The US Agency for International Development (USAID) is the largest funding agency for humanitarian and development aid worldwide. The aim of this study is to comprehensively evaluate the effect of all USAID funding on adult and child mortality over the past two decades and forecast the future effect of its defunding.
Findings
Higher levels of USAID funding -- primarily directed toward low-income and middle-income countries (LMICs), particularly African countries -- were associated with a 15% reduction in age-standardised all-cause mortality and a 32% reduction in under-five mortality. This finding indicates that 91 839 663 all-age deaths, including 30 391 980 in children younger than 5 years, were prevented by USAID funding over the 21-year study period. USAID funding was associated with a 65% reduction in mortality from HIV/AIDS (representing 25·5 million deaths), 51% from malaria (8·0 million deaths), and 50% from neglected tropical diseases (8·9 million deaths). Significant decreases were also observed in mortality from tuberculosis, nutritional deficiencies, diarrhoeal diseases, lower respiratory infections, and maternal and perinatal conditions. Forecasting models predicted that the current steep funding cuts could result in more than 14 051 750 additional all-age deaths, including 4 537 157 in children younger than age 5 years, by 2030.
Higher levels of USAID funding -- primarily directed toward low-income and middle-income countries (LMICs), particularly African countries -- were associated with a 15% reduction in age-standardised all-cause mortality and a 32% reduction in under-five mortality. This finding indicates that 91 839 663 all-age deaths, including 30 391 980 in children younger than 5 years, were prevented by USAID funding over the 21-year study period. USAID funding was associated with a 65% reduction in mortality from HIV/AIDS (representing 25·5 million deaths), 51% from malaria (8·0 million deaths), and 50% from neglected tropical diseases (8·9 million deaths). Significant decreases were also observed in mortality from tuberculosis, nutritional deficiencies, diarrhoeal diseases, lower respiratory infections, and maternal and perinatal conditions. Forecasting models predicted that the current steep funding cuts could result in more than 14 051 750 additional all-age deaths, including 4 537 157 in children younger than age 5 years, by 2030.
Interpretation
USAID funding has significantly contributed to the reduction in adult and child mortality across low-income and middle-income countries over the past two decades. Our estimates show that, unless the abrupt funding cuts announced and implemented in the first half of 2025 are reversed, a staggering number of avoidable deaths could occur by 2030.
-- Daniella Medeiros Cavalcanti, PhD et al, The Lancet "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" (30 June 2025)
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