Recent research warns that significant reductions in international aid could result in more than 22 million preventable deaths by the year 2030, with over 5.4 million of these deaths occurring among children under the age of five. This alarming prediction comes from the most extensive analysis conducted so far on the subject.

Over the last two decades, aid directed towards the developing world has dramatically decreased the mortality rate of young children succumbing to infectious diseases. However, this hard-won progress is now at risk of being undone due to sharp budget cuts from major donor countries such as the United States and the United Kingdom, as highlighted by researchers in the Lancet Global Health journal.

The team of researchers examined the relationship between the levels of aid received by countries and their corresponding death rates from 2002 to 2021. Utilizing this data, they projected three potential future scenarios to gauge the impact of varying levels of aid.

The first scenario, labeled as “business-as-usual,” assumed that current aid levels would continue without significant changes. The second scenario envisaged a “mild defunding,” mirroring recent trends with a gradual reduction in aid. The third and most drastic scenario, dubbed “severe defunding,” predicted a substantial halving of aid by 2025 and remaining at those levels through the decade’s end.

In the dire case of severe defunding, the study forecasts an additional 22.6 million deaths by 2030, with 5.4 million of these being children under five. Even under the mild defunding scenario, there could be 9.4 million excess deaths, including 2.5 million young children.

Lead researcher, Professor Davide Rasella from the Barcelona Institute for Global Health (ISGlobal), cautioned that the mild scenario is “not unlikely” if current trends persist. The more drastic scenario aligns with the policy directions of several right-wing political parties gaining influence in various nations. In the UK, Reform UK has proposed slashing the country’s aid budget by a staggering 90%.

Most traditional donor countries, including Germany, the US and Sweden, have announced large cuts. The US slashed aid spending by more than half in 2025, from $68bn to $32bn. In the UK, spending will fall from 0.5% to 0.3% of GDP by 2028 – about £6bn lower – to fund increased military spending.

Overseas aid in the past has been directly linked to a 39% reduction in deaths of under-fives, and “particularly strong effects” on mortality from infectious diseases including HIV/Aids and malaria, as well as nutritional deficiencies, the researchers found.

“Unfortunately nobody knows at this stage what is going to happen in the future, especially in foreign aid and assistance,” said Rasella.

Previous studies on cuts have focused on “US-funded programmes, a smaller number of recipient countries, or analysed a shorter timeframe, leaving the effects of overall ODA [official development assistance] on global mortality and its projections less understood”, the researchers said.

“As a scientist, we try to provide evidence,” said Rasella. “The problem was that there was very small evidence.”

Reallocation of recipient countries’ domestic resources “will never match the level of assistance we have been seeing”, he said, while “a collapse of some health systems” was a likely scenario.

Rasella said he had visited doctors in rural Mozambique. “They were telling me they had no antibiotics any more for children, because all the stock was distributed by USAID,” he said. “They have dismantled 300 primary care units in Afghanistan because they were also maintained by USAID. The situation is evolving, and now in many countries things are chaotic.”

Eric Pelofsky, vice-president of the Rockefeller Foundation, which helped fund the research, said the chasm of funding gaps were “too huge for any non-government to take on” and so philanthropic organisations were focused on both finding new innovations and “focusing the mind of decision-makers on the actual problem”.

He said aid spending could be hard for political leaders to explain to taxpayers.

“But I think what this report says is there is a genuinely concrete reality to these decisions, that’s consequential to global stability, consequential to our moral and political leadership in the world.”

Gideon Rabinowitz, director of policy and advocacy at Bond, the UK network of NGOs, said the impact of aid budget cuts by governments such as the UK’s was already being felt, with the closure of programmes focused on issues such as HIV, reproductive healthcare and female genital mutilation.

“The evidence is clear,” he said. “ODA funding is one of the most long-term, cost-effective public investments governments can make. It also contributes to making both the UK, and the world, a safer and healthier place for us all – by strengthening global health systems, preventing future pandemics and stopping diseases before they spread. We urge the UK and other governments to heed this evidence, reconsider these cuts and recognise that their choices are costing lives.”