One of the first decisions of Donald Trump when he returned to the White House on January 20 was to order the gradual dismantling of USAID (US Agency for International Development), the world's largest development aid agency. It was not an improvisation, an impulse, but the maximalist application of a perfectly defined plan whose beginning dates back a long time. The 2025 Project, the unofficial manual for a conservative government prepared by the Heritage Foundation think tank, and outlined by veterans of the first Trump Administration, dedicates an entire chapter to the reform and transformation of USAID. The goal was not only to "reduce USAID's global presence," but to "deradicalize" its programs and limit its funding to stop "destabilizing world peace by promoting ideas in foreign countries that are directly opposed to harmonious and stable internal and international relations."
However, the roadmap of the 2025 Project was actually much less ambitious. It did not propose freezing all foreign aid, firing almost all staff, or giving control to twenty-year-olds controlled by Elon Musk. Nor did it suggest closing an agency with a budget of over 40 billion dollars or assigning it to the State Department. But once the enthusiastic young members of DOGE, the newly created government efficiency department, joined forces with the toughest sector of the new Administration, it was not difficult to convince Trump and his ministers of the need to eradicate a "nest of radical lunatics" controlled by a "criminal gang."
Despite the fact that, according to their numbers, since 2000 USAID programs have prevented the deaths of 58 million people from tuberculosis, 25 million from HIV/AIDS, and over 11 million from malaria (also providing access to clean water to 70 million people and helping to almost eradicate polio), Republicans caricatured the agency's aid as programs to fund sex change operations worldwide, produce musicals about equality and diversity policies, distribute condoms, or publish books promoting homosexuality or atheism. Not to mention an Islamic Sesame Street in Iraq. They accused its officials of being scammers, communists. And what was initially thought to be a 90-day pause for transformation turned into extinction.
"As of July 1, USAID has officially ceased to implement foreign assistance. Foreign assistance programs that align with the administration's policies—and that promote U.S. interests—will be managed by the State Department, where they will be executed with greater accountability, strategy, and efficiency," the Administration explained in a statement this Tuesday.
The effects of shutting off the tap these months were immediate. The sudden cuts not only left thousands of American employees without jobs and stranded around the world, without access to their emails, phones, or credit cards. The lack of funds led to the immediate suspension of food or medicine distribution and the closure of clinics across Africa. The UN Program on HIV/AIDS estimates that since then, nearly 5,000 preventable HIV infections have occurred. Similarly, the lack of resources means there is no electricity to keep medicines cold, for the salaries of local doctors and nurses, for clinics fighting tuberculosis. In Sokoto, Nigeria, young children have died because emergency feeding centers supported by USAID ran out of the nutritious paste used to save the lives of severely malnourished patients. The personnel fighting Ebola in Uganda have been left without resources, making an outbreak more likely.
Since its founding in 1961, with President John F. Kennedy, USAID has funded a wide range of programs, from distributing school lunches to children in Haiti to distributing HIV medications in sub-Saharan Africa. It was designed to fulfill what the Democratic president defined as the country's moral duty to use its wealth to help other less prosperous nations. But, at the same time, and above all, to counter the influence of the Soviet Union in the third world at the height of the Cold War. "We have moral obligations as a wise leader and good neighbor in the interdependent community of free nations; economic obligations as the richest people in a world of mostly poor people; and political obligations as the greatest counterbalance to the adversaries of freedom," Kennedy said. That void left by the agency will be filled by China.
Until now, with a budget of over 70 billion, USAID administered around 60% of U.S. foreign aid and disbursed $43.79 billion in fiscal year 2023. According to the latest report from the Congressional Research Service (CRS), its staff consisted of 10,000 employees, of which approximately two-thirds serve abroad, providing assistance to about 130 countries.
