On June 30, 2025, The Lancet published the first large estimate of what the shutdown of the US Agency for International Development will cost in lives. The team, from the Barcelona Institute for Global Health, UCLA and partners in Brazil and Mozambique, first measured what USAID had done, then projected what its absence will do.
What USAID did
Using data from 133 countries over 2001 to 2021, the authors estimate that USAID-funded programs prevented about 92 million deaths, including more than 25 million from HIV/AIDS, around 11 million from diarrheal disease, 8 million from malaria and nearly 5 million from tuberculosis. Countries receiving high levels of USAID support saw all-cause mortality fall about 15% more than those receiving little, and under-5 mortality about 32% more.
What the cuts are projected to cost
In March 2025 Secretary of State Marco Rubio announced that 83% of USAID’s programs had been cancelled. Modeling the continuation of that policy through 2030, the authors project more than 14 million additional deaths, about 4.5 million of them children under five.
How to read a number like this
It is a projection from a statistical relationship, not a count, and it assumes no one steps in. Both of those cut in the direction of overstating the final toll: other donors and recipient governments will replace some of the money, and some cancelled programs were less effective than the average. Working against that: the cuts landed mid-year with no wind-down, so clinics closed and drug stocks ran out faster than any orderly reduction would have caused.
A reasonable reading is that the true figure is in the millions, that the uncertainty is large, and that no plausible amount of private philanthropy replaces it.
What that means for a private donor
Not that giving is pointless. The opposite: when a field loses most of its funding at once, the marginal dollar buys more, because the cheapest life-saving work is suddenly unfunded next to the merely useful.
The programs with the strongest evidence of cost per life saved sit inside the cut areas. GiveWell’s four top charities work on malaria (bed nets, seasonal preventive medicine), vitamin A supplementation and routine childhood vaccination, at estimated costs of $3,500 to $5,500 per life saved. Each reported room for more funding before the cuts. Each has more now.
Three practical points:
- Prefer programs with a measured cost per outcome over general emergency appeals. Both are legitimate; only one lets you know what your gift did.
- Do not wait for year end. Programs that lost funding in March are running down stocks by autumn.
- Ignore the argument that private giving lets governments off the hook. The hook, in this case, has already been removed. Your gift and your vote are separate tools; for the second one, Elections Simplified lists every race on your ballot with each candidate’s record.
Method notes
All figures are from the Lancet paper as summarized by UCLA and NBC News. GiveWell figures are its 2022 to 2024 averages.
Sources
Figures come from the cited sources as of the dates shown. Cost-effectiveness estimates change as programs and evidence change; check the source before giving. We are not financial advisers and receive nothing from any charity named here.