Daniella Medeiros Cavalcanti, et al., "Evaluating the impact of two decades of USAID interventions and projecting the effects of defunding on mortality up to 2030: a retrospective impact evaluation and forecasting analysis," The Lancet, June 30, 2025.
To the best of our knowledge, this study is the first to evaluate the impact of USAID funding—including all areas of its humanitarian and development assistance—on mortality, both overall and disaggregated by age and cause, over the past two decades and with projections to 2030. Our findings show that USAID-supported efforts have helped to prevent more than 91 million deaths across all age groups, including 30 million deaths among children. High levels of USAID funding were associated with a 15% reduction in all- age and all-cause mortality, a 65% reduction in mortality from HIV/AIDS, a 51% reduction from malaria, and a 50% reduction from neglected tropical diseases. Substantial decreases were also observed in mortality from tuberculosis, nutritional deficiencies, diarrhoeal diseases, lower respiratory infections, and maternal and perinatal conditions. By age group, the most pronounced reductions were seen in children younger than 5 years (32%). According to the forecasting models, the current steep funding cuts— coupled with the potential dissolution of the agency—could lead to more than 14 million additional deaths by 2030, averaging more than 2·4 million deaths per year. These deaths include 4·5 million among children younger than 5 years, or more than 700 000 deaths annually.
