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Steep cuts to the US Agency for International Development threaten to cause more than 14mn extra deaths by 2030 and reverse some gains made against diseases such as HIV/Aids, malaria and respiratory infections, new research has warned.
The slashed funding to the agency — which former presidential adviser Elon Musk boasted of feeding “into the wood chipper” — could lead to 4.5mn young children dying who would otherwise have lived, according to the paper published in the Lancet late on Monday.
The study highlights alarm about the impact of the US retreat from efforts to combat deadly diseases and promote wider public health improvements. Washington has long been a leading donor to low- and middle-income countries.
‘‘This structural defunding could represent one of the most significant setbacks to global health in decades,” said Davide Rasella, co-author of the Lancet paper and a professor at the Barcelona Institute for Global Health.
“It risks causing millions of preventable deaths, particularly among the most vulnerable, and reversing progress in health and socio-economic development,” he said.
The researchers used mortality data from 133 countries and territories to estimate the impact of all USAID funding on all mortality from 2001 to 2021. They then evaluated the deaths by age- sex- and cause-specific groups, using the findings to predict the impact of funding cuts between this year and 2030.
The Lancet research was a reasonable effort to quantify the impact of the sudden US policy shift despite inevitable uncertainties around the predictions, other researchers said. Still, source data might be patchy, while all modelling has inherent uncertainties because by definition it deals with events that have not happened, they said.
USAID-funded programmes prevented about 91.8mn deaths over the period studied, the paper says. That includes a reduction in HIV/Aids deaths by almost two-thirds, corresponding to 25.5mn people. The programmes saved another 31mn people from malaria, diarrhoeal diseases, neglected tropical diseases and lower respiratory infections, according to the calculations.
The researchers expect between 1.78mn and 2.5mn more deaths a year between 2025 and 2030 than historically, based on an estimated scenario of current and future USAID defunding.
US secretary of state Marco Rubio said in March that 83 per cent of USAID programmes would be cancelled, with the remainder to be administered by his department. USAID spent about $42.4bn in 2023, according to the last full year official figures. The agency’s total long-term funding reduction remains uncertain, with some of the cuts being challenged in the courts.
US health secretary Robert F Kennedy Jr announced last week that the US would stop funding the Gavi international vaccine alliance historically paid for via USAID. The US contributed $300mn last year.
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“Whether [the estimates] are out by 2 per cent or 20 per cent shouldn’t detract from the central fact that USAID was a colossal funder of essential health services in the world’s poorest countries,” said Luke Allen, co-director of global primary care at the University of Oxford. Allen is also a consultant to the World Health Organization, which the US has given notice it will leave early next year.
The new US approach to international collaborations and partnerships “has and will cost lives”, said Michael Head, senior research fellow in global health at the UK’s University of Southampton. “Whilst few people would argue against the idea that global health funding needs reform, even fewer would suggest that this sudden withdrawal of large volumes of funding is the way to go about it.”
The US state department did not immediately respond to a request for comment.