A new peer-reviewed study published in The Lancet Global Health by the Barcelona Institute for Global Health (ISGlobal) warns that sharp reductions in global aid could result in an estimated 22.6 million additional deaths by 2030 across 93 low- and middle-income countries, including 5.4 million children under the age of five. Supported by The Rockefeller Foundation’s RF Catalytic Capital, the study highlights that Sub-Saharan Africa faces the greatest risk, though severe impacts are projected across Asia, Latin America, the Middle East and North Africa, and parts of Europe, underscoring the truly global consequences of cuts to official development assistance (ODA).
Drawing on two decades of data from 2002 to 2021, ISGlobal’s analysis demonstrates that ODA has been one of the most effective global health interventions in modern history. Over this period, development assistance contributed to a 39% reduction in child mortality, a 70% reduction in deaths from HIV/AIDS, and a 56% decline in deaths linked to malaria and nutritional deficiencies. These gains were achieved alongside broader improvements in health systems, disease control, and epidemic preparedness in countries that collectively represent 75% of the world’s population.
The study was prompted by recent trends in donor behavior, as international aid declined in 2024 for the first time in six years and major donors such as the United States, United Kingdom, France, and Germany reduced contributions simultaneously for the first time in nearly three decades. With further reductions projected for 2025 and 2026, the researchers sought to quantify the human consequences of continued defunding at a population level.
Using a consistent methodological framework combining longitudinal panel data with country-level microsimulation models, the study projects mortality outcomes under two scenarios between 2025 and 2030. A mild defunding scenario, assuming a 6% annual reduction in aid, could lead to 9.4 million preventable deaths, including 2.5 million children under five. A severe defunding scenario, reflecting deeper and sustained cuts, could result in more than 22.6 million additional deaths of all ages, with children accounting for 5.4 million of these losses.
Beyond mortality projections, the analysis reinforces the systemic role of development assistance in strengthening public institutions and social protection systems. The findings suggest that at least three out of every four people globally live in countries where two decades of progress in health and development could be reversed, leading to the re-emergence of preventable diseases and widespread loss of life.
The research builds on earlier ISGlobal work that examined the potential consequences of dismantling a single major donor, USAID, and expands the scope to include all OECD contributors. By doing so, it provides the most comprehensive assessment to date of how global aid defunding could affect mortality worldwide, emphasizing that funding decisions made by donor governments today will have long-lasting and irreversible human impacts.
Supported through The Rockefeller Foundation’s Build the Shared Future Initiative, the study aims to inform global policy debates and encourage renewed international cooperation. The initiative seeks to help governments and partners, particularly in Sub-Saharan Africa, maximize the effectiveness of remaining aid resources while mobilizing new investments to address the scale of the challenge ahead.
