmes projected that, between 2025 and 2040, cuts could result in an additional 15·2 million AIDS-related deaths, 2·2 million tuberculosis deaths, and 7·9 million child deaths.
Inadequate Notice
Humanitarian organisations have raised serious concerns about the absence of adequate notice or planning for a phased transition.
Without time to implement adaptive responses, the most severe effects cannot be mitigated. The short-term, medium-term, and long-term consequences for public health, economic development, and societal stability could be profound.
European Donors Cut Funding
The US administration’s decision to cut funding is compounded by cuts by other donors, pushing both humanitarian and development systems to the brink of collapse.
Other Western countries announcing cuts are UK (40%), France (37%), the Netherlands (30%), and Belgium (25%). The Organisation for Economic Co-operation and Development estimates that official development assistance could drop by between 9% and 17% in 2025.
Larger Impact
Trump’s decision “has shaken the entire development system like an earthquake” writes, the German development researcher, Stephan Klingebiel,
“Almost 20 UN agencies have been affected by the forced administrative leave, directly impacting their ability to carry out their core missions. A $ 4 billion pledge to the Green Climate Fund has been rescinded. Payments to the Development Assistance Committee (DAC) of the OECD have been stopped and DAC delegates withdrawn. Development cooperation with other donors, like Canada, have been severely impacted by the administration’s actions. China and Russia are directly profiting from the USA’s withdrawal.”
Trump is also shaking the pillars of international organisations – which the US founded and has significantly shaped since World War II, with the result the entire structure or key parts of it could fall.
The United Nations as a whole, the World Bank, the International Monetary Fund, the World Trade Organization are in danger.
Klingebiel warns that the destruction of state structures in the US by an oligarchic power elite is fundamentally changing the American political model. Political scientists Steven Levitsky and Lucan Alan Way say that under Trump’s second administration, the US will stop being a liberal democracy and US politics will be nothing but “competitive authoritarianism.”
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