US funding cuts set to drive 23 million excess deaths in the poorest countries by 2030

A new analysis of the impact of overall cuts to international aid last year, especially by the US as the largest single donor, predicts 23 million excess deaths in low- and middle-income countries (LMICs) over the next four years.

The study uses both a retrospective evaluation of the impact of development funding from 2002 to 2021 based on data from 93 LMICs, together with validated country-specific models to predict future mortality. This is a collaboration by researchers from Brazil and Spain and the paper has just been published as an open access article in Lancet Global Health. [1]

The authors report that over the course of 20 years, the previous development funding led to large declines globally in all-cause mortality (by 23%), under-5 mortality (by 39%), HIV/AIDS (by 70%,) malaria (by 56%), nutritional deficiencies (by 56%) and neglected tropical diseases (by 54%). Mortality from tuberculosis, diarrhoea, lower respiratory infections and maternal and perinatal causes were also significantly reduced.

New modelling, based on the severe defunding from the US last year, projects 22.6 million additional deaths by 2030 (95% uncertainty interval: 16.3 to 29.3) including more than 5.4 million children under 5 years old.

Under a mild defunding model, defined as continuing the previous downward trend in official development assistance (ODA) from all countries, 9.4 million excess deaths are still projected overall (95% UI: 6.2 to 12.6), with 2.5 million of those among children under 5.

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The paper calls the impact of defunding aid catastrophic, potentially exceeding the impact of the COVID-19 epidemic.

This research is important for not only predicting the impact of changes in US policy, but for also showing the impact of cuts from other major funders, including the UK, France and Germany.

The Trump administration has also dramatically changed the structure of providing any future aid. Instead of continuing to contribute to international collaborative programmes, the US now requires bilateral agreements with the government of each country.

Details of each agreement have not been released but include long-term commitments to providing the US with citizens’ health records and other data, and agreeing to preferential commercial contracts with US businesses.

The front cover of the 31 January issue of the Lancet features the quote: “The USA has not met its financial obligations for either the year in which its notice [to leave WHO] was communicated [2025] or the year in which withdrawal is intended to take effect [2026] and… it [also] has outstanding arrears from the previous year [2024].”

da Silva AF et al. Impact of two decades of humanitarian and development assistance and the projected mortality consequences of current defunding to 2030: retrospective evaluation and forecasting analysis. The Lancet Global Health, DOI: 10.1016/S2214-109X(26)00008-2 (02 February 2026).
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(26)00008-2/fulltext