For the first time in nearly thirty years, the four largest transatlantic donors—the United States, United Kingdom, Germany, and France—are cutting development assistance simultaneously. The consequences, according to peer-reviewed research by the Barcelona Institute for Global Health and partners, could be catastrophic: up to 22.6 million additional deaths by 2030, including 5.4 million children under five.
This is not rhetorical hyperbole. The mortality projections derive from two complementary analyses tracking the relationship between official development assistance (ODA) and health outcomes across low- and middle-income countries. A Lancet study by ISGlobal and UCLA focusing specifically on continued USAID defunding forecasts approximately 14.1 million additional deaths by 2030, including roughly 4.5 million children under five, based on retrospective data from 133 countries between 2001 and 2021. The broader estimate of 22.6 million deaths encompasses the wider donor retrenchment now underway. As the ISGlobal-UCLA team noted, "Our projections indicate these cuts could lead to a sharp increase in preventable deaths… comparable in scale to a global pandemic or a major armed conflict."
The architecture of withdrawal
The OECD's June 2025 outlook provides the structural context. Net ODA is projected to fall a further 9–17% in 2025, following a 9% drop in 2024—a cumulative two-year decline of approximately USD 56 billion against 2023 levels. Eleven Development Assistance Committee members have signalled cuts for 2025–27. The United States alone accounted for a quarter of ODA over the past decade; together, the four major donors represent nearly two-thirds.
Sectoral damage is concentrated in health and humanitarian programming. Health ODA is projected to fall 19–33% below 2023 levels in 2025, sliding to mid-2000s levels. Humanitarian aid faces a 21–36% decline by 2025. For least-developed countries, projected bilateral ODA declines range from 13–25% in 2025; for Sub-Saharan Africa, 16–28%.
The United States shock has been the primary driver. Between January and March 2025, a 90-day freeze and stop-work order led to the cancellation of approximately 83% of USAID programmes, with some reports indicating termination rates exceeding 90% and thousands of staff affected. The global sustainable development financing gap has been estimated at over USD 4 trillion annually according to UN Financing for Sustainable Development reports, with projections suggesting it could reach USD 6.4 trillion by 2030 without systemic reforms. The FY2026 request proposes deep bilateral global health cuts of two-thirds, zero allocations to the Global Fund, Gavi, and WHO, and a 66% reduction in humanitarian funding from FY2025 levels.
Where the cuts land first
Geography matters. The OECD identifies Kenya, Mozambique, Uganda, South Africa, and Tanzania among the top recipients of health ODA, where health accounts for more than 25% of total ODA received—making them acutely vulnerable. The International Rescue Committee's analysis highlights thirteen priority countries where aid cuts intersect with conflict, climate stress, and poverty to magnify systemic risk: Afghanistan, Burkina Faso, Central African Republic, Chad, Democratic Republic of Congo, Ethiopia, Haiti, Mali, Mozambique, Somalia, South Sudan, Sudan, and Yemen.
The pattern is unmistakable: the burden falls hardest on African least-developed countries and fragile states, where health ODA is integral to basic system functioning, not supplementary. In many of these contexts, concessional development finance is the primary external flow, heavily concentrated in social sectors. Abrupt withdrawal is not rapidly substitutable by private capital or domestic revenue mobilization.
Field reports corroborate the projections. In northern Syria, field hospitals have shuttered. In Kenya, rationing of antiretrovirals has been reported. Programmes across Southern Africa have halted. Malaria vaccine trials have paused due to the USAID freeze. The World Food Programme, facing a roughly 40% funding decline, has cut approximately 6,000 staff. UNAIDS is restructuring, with potential secretariat closure by 2030 if funding is not restored.
Crisis.zone has documented how the Sahel crisis has displaced over 4 million people as schools and hospitals collapse, how Sudan's war has become the world's worst humanitarian crisis, and how Chad's humanitarian system is overwhelmed by refugee influx. The ODA contraction now compounds each of these emergencies.
Members are reading: How the multilateral shock absorbers are collapsing—and why the second wave may be deadlier than bilateral cuts.
African agency in a vacuum
African health systems and civil society organizations will carry the immediate burden of these cuts. Regional bodies, national health ministries, and local responders have agency and capacity—but they cannot replace a USD 56 billion two-year shock without coordination, targeted backfill, and policy coherence among remaining donors and domestic actors.
The vacuum also creates geopolitical openings. China stepped up WHO support in 2020; other actors are positioning for influence in humanitarian and development spaces historically dominated by Western donors. Whether these shifts produce sustainable alternatives to transatlantic ODA or simply introduce new dependencies remains an open question.
Policy choices remain available. Donors can reverse course, coordinate strategic backfill to protect highest-impact programmes, and preserve the multilateral cores that enable collective response. Or they can proceed, transforming millions of avoidable deaths from a projection into a deliberate outcome. The Lancet mortality forecasts are not inevitable—they are conditional on continued cuts. The evidence is clear. The decision is political.
Subscribe to our free newsletter to unlock direct links to all sources used in this article.
We believe you deserve to verify everything we write. That's why we meticulously document every source.
