The Trump administration is formally shutting down the United States Agency for International Development today, after cancelling 83% of its programs earlier this year.
The administration says the agency has misspent billions in funds and "has little to show since the end of the Cold War."
That argument clashes with a new study published Monday in the medical journal, the Lancet. The study estimates that USAID programs have saved over 90 million lives over the past two decades. The researchers also estimate that if the current cuts continue through 2030, 14 million people who might have otherwise lived could die.
"Is [USAID] a good use of resources? We found that the average taxpayer has contributed about 18 cents per day to USAID," says James Macinko, a health policy researcher at UCLA and study co-author. "For that small amount, we've been able to translate that into saving up to 90 million deaths around the world."
Since USAID was formed in 1961, it's funded a wide range of programs, from giving school lunches to children in Haiti to distributing HIV medication across sub-Saharan Africa. While many studies have analyzed narrower slices of USAID's portfolio, including maternal mortality and child health, no peer-reviewed research had attempted to take stock of the agency's overall impact.
As the Trump administration started cutting programs, Macinko and researchers from Europe, South America and Africa got to work assessing just what USAID's impact has been.
"What we really tried to draw out was, how did the funding from USAID influence a set of outcomes?" says Macinko. "We were most interested in looking at mortality, to really be able to quantify the impact of these investments."
The team analyzed demographic and death data from 133 different countries that received aid between 2001 and 2021. By comparing deaths across countries that received low, medium and high amounts of USAID aid — while accounting for differences in population, income, education and other non-aid factors — the team was able to estimate the human effects of that aid.
And those effects were substantial. They found that high levels of USAID funding were associated with a 15% reduction in deaths from any cause, across all ages. For children under five, the percentage more than doubled to 32%.
"Once you translate that 15% reduction into the number of lives, it actually represents 91million deaths averted," says Macinko. "When we saw that number, we were indeed surprised."
Digging into the data further revealed that USAID programs were associated with the biggest reductions in deaths from HIV/AIDS, malaria, and neglected tropical diseases such as dengue or chikungunya. Smaller, but still statistically significant reductions in mortality were seen for tuberculosis, nutritional deficiencies, diarrhoeal diseases, maternal and perinatal conditions and lower respiratory infections.
The Trump administration's abrupt and steep cuts to foreign aid have halted most of USAID's programs. To estimate how many lives could be affected by the dismantling of the agency going forward, the researchers used what they'd learned in the retrospective analysis to estimate how many preventable deaths might occur if the current USAID cuts become permanent. If that happens, they estimate that somewhere between 8 and 19 million people could die, including 4.5 million children, by 2030.
"Even if you take the most conservative estimate, these are still really significant in terms of lives lost," says Macinko.
A State Department official who briefed reporters said that "these sorts of studies are based on incorrect assumptions about what Secretary Rubio intends to and has done to foreign assistance. I think he's been very clear that a lot of the life saving work that we do will continue and will be made more efficient."
Overall, the study fills a major gap in providing a "birds-eye view" of USAID's impact, says Brooke Nichols, an infectious disease modeler at Boston University who wasn't involved in the study.
"I like their statistical approach, it was really well done and robust," she says, noting that analyzing the impact of so many programs across so many countries is challenging. Death data isn't perfect in many countries, which adds some uncertainty.
While USAID is often the biggest foreign aid donor, other nations and organizations also contribute. If contributions from other groups are correlated with USAID funding in a particular country, it could be hard to parse the specific impact of USAID, she says. Still, she praises the timeliness of the study.
"The value of the retrospective work is helpful to show the world what can be done with concerted effort, bipartisan support … to show just how much impact you can have," she says.
Putting numbers to the lives that could be lost if funding isn't restored does something very important, she says. It highlights the costs that policy decisions can have on human lives.
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