Trump’s 9 million death gamble: One year since he axed USAID

Key Concepts

• US Aid (USAID): The former United States Agency for International Development, historically the largest single funder of aid globally, responsible for 47% of the global humanitarian appeal in 2024.
• Global Health Security: The protection of populations from infectious disease outbreaks and other health threats that can cross borders and impact national security.
• PEPFAR: The US President's Emergency Plan for AIDS Relief, a significant US initiative focused on combating HIV/AIDS globally.
• OTI (Office of Transition Initiatives): A former USAID office focused on supporting conflict prevention and stability through engagement with local communities and governance structures.
• Impact Counter: A website utilizing infectious disease mathematical modeling to estimate the health impacts of aid cuts.
• America First Global Health Strategy: A US policy approach prioritizing national interests and co-investment with partner countries in global health initiatives.
• Global Fragility Act, Women Peace and Security Act, Ellie Wiselle Genocide Atrocity Prevention Act: US legislation aimed at reforming approaches to conflict prevention, peacebuilding, and atrocity prevention.

The Shuttering of US Aid and its Global Consequences

On February 11th, 2026, the podcast "Battle Lines Global Health Security" discussed the dramatic impact of the closure of US Aid (USAID) following its dismantling by the Trump administration. The discussion centered on the scale of the cuts, the resulting consequences for global health, and potential pathways for recovery.

The Magnitude of the Cuts

US Aid was, until its closure, the world’s largest single funder of aid, providing 47% of the global humanitarian appeal in 2024, totaling $68 billion. This funding was abruptly reduced to approximately $34 billion following the agency’s closure. This represents a significant contraction in global aid resources. The closure wasn’t simply a reduction in funding; it was a complete shutdown of a massive organization. Elon Musk’s earlier comment about “feeding it to a wood chipper” was referenced as indicative of the administration’s intent.

Projected Health Impacts & Mortality Estimates

The podcast highlighted alarming projections regarding the health consequences of these cuts. A recent Lancet study estimates that, if current funding trends continue, the cuts could lead to at least 9.4 million additional deaths by 2030, with approximately 2.5 million of those deaths being children under the age of five. Impact Counter, a website employing infectious disease modeling, estimates that 250,000 adults and over 530,000 children have already died as a result of the aid cuts. While acknowledging the inherent difficulty in accurately predicting such figures, the panelists emphasized the gravity of the potential loss of life. Paul Nuki stated, “every one of these lives… those are lives that won't exist in the way that we've enjoyed our lives.”

The Impact on Existing Programs

Many projects reliant on US Aid funding were forced to close entirely, while others struggled to continue on severely reduced budgets. The overall impact on the global aid system has been described as akin to a “heart attack,” with efforts underway to “revive it.”

The Strategic Value of Aid & The "Investment" Argument

A key argument presented was that aid is not simply charity, but a strategic investment with significant returns. Paul Nuki drew parallels to the Marshall Plan, arguing that aid to developing economies, like the post-WWII aid to Europe, fosters economic growth and creates new markets. He stated, “The aid that is poured into developing economies… has grown the world. The Marshall Plan… grew Italy… and made it enormous markets for America.” He emphasized that aid expands the “cake” rather than simply redistributing a fixed amount. He urged a shift in perspective, framing aid as an investment that yields economic benefits for donor countries. He specifically addressed a hypothetical conversation with Donald Trump, arguing that aid, like any investment, is expected to generate future returns.

The Case of HIV/AIDS Funding

The discussion specifically highlighted the success of PEPFAR (The US President's Emergency Plan for AIDS Relief) in combating HIV/AIDS. Angelie Ashra, UNA’s deputy executive director, noted that the US government has recently reinstated significant funding for the HIV response, including a $5.88 billion allocation in fiscal year 2026 and a $4.6 billion pledge to the Global Fund. This resurgence in funding is attributed to the recognition of the program’s impact and the strategic benefits of controlling the epidemic. The cost of treating HIV has dramatically decreased – to approximately $1 per day – due to sustained investment and patent sharing. Ashra emphasized that investments in HIV prevention and treatment also strengthen health systems, making them more resilient to other health threats.

The Role of OTI and the Loss of a Key Capability

Kevin Melton, founder of risk consultancy group PAX Strategies and a former US Aid employee, discussed the closure of the Office of Transition Initiatives (OTI). OTI was described as a crucial component of US foreign policy, focused on conflict prevention and stability by engaging with local communities and supporting governance structures. Melton highlighted the loss of a valuable capability – the ability to integrate security, development, and diplomacy – and the resulting gap in expertise. He noted that OTI’s closure occurred despite the existence of legislation (Global Fragility Act, Women Peace and Security Act, Ellie Wiselle Genocide Atrocity Prevention Act) intended to promote a more integrated and effective approach to conflict prevention. He stated, “We used to have US aid people sit next to four-star commanders. That’s gone now.” PAX Strategies was founded to fill this gap, leveraging the expertise of former OTI staff to provide risk analysis and stability-building services to governments and organizations.

The "America First" Approach and its Implications

The podcast explored the implications of the “America First” global health strategy adopted by the Trump administration. While acknowledging the potential for prioritizing national interests, the panelists cautioned against a purely transactional approach to global health security. Nuki argued that global health threats transcend borders and that investing in global health is ultimately in the US’s own self-interest. Melton emphasized the importance of co-investment and shared responsibility, but also highlighted the need to educate stakeholders about the value of a more holistic approach to stability and security.

Synthesis & Conclusion

The closure of US Aid represents a significant disruption to the global health landscape, with potentially devastating consequences for millions of people. While the cuts have been partially offset by renewed funding for specific programs like PEPFAR, the loss of a major aid agency and the expertise of OTI has created a critical gap in global health security. The discussion underscored the importance of viewing aid not as charity, but as a strategic investment that yields economic and security benefits for both donor and recipient countries. The future of global health security hinges on a renewed commitment to international cooperation and a recognition that addressing global health challenges requires a holistic, integrated approach. The podcast concluded with a cautious optimism, acknowledging the challenges ahead but emphasizing the opportunity to build a more resilient and equitable global health system.