In about three short months, the Trump administration took a wrecking ball to foreign aid, threatening millions of lives and livelihoods around the world. After initially pausing all US foreign aid spending for 90 days, President Donald Trump handed over the reins to Elon Musk’s Department of Government Efficiency (DOGE).
The damage as DOGE went about clear-cutting the US Agency for International Development (USAID) was swift and extensive. Health clinics from Afghanistan to Burundi shuttered. Oxygen tanks, HIV and malaria medications, and other medical supplies amounting to at least $240 million remain stuck at ports or storage facilities around the world. Ebola prevention and response funding, which Musk claimed at the end of February was restored with “no interruption” during the 90-day freeze, is reportedly still not operational, according to several public health experts. Whether it’s aid for malnutrition, clean water, or outbreak response, even a handful of days can undo years of progress in the making.
The Trump administration slashed at least $54 billion in foreign aid contracts. Around the world, around 60,000 aid workers lost their jobs, including some 2,000 USAID employees. Much of the world has lost its primary health support, and they won’t get it back anytime soon. Secretary of State Marco Rubio, who took over as USAID’s interim leader in early February, announced Monday that 83 percent of the agency’s programs had been canceled, while other restored projects have been shrunk considerably.
The administration has not yet published a full list of all affected programs and projects. But former USAID workers and contractors are counting up canceled projects based on termination notices received by project staff. So far, many foundational global health efforts to treat malnutrition, prevent newborn and maternal mortality, or eliminate infectious diseases such as HIV, malaria, tuberculosis, malnutrition, and polio have been impacted. Projects that aimed to improve infectious disease surveillance in foreign countries and to help prevent and contain future pandemics — which could directly impact American health and security — were also cut.
These cuts and the US’s recent withdrawal from the World Health Organization come on top of years of declines in global funding for health. The timing couldn’t be possibly worse: Five years after the Covid pandemic began, the world now faces a surge of infectious disease outbreaks from dengue and malaria to Ebola and even a mysterious but deadly disease in Congo.
The consequences that have been documented so far are severe and widesweeping, and yet they represent an incomplete tally of how billions of lives and livelihoods will be affected now or in the future. Here is everything we know about the US foreign aid’s global health effects around the world in three charts.
Millions of patients stranded
Until very recently, USAID worked in 160 countries to spread democracy, reduce poverty, improve health, prevent and contain infectious disease outbreaks and provide food, clean water, and education to rural, underserved, refugee, and conflict-affected communities. In the decades since President John F. Kennedy established the agency in 1961, USAID became a household name in many countries. US foreign aid in those decades was a critical and oft-studied tool of global diplomacy, and one that — until recently — has had consistent bipartisan support.
When it comes to aid, the US is irreplaceable. US donations to the United Nations in 2024 comprised 40 percent of all funds for humanitarian aid. The US donated almost half of all global food aid and made huge contributions to the World Health Organization for disease outbreaks and health emergencies.
In all, the US spent more than $10 billion on health aid around the world in 2024. Countries in sub-Saharan Africa received the lion’s share of that aid, but developing countries everywhere have been affected by US funding cuts. Here are some key impacts that the US foreign funding freeze has had so far:
- An estimated 3.8 million women lost access to contraception globally.
- 9 million people in Afghanistan — nearly a quarter of the population — will no longer receive US-funded healthcare services .
- Nearly 700,000 people in Burkina Faso and Mali have lost access to water, food, or health services.
- The World Food Programme, for which the US is the largest single donor, has shut down its operations in South Africa, where 27 million people are at risk of hunger as the country faces its worst drought in decades.
- In Nigeria, 25,000 extremely malnourished children will no longer be receiving food assistance by April.
Perhaps the most important program targeted is the President’s Emergency Plan for AIDS Relief (PEPFAR). PEPFAR, which provides testing services and treatment to prevent and treat HIV, is credited with saving some 25 million lives. Although the program was not entirely cancelled, several major contracts were cut or shrunk down considerably. As a result, 20.6 million people, including almost 600,000 children, are no longer receiving HIV treatment that was previously funded by the US. Experts estimate that HIV burden could increase sixfold in the next four years.
The Trump administration’s dismantling of USAID and other government agencies has been messy. There have been a flurry of lawsuits still awaiting court decisions that allege the Trump administration’s actions against USAID and its contractors are unlawful; however, on Monday, a federal judge declined to order the administration to restore canceled contracts.
China is already moving into the void. Local media outlets from Nepal to Colombia have reported that representatives of the Chinese government have already come forward with offers to expand its assistance in areas from agriculture and disaster relief to health care and poverty alleviation. After floods devastated parts of Madagascar, Chinese officials mounted their first-ever humanitarian response in the country. Within days, Chinese aid tents lined the Ikopa River.
How much China will aim to capitalize on this opportunity is not yet clear. And while the US foreign aid freeze and cuts have already had enormous repercussions, its full effects won’t be felt in full for months or even years to come. USAID-funded agriculture programs, for instance, were not able to disperse seeds in time for planting, which means that farmers may miss an entire growing season, a spokesperson for a US nonprofit company that receives USAID contracts told me. This will worsen food insecurity and could plunge families into poverty.
In other places, time-sensitive mosquito control activities — like spraying insecticide to kill larva before they become mosquitos — were missed, which will likely result in an explosion of dengue, malaria, and other mosquito-borne infectious diseases in a few months.
A lack of US funding for polio eradication efforts will likely lead to an additional 200,000 polio cases a year. Some 10.6 million cases of tuberculosis and 2.2 million deaths will not be prevented in the void of US foreign aid funding.
If you’re an optimist, then you might hold on to a bit of hope that some of these programs might be restored, that the bipartisan consensus that once supported foreign aid can be rebuilt. But as the days go by, that seems increasingly unlikely. The hard reality is that the Trump administration’s actions have left massive gaps in global aid that will ultimately be measured in lives lost.
