Update on Lives Lost from USAID Cuts

The US was (and remains) the world’s largest funder of global health aid and humanitarian relief. At the start of the year, the Trump administration announced a funding pause followed by widespread cancellation of foreign assistance awards, fueling widespread concern alongside mounting journalistic reports that the cuts were leading to increased morbidity and death. In a CEPR chapter back in June 2025, we calculated that the USAID program cancellations announced by Secretary of State Marco Rubio could contribute to as many as 500,000 to 700,000 additional deaths annually.

In this blog, we report on an update to our earlier estimates of the potential mortality impacts of the administration’s cuts, based on an addendum to the CEPR chapter published this month (December 2025). A similar approach to our original estimates using financial data to the end of the fiscal year suggests that lives lost based on the decline in outlays (current spending) may be in the range of 500,000 to 1,000,000 and potential lives lost based on the decline in obligations (commitments to future spending) are between 670,000 and 1,600,000.

Our forecasts of lives lost from US aid cuts look similar or worse than they did back in June

In the CEPR chapter, we estimated the potential lives lost from Trump’s aid cuts as the product of two separate calculations:

Lives lost = (lives saved per dollar by US foreign aid) x (dollars cut in 2025)

Our estimates of lives saved per dollar combined our own calculations with a variety of estimates from the empirical social science literature on the impact of (primarily US) aid programs including HIV/AIDS treatment, malaria and tuberculosis control, and humanitarian relief. And we estimated the dollar value of aid cuts by sector using foreignassistance.gov data from 2024 and early 2025 on obligations to awards and lists of cancelled and retained awards provided to Congress in March.

While our estimates of “lives saved per dollar” from US aid are, at best, ballpark estimates, they remain unchanged. It is the last term in the formula above that has evolved: how much did the administration actually cut?

The picture remains confusing: since June it has become clear that the list of cancelled and retained awards provided to Congress that we used in our analysis was incomplete and subject to reversal. Awards worth at least $21.8 billion in obligated value as of August this year were still reported active in USASpending.gov (although many are being closed out). In addition, we are unable to directly update our analysis using the previous approach given the complexity of using USASpending.gov and SF133 report data from the Office of Management and Budget (OMB) to update from foreignassistance.gov because ID codes do not match up.

Instead, we use less granular data on the status of FY2025 outlays regarding global health spending, humanitarian relief, and food aid using SF133 reports, alongside FY2025 obligations (a leading indicator with regard to outcomes) and the revised FY2025 and proposed FY2026 federal budgets (again leading indicators). We apply the average cost per life saved across the entire US global health portfolio, weighted by baseline spending amounts. This works out to $3,457 per life saved for health aid. For humanitarian and food aid our estimate remains $17,837.

If spending patterns at the level of the Global Health and humanitarian accounts were reflected at the sectoral level for lifesaving aid, as of end-September our original method would suggest 510,000 deaths from global health cuts over the year looking at outlays at that point compared to 2023, but about one million compared to 2024.

Estimated lives lost in FY25 compared to previous fiscal years, based on outlays and obligations

Source for budget data: USAspending.gov and OMB. We define “humanitarian and food aid” to include the following federal accounts: “International Disaster Assistance, Funds Appropriated to the President, USAID,” “Migration and Refugee Assistance, State,” and “Food for Peace Title II Grants, Foreign Agricultural Service, Agriculture”. Average cost per life saved for global health and humanitarian spending calculated as per text.

Turning to obligations, for global health, 2025 totals were still within the range of previous years (and almost 90 percent of FY2023 levels), but 33 percent below FY2024. Humanitarian and food assistance lagged 2024 obligations by 58 percent. Relative to FY2024, declining obligations to global health implies the potential for 1.1 million lives lost per year if these trends continue. For humanitarian and food aid, the decline suggests the potential for 490,000 lives lost per year, bringing the total lives at risk from aid cuts to 1.6 million lives lost per year if obligations do not revive. Compared to FY2023, this falls to around 670,000 lives lost per year.

The budget picture

Turning to FY2026 and the foreign assistance budget, while there were significant rescissions overall to the FY2025 foreign assistance accounts that may amount to over $10 billion, the global health account saw a cut of only $500 million out of $10 billion originally budgeted. Humanitarian assistance was subject to administration actions which reduced an initial $8.7 billion budget to $5.9 billion. For FY2026, the administration has suggested further severe cuts that could lead to considerably greater mortality in line with our estimates above, but it appears Congress may largely preserve health and humanitarian funding. If obligations follow likely budget availability, any future death toll would be considerably reduced.

