Trump closing U.S.A.I.D. could cost an estimated 14 million lives by 2030

Kevin ClarkeJuly 02, 2025

Workers unload food commodities from Catholic Relief Services and USAID in the village of Behera, near Tulear, Madagascar, Oct. 22, 2016. (OSV News Photo/Nancy McNally, Catholic Relief Services)

Though its near clandestine dismantling by Elon Musk occurred months ago, the U.S. Agency for International Development’s 64-year institutional life officially concluded on July 1, when its remnant operations were turned over to the Department of State. In February, more than 80 percent of the contracts administered by U.S.A.I.D. were canceled by the Trump administration. That meant the end of thousands of hunger-relief, health care and peace- and democracy-building efforts in more than 130 countries.

Bill O’Keeke is Catholic Relief Services’ executive vice president for mission and mobilization. He reports that C.R.S. terminated over 90 programs and laid off more than 3,000 staff members in the wake of the demolition of U.S.A.I.D. “And our church partners have also really taken a very serious, serious hit because of the depth of these cuts.”

Looking ahead, he says, if the State Department is indeed going to assume humanitarian obligations once shouldered by U.S.A.I.D., “there needs to be adequate technical, managerial and accountable capacity to manage high-quality programs that the American people can be proud of…and there also needs to be adequate funding.”

Unfortunately, at this moment, there is little sign of that happening. In fact, Congress and the Trump administration are already backtracking on commitments made in March to humanitarian spending for 2025. “They’re killing the future by rescinding the money they just approved,” he said.

“Killing the future” turns out to be a painfully apt phrase. The formal termination of U.S.A.I.D. this week has been accompanied by the release of a grim assessment of the likely impact of that sudden shift in U.S. humanitarian commitments. The analysis, published in the venerable U.K. medical journal The Lancet, warns that the end of U.S.A.I.D. will result in the loss of a “staggering” 14 million lives by 2030, including the deaths of 4.5 million children under age 5.

The report’s authors, medical researchers from the United States, Spain, Brazil and Mozambique, conclude: “Current and proposed US aid cuts…threaten to abruptly halt and reverse one of the most important periods of progress in human development.” They say “the resulting shock” from the loss of U.S. assistance “would be similar in scale to a global pandemic or a major armed conflict. Unlike those events, however, this crisis would stem from a conscious and avoidable policy choice—one whose burden would fall disproportionately on children and younger populations, and whose consequences could reverberate for decades.”

According to the report, over the course of the last two decades, U.S.A.I.D. programs saved almost 92 million lives, including the lives of 30 million children under 5. The study found that higher levels of U.S.A.I.D. funding for programs in low- to middle-income nations, particularly in Africa, were associated with a 15 percent reduction in all causes of mortality across all age groups and a 32 percent reduction in under-5 mortality.

U.S.A.I.D. funding was associated with a 65 percent reduction in mortality from H.I.V./AIDS, preventing 26 million deaths; a 51 percent reduction in deaths from malaria, representing eight million lives; and a 50 percent reduction in mortality from neglected tropical diseases, saving about nine million lives.

The researchers add: “Significant decreases were also observed in mortality from tuberculosis, nutritional deficiencies, diarrhoeal diseases, lower respiratory infections, and maternal and perinatal conditions.”

Those who cheered the agency’s institutional dismemberment seemed not to notice that global impact, highlighting instead alleged fraud or malfeasance in the awarding of programmatic grants. But so far, Mr. Musk’s Department of Government Efficiency and the Trump administration have managed to produce little evidence of either problem, just programs they did not like for one ideological reason or another. And purported cost-saving of billions has likewise not materialized.

In fact, shutting down the agency without a plan to replace it has resulted in the abandonment and spoilage of significant food and medical reserves and an additional $6 billion in costs, according to an internal memo delivered on June 3 to Secretary of State Marco Rubio, viewed by Bloomberg Government.

A recent report from The New York Times tracked the chaotic demise of U.S.A.I.D. after it had proved an easy demonstration target for DOGE. The incoming administration just about stumbled into the agency’s deconstruction, responding to the juvenile pique of Mr. Musk, who joked about feeding U.S.A.I.D. “into the wood chipper.” In the end, there had been no attention to the practical and completely predictable consequences of the sudden termination of U.S.-funded humanitarian programs.

The agency has always been a favorite target of alleged budget hawks, but its comparably tiny budget—in a given year typically less than 1 percent of total U.S. spending and only about half of that devoted strictly to development or humanitarian assistance—means that even the complete shutdown of U.S.A.I.D. has had a negligible impact on America’s fiscal imbalances.

What the agency represented, however, was a small, wise investment in peacemaking and in mitigating grave human suffering and deprivation.

Prior to the DOGE rampage, the United States had been the world’s largest single donor to humanitarian assistance, funding programs to combat hunger and premature deaths because of preventable or treatable illness, offering lifelines and stability to fragile nations around the world. U.S.A.I.D. had been the primary agent of so-called soft power, the use of nonmilitary force that acts as an expression of national goodwill. With the United States removed from that arena, critics of the Trump administration’s improvisational approach to diplomacy and international assistance warn that China will quickly step in.

Catholic Relief Services had been the largest faith-based subcontractor for U.S.A.I.D. Over decades its work in scores of developing nations has been partly or fully funded by the U.S. agency. The abrupt contract terminations led to substantial reductions in C.R.S. programs around the world that affected more than 20 million people.

In a statement released in March, C.R.S., like other agencies that had worked with U.S.A.I.D, reported that the sudden halt to government payments meant “food in warehouses could not be distributed to the hungry and women and children could not get vital health and nutrition services.”

“These programs do more than save lives,” C.R.S. said. “They help lift communities and countries out of poverty. They support local faith-based and church partners that provide services and stability to their communities and to their countries.”

“By ending these life-saving programs, our government is not only neglecting our nation’s responsibility, but also weakening the very foundations of peace, stability and prosperity,” C.R.S. said. “We urge the administration to reverse these terminations and issue prompt payments to continue this life-saving and life-giving assistance.” And in that urging there lies a degree of hope as we consider this week the implications of the report from The Lancet. The avoidable deaths that its researchers project are just that: projections of what may come unless there is a course correction from the United States and the Trump administration.

The administration may have hoped to secure its “America first” and fiscal-responsibility bona fides when it began the institutional purge of U.S.A.I.D. on Jan. 20. Can it acknowledge now that it was never the plan or the intention to risk so many lives among the world’s most vulnerable populations—people enduring conflict and climate change deprivations in Sudan and Honduras, people confronting poverty and disease in South Africa and Uganda?

Is it permissible now to get on with the work, long supported by the general public, of investing a small portion of the wealth of this great nation into the preservation of lives and communities around the world?

After these last calamitous weeks, it is not too late to come up with mitigating responses. “The question is: What is in the pipeline for the future?” Mr. O’Keefe asks. “How are we going to meet the needs of the coming hurricane season? What happens if there’s a tsunami or an earthquake, and what happens if the conflicts that we all hope will end don’t?”

Those crises, he says, represent “huge human need.”

“And while we all want other governments to do more, the United States, as the richest, most powerful country, has a moral responsibility in Catholic teaching to step up.” He worries instead, “it’s stepping back.”

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