As rich nations cut aid, Lancet study warns of 22 million preventable deaths by 2030

Study finds that falling global aid support to low- and middle-income countries risks decades of health gains, with children likely to bear the brunt.

Representational image. Children under five would account for about 5.4 million of these projected deaths, the study finds. | Commons

New Delhi: At a time when the world faces mounting health challenges, cuts to global aid could reverse decades of health gains in India and other low- and middle-income countries, causing over 22 million preventable deaths, according to a new study published Tuesday in The Lancet Global Health.

The study, led by the Barcelona Institute for Global Health and supported by Rockefeller Foundation, examines two decades of official development assistance (ODA), which are funds provided by rich countries to support health, nutrition, education and humanitarian programmes in low- and middle-income countries. It finds that higher aid spending between 2002 and 2021 was closely linked to lower death rates, especially among children.

The study predicts two possible trajectories to assess the health impact of aid cuts by 2030. 

In a milder cutback scenario, where funding falls by about 10.6 percent each year, global deaths could rise by an estimated 9.4 million, including roughly 2.5 million children below the age of five. In a more severe scenario, with sharper and sustained reductions in aid until 2030, the additional death toll could reach 22.6 million. Children under five would account for about 5.4 million of these deaths, the study finds.

Using data from 93 countries that together account for about 75 percent of the global population, the researchers found that ODA contributed to a 39 percent reduction in child mortality over two decades. 

Deaths from HIV/AIDS declined by 70 percent, while deaths from malaria and nutritional deficiencies fell by 56 percent. Mortality from diarrhoeal diseases and neglected tropical diseases also dropped by more than 50 percent during this period, the study notes.

“Our analyses show that development assistance is among the most effective global health interventions available. Over the past two decades, it has saved an extraordinary number of lives and strengthened fragile welfare states and healthcare systems,” said Davide Rasella, the Coordinator of the study, and ICREA Research Professor at ISGlobal and at the Brazilian Institute of Collective Health.

“Withdrawing this support now would not only reverse hard-won progress, but would translate directly into millions of preventable adult and child deaths in the coming years,” he added.

The findings come at a time when several major donor countries have reduced their aid budgets.

According to the Lancet study, the United States, the United Kingdom, Germany, France and others have announced or implemented cuts over the past two years.

“In 2023, total ODA reached US$ 250.3 billion, with the USA, Germany, Japan, France, and the UK contributing roughly 70 percent of the total. All of these major donors— except for Japan —reduced their ODA contribution in 2024, marking the first such decline in nearly three decades,” the Lancet study notes.

‘2025—one of most difficult years’

While addressing the World Health Organization (WHO) Executive Board in Geneva Monday, Director General Tedros Adhanom Ghebreyesus warned that international aid cuts and persistent funding reductions are undermining the global health system.  

He described the year 2025 as “one of the most difficult years” in the agency’s history.  

“In response to funding cuts, the WHO is supporting many countries to sustain essential health services, and to transition away from aid dependency towards self-reliance,” Tedros said. However, the scale of unmet needs remains vast.

According to WHO, 4.6 billion people still lack access to essential health services, while 2.1 billion face financial hardship because of health costs. At the same time, the world faces a projected shortage of 11 million health workers by 2030, more than half of them nurses.

Besides, the dismantling of the US Agency for International Development (USAID) in 2025, along with reductions by European donors, contributed to what researchers describe as a “systemic funding crisis”.

On 22 January 2026, the US officially exited the WHO, a year after President Donald Trump signed an executive order on 20 January 2025 to begin withdrawing from WHO.

“As a founding member of the WHO, the United States of America has contributed significantly to many of WHO’s greatest achievements, including the eradication of smallpox, and progress against many other public health threats including polio, HIV, Ebola, influenza, tuberculosis, malaria, neglected tropical diseases, antimicrobial resistance, food safety and more,” the WHO said in a statement responding to this withdrawal.

“WHO therefore regrets the United States’ notification of withdrawal from WHO – a decision that makes both the United States and the world less safe,” it added.

WHO works to control spread of infections, mitigating natural disasters, making health services and medicine available and tackling chronic diseases. Some of these public health issues require cross border collaborations.

The US has consistently been a top contributor to WHO over the past decade, with annual funding fluctuating between roughly $163 million and $816 million.

With this, aid for health is expected to be among the worst affected areas. 

The study notes that bilateral aid for health could fall by up to one-third compared to 2023 levels, with the poorest countries facing the largest reductions.

The authors argue that aid has played a central role in reducing preventable deaths over the past 20 years by supporting vaccination programmes, access to medicines, nutrition schemes, clean water, sanitation and stronger health systems. A sudden withdrawal of this support, they warn, risks reversing decades of progress.

While the study acknowledges limitations — including reliance on country-level data and uncertainty in future projections — the researchers say the overall pattern is clear. Large and rapid cuts in aid are likely to translate into higher mortality, particularly among children and vulnerable populations.

“These findings are a warning of the profound moral cost of the zero-sum approach many political leaders are taking—and they are an urgent call to action to all of us to prevent this human suffering,” said Dr. Rajiv J. Shah, President of The Rockefeller Foundation in a Statement on the ‘Human Cost of Foreign Aid Cuts’.

“The question before humanity today is whether we will accept a global retreat from commitments to feed the hungry, cure the sick, and lift up the most vulnerable define the future or whether we will come together to build new models of cooperation worthy of the tens of millions of people who could lose their lives if we do not,” he added.

(Edited by Ajeet Tiwari)