Jeremy Lewin is 28 years old, but he argues like a fifteen year old in a bottle. In his speechthis rising star of American foreign policy combines the falsehoods and extractivism of the Trump doctrine with an astonishing ignorance of history and geopolitics, which often leads him to put himself in the position of victim: “We have been the linnets of the global system for so long,” he says. His contempt for international organizations and the public sector is rivaled only by his canine servility towards the president and the admiration he professes for Elon Musk, in whose administrative demolition unit – known as the Department of Government Efficiency, DOGE – he cut his teeth. What he learned in those months will have consequences for decades.
By now in the party we have healed from the fear of the new American administration, but Lewin’s case has particular relevance: since last July 11th he has held the position of undersecretary for “Foreign aid, humanitarian affairs and religious freedom”, at the helm of what was previously the national agency for development cooperation (USAID). And his declared plan is the demolition and reconstruction according to specific plans of a system on which today the survival of entire populations literally depends. In the field of global health alone, the dismantling of the US cooperation system will have devastating consequences: according to our calculations, 14 million more people – a third of them under the age of 5 – will lose their lives between now and 2030 if the Trump administration keeps its promise to cut aid by 83%. A large part of these deaths can be explained by the interruption of childhood vaccination programs, the blocking of the distribution of antiretrovirals against HIV or the disappearance of rural programs against malaria.
In the short time since this first study was published, it has become clear that Trump is not alone in his drift, nor are these changes a temporary problem. The topics are variations of the same melody. Where Lewin describes an existential conflict between the interests of American taxpayers and those of the “global humanitarian fabric”, British Prime Minister Keir Starmer supports cutting aid to finance military spending. in a single movement qualified defined by US Secretary of War Pete Hegseth as “a decisive step from a reliable partner”, this unlikely Labor government announced a cut of at least 40% in development aid budgets. In the case of France, the reasons are more conventional but no less unappealable: if Macron’s budget sobriety plans go ahead, the French government they will reduce their cooperation budgets in over 700 million euros, in contravention of the law approved by Parliament only four years ago. Adding to this equation the case of Germany, which is also reducing funding citing economic difficulties, it will be the first time that the four largest donors have reduced their aid for two consecutive years, returning the system to 2020 financial levels.
The scale of this predictable and avoidable tragedy risks taking on pandemic dimensions and has become a symbol of the nationalist and transactional logic that spreads like a plague
Whether due to ideology, warmongering or austerity, the result of these and other cuts will be identical: the world proposed by the former global development powers will be poorer, sicker and more insecure. In the immediate term, their decisions will cause the suffering of hundreds of millions of people, some of whom will not live to tell the tale.
Once all donor countries’ cooperation reduction scenarios are incorporated, our new analysis suggests that the number of avoidable deaths will rise to 22 million humans. Of these, 5.4 million will be boys and girls under 5 years old. This figure is three times the number of children of that age living in Spain. The scale of this predictable and avoidable tragedy risks taking on the dimensions of a pandemic and has become a symbol of the nationalist and transactional logic that is spreading like a plague and at breakneck speed through the international community.
Curiously, you don’t have to wear a MAGA hat to recognize that international aid needs major reform. It is undoubtedly possible to conceive better models, better managed and more suited to people’s true priorities. But this sudden pendulum has nothing to do with it. As I remembered a recent report from the magazine The economist, the idea that poorer states are responsible for a larger share of their health care spending “In theory this is very good, but in practice many people will die if aid is reduced”. In countries like Somalia, South Sudan or Liberia, only US bilateral cooperation has equaled or doubled all the investments in healthcare made by the states themselves. The digital magazine Devex he started collecting information on documented cases where US aid disappears with no alternative but emptiness, suffering and chaos: from spikes in childhood malaria in Cameroon and the Democratic Republic of Congo, to girls forced to drop out of school in Uganda or food shortages for Syrian refugees.
At stake is sustaining or reversing three of the most extraordinary decades of human progress
Each of these programs depends on healthcare systems that cannot be repaired like an old washing machine. Even if the funds returned in a few years, the relative cost of reconstruction would be infinitely higher than that of a controlled transition today. Beyond rhetorical devices, what is at stake is to support or retrace three of the most brilliant decades of human progress, where the concerted action of public and private actors managed to reduce infant mortality levels by less than half and save dozens of countries from medieval levels of life expectancy.
This is the truly relevant question on the table of international leaders who will meet this week in South Africa for the G20 summit. Very consciously, the meeting coincides, in time and space, with the financial reconstitution ceremony of the Global Fund to fight AIDS, tuberculosis and malaria, whose future embodies all the seriousness of the debate. Too steep a decline in the Fund’s budgets over the next three years – something that has already happened to the Global Alliance for Immunization (GAVI), which raised 25% less than expected in June – would send a disturbing message to the people who depend on its programs. The NGO Doctors Without Borders has just published a disturbing relationship which describes the practical consequences that a weakened Global Fund would have for 26 million people who today depend, for example, on their antiretroviral drugs.
Equally important, none of the governments that are reducing their cooperation budgets appear to be assessing the wider consequences of their decisions. For countries in the Global South, the message is that we have entered a new era in which collective responsibilities and aspirations, such as health, have been totally replaced by short-term national interests. Five years after a devastating pandemic and in the midst of a forced displacement crisis that knows no borders, giving up on jointly managing these challenges seems like a huge mistake.
Hope lies in initiatives that seek to reconsider, rather than destroy, the architecture of development financing and governance. One of the most important is occurring in the field of global health and Spain – which has increased its contributions to the Global Fund – he was fully involved in this process, which gained cruising speed after the Seville Financing Summit. Its mere existence demonstrates that Lewin’s is not the only possible vision of the future.