Two examples. To combat HIV globally, George W. Bush launched the President's Emergency Plan for AIDS Relief (PEPFAR) in 2003. The program supports around 20.6 million people worldwide, including 566,000 children, with antiretroviral therapy. In 2024 alone, the program funded HIV testing for 83.8 million people. Without funds, over 630,000 people could die each year from AIDS. A study from Boston University indicates that there could be nearly 10 million additional malaria cases worldwide (of which approximately seven million would affect children) in just one year due to USAID funding cuts.
Trump's executive order almost immediately eliminated between 83% and 90% of all U.S. foreign aid contracts and associated programs. Ethiopia, for example, received over $1.7 billion in aid annually. The same applied to Somalia, the Democratic Republic of the Congo, Nigeria, Kenya, South Sudan, Uganda, and Mozambique, all receiving over $400 million in aid each year. Since the U.S. provided 26% of all aid to the African continent, after the agency's near extinction, total aid to Africa will be reduced by 20%.
According to Oxfam estimates, "the effect of these cuts on people will be devastating: at least 23 million children could lose access to education and up to 95 million people would lose access to basic healthcare, potentially resulting in over three million preventable deaths per year." A recent study published in the medical journal Lancet is much more brutal. The report estimates that USAID programs have saved over 90 million lives in the last two decades, and researchers believe that if Trump Administration cuts continue until 2030, more than 14 million people who would have otherwise survived could die.
According to James Macinko, a health policy researcher at UCLA and co-author of the Lancet study, the average American taxpayer contributed about 18 cents a day to fund USAID. "With that small amount, we have been able to prevent up to 90 million deaths worldwide," he explains. However, the Donald Trump administration believed it was a waste of money, because that investment, which not only saves lives but also prevents diseases or epidemics, was a waste because it was not serving to strengthen Washington's political or geopolitical interests.
"Every public servant has an obligation to American citizens to ensure that the programs they fund promote our nation's interests. During the exhaustive review that the Trump Administration conducted of thousands of programs and over $715 billion in inflation-adjusted spending over the decades, it has become clear that the United States Agency for International Development (USAID) fell far short of this standard. USAID had nearly infinite funding to boost U.S. influence, promote global economic development, and enable billions of people to sustain themselves. Beyond creating a global NGO industrial complex at the expense of taxpayers, USAID has little to show since the end of the Cold War," said U.S. Secretary of State, Marco Rubio, in a post published on his Ministry's blog this same week.
Rubio, responsible for the agency following the administrative changes, and one of the most vocal defenders, even in Congress, that the cuts have not cost anyone's life anywhere in the world, states that "development goals are rarely met, instability often worsens, and anti-American sentiment has only grown. Globally, countries that benefit most from our generosity often do not reciprocate. For example, in 2023, sub-Saharan African nations voted with the United States only 29% of the time on essential UN resolutions, despite receiving $165 billion in disbursements since 1991. That is the lowest rate in the world. During the same period, over $89 billion invested in the Middle East and North Africa left the United States with lower approval ratings than China in all countries except Morocco. The agency's $9.3 billion spending in Gaza and the West Bank since 1991, benefiting Hamas allies, has generated grievances rather than gratitude towards the United States. The only ones living well were the executives of countless NGOs, often enjoying a luxurious lifestyle funded by American taxpayers, while those they purported to help fell further behind." The team behind the study in The Lancet analyzed demographic and mortality data from 133 countries that received aid between 2001 and 2021 and concluded that high levels of USAID assistance are associated with a 15% reduction in deaths from any cause, across all ages. In the case of children under five, the percentage more than doubled, reaching 32%. "Once that 15% reduction in the number of lives is translated, it actually represents 91 million deaths averted," says Macinko.
Therefore, if the agency's aid were to disappear completely, they estimate that by 2030 between eight and 19 million people could die, including 4.5 million children. According to another study published in Nature in April, the United States spent approximately $12 billion on global health in 2024. "Without this annual expenditure, around 25 million people could die in the next 15 years, according to models estimating the impact of such cuts on tuberculosis, HIV, family planning, and maternal and child health programs."