The calculations are increasingly alarming. A new study by the Barcelona Institute for Global Health (ISGlobal) has quantified that 22.6 million people – almost half of Spain – will die between now and 2030 if the sharp decrease in official development assistance (ODA) continues, i.e. subsidies and loans granted by countries, international NGOs and multilateral institutions to the official sector of low- and middle-income countries or in crisis situations. If the prediction comes true, the lethality will be higher than that of the Covid 19 pandemic. According to estimates by the World Health Organization (WHO), between 2020 and 2021 there were 14.9 million more deaths in the world.
Although several calculations have been made in recent months on the lethal effect of the dismantling of the US cooperation agency USAID, this is the first time that a group of researchers has calculated how many lives have been saved by different funders such as USAID, the Global Fund or the States in the last 20 years and how much would be lost in a “severe” cuts scenario and in a slightly more “moderate” one.
Davide Rasella, ISGlobal researcher and lead author of the study, explains that moderate simulation “is the most likely scenario”. This includes the 2025 cuts plus an annual funding reduction of 10.6% between 2026 and 2030. This will produce 9.4 million deaths, the equivalent of wiping out all of London. “Even if a 10% annual reduction doesn’t seem like much, we are talking about huge (death) numbers,” Rasella says in a video call interview with EL PAÍS.
The severe cuts scenario, which includes the sharp reduction of funds in 2025 and a “substantial” annual decrease between 2026 and 2030, would produce 22.6 million avoidable deaths, of which 5.4 million would correspond to children under five years of age. “We simulate this scenario because we are in a polycrisis and because we want to show what happens when a sudden dismantling occurs,” adds the epidemiologist and public health doctor.
The study seeks to measure the impact of the dismantling of USAID ordered by Donald Trump in January and the cuts announced by countries such as the United Kingdom, Germany, France, the Netherlands and Belgium in cooperation to redirect resources towards military spending and other sectors.
To calculate the impact on future mortality, ISGlobal first measured the benefits of aid in the past. To do this, researchers analyzed how many lives were saved between 2002 and 2021 thanks to APS contributions. Using this data, they projected how many lives would continue to be saved through 2030 if funding remained unchanged. And, then, they calculated what would happen if APS was reduced by different percentages: hence the number of additional deaths.
ISGlobal took into account not only cuts to global health programs, but, in general, to the humanitarian aid, social services and infrastructure sectors. “We firmly believe that education, food support or sanitation are part of the great impact of APS,” says Rasella.
ISGlobal, with funding from the Rockefeller Foundation, analyzes the impact of cuts in different countries. “In Mozambique,” Rasella quotes, “a sort of collapse is occurring in various sectors of the health system.” Caterina Monti, co-author of the study, explains, also via video call, what she saw in Somalia at the beginning of the year. “USAID sponsored a community surveillance program in Somalia that detected diseases with epidemic potential and notified regional health authorities. This no longer exists and we will not see the consequences until the next epidemic is declared,” he says.
The study is published on the eve of the replenishment of the resources of the Global Fund to fight HIV/AIDS, tuberculosis and malaria. The international organization seeks to raise $18 billion for the 2027-2029 funding cycle. However, the already announced reduction of the contributions of the United Kingdom and Germany and the silence of the United States raise fears that the objective will not be reached.
Although the dismantling of USAID – and the end of 83% of its programs – ordered by Donald Trump marked the beginning of sharp cuts to development aid during 2025, it is also true that the decline in resources began five years ago. According to the Organization for Economic Co-operation and Development (OECD), between 2021 and 2022, grants to developing regions decreased by 8%, while loans increased by 11%.
Now, in 2025, and for the first time in 30 years, the United States, France, Germany and the United Kingdom – the countries that have led contributions to ODA – will simultaneously cut their aid for two consecutive years. It is estimated that total ODA funding in 2025 will be reduced by 21% compared to 2023.
USAID sponsored a community surveillance program in Somalia that detected diseases with epidemic potential and reported them to regional health authorities. This no longer exists and we will not see the consequences until the next epidemic is declared.
Caterina Monti, co-author of the study
Researchers estimated that between 2002 and 2021, higher levels of ODA funding were associated with a 23% reduction in overall mortality and a 39% reduction in child mortality in 93 low- and middle-income countries. These investments also reduced mortality from HIV by 70%, malaria by 56% and nutritional deficiencies by 56%. Furthermore, the study concludes, there was a significant reduction in mortality from tuberculosis, diarrheal diseases, respiratory diseases and maternal and perinatal causes.
This progress is what is at risk. The study warns that not only will the humanitarian consequences likely be “devastating,” but “the medium- and long-term consequences for public health, economic development and social stability could be even more important.”
There has been no transition strategy and we need to think about how to implement it in a more compatible and respectful way so as not to harm the population.
Davide Rasella, ISGlobal researcher
ODA, the researchers point out, has not only served to address crises and inequalities in countries, but also to strengthen and maintain health systems so that they are able to control and eradicate diseases and deal with outbreaks and epidemics. Monti explains that withdrawing funding in this case implies “eliminating one or more parts of the puzzle” of the system and that the real consequences will be seen in the long term.
ISGlobal researchers urge donors not to abruptly withdraw funding. “There was no transition strategy and we need to think about how to implement it in a more compatible and respectful way so as not to harm the population,” says Rasella and warns that changes in ODA must take into account the current situation in the beneficiary countries. “The majority spends more on repaying their debts than on education and healthcare,” he recalls, “if we don’t do it carefully, there will be enormous avoidable mortality.”
