Cuts in global aid could reverse decades of progress in health and development

1. Follow-up to previous findings on USAID funding cuts
2. ODA saved millions of lives; now millions are at risk
3. An unprecedented contraction in aid
4. A wake-up call for the international community

The rapid decline in Official Development Assistance (ODA) could lead to more than 22 million additional deaths by 2030, including 5.4 million children under the age of five, according to a new study led by the Barcelona Institute for Global Health (ISGlobal), with support from The Rockefeller Foundation through its charitable organisation RF Catalytic Capital.

The findings show that current cuts in global aid not only threaten humanitarian and development programmes, but could also undo decades of progress in reducing preventable mortality in low- and middle-income countries (LMICs).

The study, "The Impact of Two Decades of Humanitarian and Development Assistance and the Projected Mortality Consequences of Current Defunding to 2030: Retrospective Evaluation and Forecasting Analysis‘, was conducted by researchers from ISGlobal (Spain), a centre promoted by the ’la Caixa" Foundation, the Institute of Collective Health at the Federal University of Bahia (Brazil), the Manhiça Health Research Centre (CISM) and the National Institute of Health (INS) in Mozambique. The research, currently available in preprint format, combines a retrospective analysis of the health impact of ODA between 2002 and 2021 with projection models up to 2030, which estimate mortality in current and future scenarios of funding cuts.

‘These results reveal the enormous contribution of international aid to global health over the last two decades,’ says Davide Rasella, study coordinator and ICREA researcher at ISGlobal. "The abrupt contraction in ODA funding could have serious repercussions, leading to substantial increases in preventable deaths among adults and children in the coming years. Beyond the immediate human impact, it could also critically undermine the achievement of the Sustainable Development Goals (SDGs) by 2030."

Follow-up to previous findings on USAID funding cuts

This work expands on a previous study led by ISGlobal, published earlier this year, which estimated that the dismantling of the United States Agency for International Development (USAID) could cause more than 14 million additional preventable deaths by 2030. Both analyses apply the same methodological framework, integrating longitudinal data with country-level validated microsimulation models to quantify the health consequences of funding reductions. While the USAID study focused on a single donor, this new analysis covers all OECD contributors, providing a comprehensive assessment of the impact that cuts would have on mortality.

ODA saved millions of lives; now millions are at risk

Using this approach, the research team found that ODA has had a measurable and sustained impact on global health. Between 2002 and 2021, higher levels of funding were associated with a 23% reduction in mortality from all causes and a 39% decrease in child mortality in 93 low- and middle-income countries. Aid investments were particularly effective in reducing deaths from HIV/AIDS (70%), malaria (5%) and nutritional deficiencies (56%), as well as achieving significant reductions in mortality from tuberculosis, diarrhoeal diseases, respiratory infections, and maternal and perinatal causes.

Beyond its direct impact, ODA has been essential in strengthening and sustaining health systems, supporting disease control and eradication programmes, and improving preparedness for outbreaks and epidemics.

However, simulations show that the current wave of cuts, driven by sharp reductions in the United States, the United Kingdom, France and Germany, among others, could reverse these gains. In a scenario of severe cuts, the study projects 22.6 million additional deaths by 2030, while even a moderate scenario could cause 9.4 million preventable deaths. The magnitude of this impact is comparable to a global crisis. At the peak of the COVID-19 pandemic, there were an estimated 14.9 million excess deaths worldwide, according to the World Health Organisation. Mortality associated with current cuts could even exceed that figure.

An unprecedented contraction in aid

‘ODA, which accounts for the bulk of international funding for development and humanitarian action, supports key sectors such as health, education, water and sanitation, and food security,’ says Andrea Ferreira da Silva, a postdoctoral researcher at the Institute of Collective Health (ISC) in Brazil.

For the first time in nearly 30 years, the United States, France, Germany and the United Kingdom have reduced their ODA contributions in 2024. If they also implement the cuts announced for 2025, it will be the first time in history that all four countries have cut ODA simultaneously for two consecutive years. The dismantling of USAID alone represents an estimated 83% reduction in its programmes, cutting total US aid by approximately half, while total ODA funding is estimated to fall by 21% in 2025 compared to 2023.

‘This is not just a budget issue,’ says Claudia García-Vaz, policy analysis coordinator at ISGlobal. "It is a matter of life and death for millions of people. Cuts in global aid are a moral catastrophe and a drag on global prosperity.‘ Ariel Nhacolo, senior demographer at CISM in Mozambique, adds: ’Abrupt cuts in ODA are already severely affecting the most vulnerable."

A wake-up call for the international community

‘Development aid remains one of the most effective tools for saving lives, strengthening health systems and reducing poverty,’ stresses Rodrigo Volmir Anderle, postdoctoral researcher at ISC. The research team urges donor countries and international organisations to urgently reconsider current funding decisions, cover the shortfall and reaffirm their commitment to the SDGs. ‘The sudden withdrawal of aid threatens to dismantle systems that have taken decades to build,’ concludes Rasella. ‘Reversing this trend is essential not only for global health, but also for global stability.’