Are cuts targeting waste and sparing life-saving aid?

The estimates compared to FY2024 are pessimistic. We are applying average cost effectiveness figures to current cuts, and lifesaving assistance has been at least somewhat prioritized. There is also some evidence of modifications to still extant awards to pick up the slack from cancelled activities, including improving the supply of HIV medications in Kenya, for example.

That said, the average efficacy of foreign assistance outlays in terms of development outcomes including in health has plausibly deteriorated—not least, resources have been diverted from providing assistance to funding USAID shutdown costs that might reach $6 billion according to internal State Department estimates reported in the press. Many lifesaving awards have been terminated. For example, terminated USAID awards were responsible for supporting an estimated 2.3 million people on lifesaving antiretroviral treatment. Extensive award cancellations and payment delays have led to widespread and numerous cases of stock-outs of lifesaving medicines and widespread service suspension. US cuts to the World Food Programme’s operations in Yemen alone ended lifesaving food assistance to 2.4 million people and stopped nutritional care for 100,000 children.

There is on-the-ground evidence of resulting impacts: Rising malnutrition mortality in northern Nigeria, Somalia, and in the Rohingya refugee camps on the Myanmar border and rising food insecurity in northeast Kenya, in part linked to the global collapse of therapeutic food supply chains. Spiking malaria deaths in northern Cameroon, again linked to breakdown in the global supply of antimalarials, and a risk of reversal in Lesotho’s fight against HIV, part of a broader health crisis across Africa.

But perhaps as significantly, between January 21st and the end of the fiscal year, USAspending reported only one new relief award from the International Disaster Assistance account with more than $2 million in obligations issued (a $30 million food assistance grant to the Gaza Humanitarian Foundation in June). There have been no other awards made to respond to new or expanded humanitarian emergencies. The pattern of very few new sizeable awards is repeated across foreign assistance more broadly, and increasingly that (rather than award cancellations) is the driving force behind lower obligation and outlay numbers.

Are others stepping in to fill the gaps USAID left?

Another way in which we may be pessimistic here is by ignoring the global response to the US retreat from foreign aid. The estimates we report above are based on what we called, in our original chapter, “gross lives saved,” i.e., before allowing for any compensating response by other donors or national governments.

The prospect of other donors filling in the gaps left by USAID is undercut by the fact that foreign aid budgets are in decline in many other donor countries as well. The OECD estimates an overall decline in overseas development assistance in 2025 of 9–17 percent, including 16–28 percent for sub-Saharan Africa. They forecast that “health funding could drop by up to 60% from its 2022 peak” (about 20 percent from pre-pandemic levels).

In South Africa, the country with the largest absolute number of people receiving treatment under PEPFAR awards that have been cancelled, the government has pledged additional funding to maintain treatment provision.

In Nigeria, lawmakers responded quickly to USAID’s suspension of health programs with a supplemental health budget of $200 million, with a focus on immunization and epidemic response. Minister of Health Mohammed Pate noted, “We appreciate the billions of dollars in support from the US government over the years, but the responsibility to provide healthcare for our citizens ultimately rests on us.”

The speed and scale of Nigeria’s response has been fairly exceptional among countries at similar income levels. Even so, it is only partial. According to (again, partial) data from foreignassistance.gov, from FY24 to FY25 the flow of American health aid to Nigeria may have fallen by about $500 million.

Conclusion

The enormous caveat that must be attached to any discussion of the health and humanitarian impacts from aid cuts is that we lack direct, systematic data from the ground on what has happened to the pipeline of US lifesaving assistance. Aggregate information on delivery of the two largest US bilateral global health programs remains unavailable: for malaria, the PMI.gov website is still down, and for HIV/AIDS there is no recent monitoring and evaluation data for PEPFAR. Without this information and representative survey work of beneficiaries, any estimates of lives lost remain guesswork. But there has been well-documented and extensive disruption of life-saving programs, and destruction of implementation capacity both within USAID and implementing partners, which is not well-captured in aggregate spending figures. While quantification is difficult, there is little doubt many people have died as a result, and without action many more will die in the future.