US Secretary of State Marco Rubio announced the official end of USAID, eliminating the world’s largest humanitarian aid agency just days after The Lancet medical journal warned the closure would cause 2.4 million preventable deaths every year.

The landmark Lancet study found USAID programs saved 92 million lives in low- and middle-income countries over the past two decades, including 30.4 million children under five. Without these programs, researchers project 14 million additional deaths by 2030 from the closure of the agency founded in 1961.

“Unless the abrupt funding cuts announced and implemented in the first half of 2025 are reversed, a staggering number of avoidable deaths could occur by 2030,” the Lancet warned.

The US did not heed the warning.

In a State Department memo titled “Make Foreign Aid Great Again” announcing the shutdown, Rubio laid into USAID, stating its “charity-based” model was against American interests, that it spawned “a globe-spanning NGO industrial complex at taxpayer expense,” and attacked countries and regions – notably Sub-Saharan Africa – for not repaying the US with UN votes despite billions in aid.

The move marks the final chapter in a rapid dismantling of the agency relied upon for health and survival by millions of the world’s most vulnerable people. That saga began in January, when Elon Musk, the world’s richest man, famously tweeted he had skipped “some great parties” to put USAID “into the wood chipper,” telling the agency: “Time to die.”

The Trump administration had previously cancelled 83% of its aid operations earlier this year, throwing the international aid world into chaos. What remains of US aid operations will be “targeted and limited,” and be folded into the State Department, the memo said.

“USAID viewed its constituency as the United Nations, multinational NGOs, and the broader global community—not the U.S. taxpayers who funded its budget or the President they elected to represent their interests on the world stage,” Rubio wrote, adding that the agency “has little to show since the end of the Cold War.”

‘No one has died’

Rubio’s State Department letter makes no mention of humanitarian concerns, instead reflecting the transactional view that has underpinned the Trump administration’s trade policy and America First foreign policy approach.

As the Lancet estimates millions will die, the architects of USAID’s dismantling tell a different story: no one is, has or will die.

“No one has died because of USAID [cuts,]” Rubio told Congress in late May, months after the majority of its operations were already terminated. “No children are dying on my watch.”

Musk echoed the same sentiment in March: “No one has died as a result of a brief pause to do a sanity check on foreign aid funding. No one.”

That’s not true.

In Sudan, where US-supported soup kitchens were forced to close, mothers report watching their babies starve while older children died begging for food, according to interviews by the Washington Post. Critical medical supplies never arrived after funding stopped, doctors said, and the absence of US-funded disease response teams has made it harder to contain deadly cholera outbreaks.

In Uganda, where USAID has long provided HIV medication, the sudden cuts left thousands without access to life-saving antiretroviral drugs, according to the New York Times.

Thousands of organizations running health clinics, vaccination centres, food distribution sites, water purification drives, and other life-saving activities will be forced to shut down, cutting off basic services.

In 2023 alone, USAID provided essential healthcare to 92 million women and children. Those services are gone.

International aid organizations, including UN agencies and major charities, are struggling to cope with the loss of more than $60 billion in US funding. Facing steep staff cuts and slashed budgets, none are positioned to quickly replace USAID’s operations or maintain the same reach to vulnerable populations.

USAID’s Health Legacy

That “sanity check” on foreign aid has since morphed into a total halt. This is particularly dramatic in the health sector, where the US has been the backbone of aid – totalling nearly a third of all health aid globally – for decades as the Lancet illuminates what will be lost.

The Lancet analysis found that higher levels of USAID funding—primarily directed toward low and middle-income countries, particularly in Africa—were associated with a 15% reduction in all-cause mortality and a 32% reduction in deaths of children under five.

The agency’s programs achieved remarkable reductions across multiple disease categories: a 65% reduction in HIV/AIDS deaths (saving 25.5 million lives), 51% reduction in malaria deaths (8 million lives), and 50% reduction in deaths from neglected tropical diseases (8.9 million lives).

Among the programs affected by the cuts is the President’s Emergency Plan for AIDS Relief (PEPFAR), which has saved an estimated 26 million lives through HIV treatment and prevention. Its collapse would have immediate, devastating consequences: in just three months, nearly 136,000 babies – about 1,500 each day – would be born with HIV as pregnant women lose access to transmission-prevention medication.

Significant decreases were also observed in mortality from tuberculosis, nutritional deficiencies, diarrheal diseases, lower respiratory infections, and maternal and perinatal conditions.

“Is [USAID] a good use of resources? We found that the average taxpayer has contributed about 18 cents per day to USAID,” James Macinko, a health policy researcher at UCLA and study co-author told NPR. “For that small amount, we’ve been able to translate that into saving up to 90 million deaths around the world.”

Charity is bad

July 1 is the first day of a new era of global partnership.

Under the leadership of @POTUS and at the direction of @SecRubio, the State Department will lead a foreign assistance program that prioritizes our national interest.

Read more about Secretary Rubio’s vision for America… pic.twitter.com/ArgGXBzM1U

— Department of State (@StateDept) July 1, 2025

Low-income countries on average depend on foreign aid for one-third of their national health spending. Eight of the world’s poorest countries—South Sudan, Somalia, Democratic Republic of Congo, Liberia, Afghanistan, Sudan, Uganda and Ethiopia—rely on USAID for over 20% of their total foreign assistance.

Facing their highest debt burdens in decades, many of the world’s poorest nations are unlikely to be able to compensate for the budget hole blown open by USAID’s withdrawal.

Former President Barack Obama called the decision to dismantle USAID a “colossal mistake,” saying the agency’s efforts to prevent disease, fight drought and build schools made it synonymous with America itself. “To many people around the world, USAID is the United States,” Obama said.

Citing two anecdotes – a Zambian man who told American diplomats teaching his countrymen to “learn to fish” instead of receiving US aid, and an Ethiopian woman praising two-way investment schemes – Rubio said the new model will provide “targeted and limited” aid, while favoring nations who demonstrate an “ability and willingness to help themselves” and welcome US investment.

“The charity-based model failed because the leadership of these developing nations developed an addiction,” Rubio said. “That ends today, and where there was once a rainbow of unidentifiable logos on life-saving aid, there will now be one recognizable symbol: the American flag.”

The United States flag has for decades been on the center of all aid packages distributed by the agency.

Image Credits: White House .