Two decades of humanitarian and development assistance have driven major reductions in preventable deaths worldwide, but ongoing and proposed cuts to global aid funding could reverse that progress and result in millions of additional deaths by the end of the decade, according to an analysis published this week in The Lancet Global Health.
For the study, a team led by researchers from the Institute of Collective Health at the Federal University of Bahia in Brazil examined data from 93 low- and middle-income countries (LMICs) representing 6.3 billion people.
They estimated that higher levels of official development assistance (ODA) were associated with a 23% reduction in age-standardized all-cause mortality and a 39% reduction in deaths among children younger than 5 years across LMICs from 2002 to 2021. The biggest declines were observed for deaths from communicable diseases, including HIV/AIDS (70%), malaria (56%), and neglected tropical diseases (54%). Other significant declines were seen in deaths from tuberculosis, diarrheal diseases, lower respiratory tract infections, and maternal/perinatal causes.
Using forecasting models to look at current defunding trends, the researchers estimate that funding cuts could result in 9.4 million overall deaths worldwide, including 2.5 million among children 5 years and younger, by 2030. In a severe defunding scenario, the authors write, projected overall deaths could reach 22.6 million, including 5.4 million deaths among children younger than 5 years.
Dramatic shifts in global aid policy
The study comes amid a sharp shift in global aid policy. In 2023, total ODA reached a record $250.3 billion, but major donor countries, including the United States, the United Kingdom, Germany, and France, have since announced substantial reductions. These changes mark the first major funding decline in almost three decades.
The dismantling of the US Agency for International Development (USAID) in July 2025 deepened concerns about global assistance, especially for the world’s poorest countries. “The resulting loss in overall USAID funding is currently estimated at nearly 40%,” write the authors. In 2025, the world’s least developed countries “were expected to experience a 13–25% reduction in net bilateral ODA, while countries in sub-Saharan Africa faced potential declines of 16–28%.” Health-specific aid in 2025 was projected to fall by 19 to 33% compared with 2023 levels.
Beyond 2025, the outlook for ODA is uncertain. Preliminary projections as of late 2025 indicate “further substantial reductions” from major donor countries, write the authors, “amounting to an estimated overall decline of 11.3% from 2025 to 2026, and resulting in estimated reductions in ODA funding by 2026—relative to 2023 levels—of 56.1% for the USA, 38.9% for the UK, 36.0% for Germany, 18.5% for France, and similarly large decreases for nearly all other donor countries, with only a few exceptions.”
These cuts could have profound implications for LMICs. Some models project 14.1 million deaths in LMICs by 2030, including 4.5 million deaths among children, if USAID programs remain halted. Other models that looked at a smaller subset of LMICs estimated that an abrupt stop to USAID from 2025 to 2030 could add more than 4 million AIDS deaths, more than 600,000 deaths from tuberculosis, and 2.5 million child deaths, as well as millions of unplanned pregnancies and unsafe abortions.
The findings, write the authors, shine a spotlight on the human toll of rapid aid withdrawal. “Our findings underscore the pivotal contribution of ODA funding to mortality reduction across LMICs over the past two decades,” the authors wrote. Abrupt and sustained reductions, they add, “could have grave repercussions, potentially resulting in a global death toll approaching—or even exceeding—that of the COVID-19 pandemic.”
