Lancet Study Projects 14 Million Preventable Deaths by 2030 from U.S. Foreign Aid Cuts

What Does the Research Say About the Consequences of Cutting U.S. Foreign Aid?

A peer-reviewed study published in The Lancet analyzed data from 133 low- and middle-income countries and found that USAID-funded programs prevented an estimated 91 million deaths between 2001 and 2021. The same study projects that if current funding cuts continue, more than 14 million additional deaths could occur by 2030, including 4.5 million children under five.

When USAID was effectively shut down in early 2025, the stated justification was fraud, waste, and abuse. But what does the peer-reviewed evidence actually show about the consequences of that decision? Multiple research teams across leading academic institutions have now published projections, and the findings are striking in both their scale and their consistency. This article examines the key studies, what they found, and what the data suggests about the road ahead.

This article accompanies Episode 40 of The Dr Kumar Discovery, where Dr. Kumar and Keith Hourihan, a 20-year veteran of international audit and fraud investigations, discuss the inside story of USAID and the reality behind the allegations that led to its closure.

Dr. Kumar’s Take

This Lancet study is one of the most comprehensive analyses of foreign aid effectiveness I have ever seen. It did not just look at one disease or one country. It analyzed 133 nations across two decades and found that USAID programs were associated with a 15% reduction in all-cause mortality. That is a massive effect at a population level. The projections about what happens when you remove that funding are sobering. Fourteen million additional deaths by 2030, including 4.5 million children under five. Those are not political talking points. They are the output of rigorous statistical modeling published in one of the most respected medical journals in the world. I think everyone deserves to see this data before forming an opinion about whether cutting foreign aid was justified.

The Lancet Study: Two Decades of Evidence

The study, led by Cavalcanti, Rasella, and colleagues and published in The Lancet in 2025, is titled “Evaluating the impact of two decades of USAID interventions and projecting the effects of defunding on mortality up to 2030: a retrospective impact evaluation and forecasting analysis.”

The researchers analyzed mortality data from 133 low- and middle-income countries across the period from 2001 to 2021. They compared outcomes in countries that received high levels of USAID funding against those with low or no funding, controlling for confounding factors like GDP, governance, and baseline health infrastructure.

The key findings were significant across multiple disease categories. In countries receiving the highest levels of USAID support:

• All-age, all-cause mortality was reduced by 15%
• HIV/AIDS mortality was reduced by 65%
• Malaria mortality was reduced by 53%
• Neglected tropical diseases mortality was reduced by 51%
• Substantial reductions were also documented in tuberculosis, nutritional deficiencies, diarrheal diseases, lower respiratory infections, and maternal and perinatal conditions

The total number of deaths prevented was estimated at 91 million, including 30 million among children.

The Projections: What Cutting Aid Could Mean

The same research team modeled what would happen if the steep funding cuts initiated in January 2025 continued through the end of the decade. Under this scenario, the model projected more than 14 million additional all-age deaths by 2030, including over 4.5 million children younger than five years. That translates to roughly 700,000 additional child deaths per year.

If funding cuts were to deepen further, which subsequent budget proposals have suggested, the researchers estimated the death toll could reach 22.6 million by 2030.

A separate analysis from the Harvard T.H. Chan School of Public Health estimated that as of early 2026, the cuts had already contributed to more than 762,000 deaths, including over 500,000 children.

The OECD Data: A Global Domino Effect

One of the most concerning developments has been the cascading effect on other donor nations. According to OECD data released in April 2026, international development assistance from DAC member countries fell by 23.1% in 2025 compared to 2024, the largest annual decline in the history of official development assistance.

The United States drove three-quarters of that decline, with U.S. development assistance falling by 56.9%. But critically, the other top four contributors, Germany, the United Kingdom, Japan, and France, also reduced their aid. This marked the first time all five of the OECD’s top donors simultaneously cut their foreign assistance budgets.

Total ODA dropped from $215.1 billion in 2024 to $174.3 billion in 2025, bringing development assistance to levels not seen since 2015.

Keith Hourihan described this domino effect during his conversation with Dr. Kumar, noting that when the U.S. pulled back, other Western nations followed, compounding the impact of the American withdrawal and leaving a much smaller pool of funding from private foundations and remaining government donors.

Specific Disease and Program Impacts

The consequences are not evenly distributed. The areas most affected are those where USAID funding was most concentrated:

HIV/AIDS: PEPFAR, which was largely implemented through USAID, was supporting antiretroviral therapy for 20.6 million people. Disruptions to treatment supply chains risk viral rebound, drug resistance, and increased transmission.

Malaria Prevention: USAID was the primary funder of bed net distribution, indoor residual spraying, and antimalarial drug access in dozens of countries. The President’s Malaria Initiative, which operated through USAID, contributed to global efforts that have collectively prevented over 1.5 billion malaria infections since 2000, and PMI itself was credited with preventing approximately 185 million malaria cases between 2005 and 2017.

Maternal and Child Health: USAID-supported programs in 25 priority countries had saved 4.6 million children and 200,000 women since 2008. These programs included prenatal care, skilled birth attendance, childhood vaccination, and nutrition support.

Food Security: Programs addressing malnutrition, agricultural development, and emergency food assistance were terminated across dozens of countries, with cascading effects on childhood development and mortality.

How This Compares to Other Government Spending

As Dr. Kumar pointed out in his podcast commentary, context matters when evaluating claims of waste. USAID’s total annual budget of approximately $23 billion represented about 0.6% of the federal budget. In September 2025, the Pentagon spent $93.4 billion in a single month on contracts and grants, the highest single-month spending by any federal agency since at least 2008, according to the government watchdog organization Open the Books. In just the last five business days of that month alone, the Department of Defense spent $50.1 billion, more than the entire annual defense budgets of Israel and Italy.

Practical Takeaways

• A Lancet study of 133 countries found that USAID programs were associated with a 15% reduction in all-cause mortality and prevented an estimated 91 million deaths over two decades, providing strong evidence that foreign health aid works at scale.
• Projections from multiple research teams consistently estimate that current funding cuts will result in millions of additional preventable deaths by 2030, with children under five being disproportionately affected.
• The cuts have triggered a global domino effect, with total OECD development assistance falling by 23.1% in 2025, the largest decline ever recorded, as other donor nations followed the U.S. lead in reducing their foreign aid budgets.

Related Studies and Research

• PEPFAR put 20 million people on HIV treatment and prevented nearly 8 million infected births examines the peer-reviewed evidence on the world’s largest HIV/AIDS program.
• How foreign aid builds soft power: the evidence for health diplomacy reviews research showing that health aid uniquely improves global perceptions of the United States.
• What the data actually shows about fraud in U.S. foreign aid programs separates the political narrative from the audited evidence on fraud rates.

FAQs

How reliable are the projections of 14 million additional deaths?

The projections come from a peer-reviewed study published in The Lancet, one of the most respected medical journals in the world. The researchers used established statistical methods, analyzed data from 133 countries over two decades, and controlled for confounding variables like economic growth and governance quality. While any projection carries uncertainty, the methods are consistent with standard epidemiological forecasting, and the findings align with independent analyses from Harvard, Boston University, and the Center for Global Development.

Could other countries or organizations fill the gap left by USAID?

The OECD data suggests that this is not happening. Instead of stepping up, other major donor nations have also reduced their foreign aid budgets. Total development assistance fell by 23.1% in 2025. While private foundations like the Gates Foundation continue to provide significant funding, their resources are a fraction of what government donors contribute collectively. As Keith Hourihan noted in the podcast, there is currently an overreliance on a much smaller pool of funding.

Did USAID spending actually represent a significant portion of the U.S. budget?

No. USAID’s annual budget of approximately $23 billion represented about 0.6% of total federal spending. Surveys consistently show that Americans believe foreign aid makes up a much larger share of the budget than it actually does. For comparison, the Department of Defense spent $93.4 billion in contracts and grants in the single month of September 2025.

Bottom Line

The peer-reviewed evidence is clear: USAID-funded programs prevented tens of millions of deaths over two decades, and removing that funding is projected to result in millions of additional preventable deaths by 2030. The cascading effect on other donor nations has compounded the impact beyond what the U.S. cuts alone would produce. These findings are not opinions. They are the product of large-scale analyses published in leading medical journals.

Listen to the full conversation on Episode 40 of The Dr Kumar Discovery.

Sources:

• Cavalcanti DM, Rasella D, et al. “Evaluating the impact of two decades of USAID interventions and projecting the effects of defunding on mortality up to 2030." The Lancet. 2025.
• OECD. “International aid fell sharply in 2025." OECD Press Release, April 2026.
• Harvard T.H. Chan School of Public Health. “USAID shutdown has led to hundreds of thousands of deaths." 2026.
• Open the Books. Pentagon September 2025 spending analysis. Published March 2026.