In a stark illustration of the human cost of government efficiency drives, the dismantling of the United States Agency for International Development (USAID) — an agency that Elon Musk once said he “fed into the wood chipper” — is projected to cause an extra 14 million deaths by 2030. That estimate, published as a peer-reviewed study in The Lancet in 2025, includes 4.5 million deaths among children under the age of five. The figure has taken on new urgency as the full scale of the agency’s shutdown becomes clear.
The revelation comes as Musk’s SpaceX trades at $141.10 per share, above its initial public offering price of $135, suggesting that the market has not penalized the entrepreneur for his role in reshaping US foreign aid. But the study offers a grim counterweight to that financial optimism, quantifying the mortality toll that could follow from ending USAID programs that have saved millions of lives over two decades.
The study behind the number
The analysis, titled “Evaluating the impact of two decades of USAID interventions and projecting the effects of defunding on mortality up to 2030,” was published in The Lancet in 2025. It is described as a retrospective impact evaluation and forecasting analysis. The researchers used historical data on USAID spending, disease burden, and mortality trends to model what would happen if the agency’s funding were eliminated entirely.
The model focuses on the period from 2025 through 2030, estimating cumulative excess deaths attributable to the loss of USAID-supported programs. The central projection is 14 million additional deaths, a figure that dwarfs the annual death tolls of many armed conflicts. The pediatric component is particularly devastating: 4.5 million of those deaths are expected to occur in children under five, largely due to disruptions in vaccination campaigns, nutrition programs, and treatment for infectious diseases like malaria, pneumonia, and diarrhea.
The study’s authors note that USAID has been a cornerstone of global health for decades, funding everything from HIV treatment and malaria bed nets to maternal health services and emergency famine relief. When those programs stop, the effects are not immediate but accumulate over years as diseases resurge, health systems weaken, and vulnerable populations lose access to care.
How USAID became a target
USAID was established in 1961 by President John F. Kennedy as an independent agency responsible for civilian foreign aid and development assistance. Over the decades, it grew into the world’s largest bilateral aid donor, distributing tens of billions of dollars annually to more than 100 countries. Its programs have been credited with eradicating smallpox, reducing polio by 99%, and dramatically lowering child mortality from preventable diseases.
But the agency became a lightning rod for criticism from conservative groups and, more recently, from figures within the so-called “government efficiency” movement. Elon Musk, tasked by the current administration with slashing federal spending, singled out USAID as a prime example of waste and ideological bias. In a series of social media posts and public remarks, he called the agency a “criminal organization” and said he had “fed it into the wood chipper.” The White House subsequently moved to dismantle USAID, folding its remnants into the State Department and letting go the vast majority of its staff.
Supporters of the cuts argued that USAID was funding left-wing causes and programs that did not align with American interests. Critics countered that the agency’s work was not charity but strategic investment, preventing instability and disease from spreading to US shores. Whatever the merits of those arguments, the new study provides a measurable, if theoretical, accounting of the human toll.
The mechanics of mortality
The 14 million projected deaths are not a single event but an accumulation of failures across many domains. The study breaks down the causes into several categories:
- Infectious disease control: USAID has been a leading funder of malaria prevention and treatment. Withdrawal of support is projected to lead to a resurgence of malaria cases, particularly in sub-Saharan Africa, where the disease already kills hundreds of thousands of children each year.
- Child health programs: USAID-supported immunization campaigns, oral rehydration therapy, and vitamin A supplementation have been instrumental in reducing under-five mortality. Cutting these programs is directly linked to the 4.5 million child deaths.
- Maternal health: The agency has funded maternal care, safe delivery services, and family planning. Loss of these services increases maternal mortality and contributes to poor birth outcomes.
- HIV/AIDS treatment: USAID is a major contributor to the President’s Emergency Plan for AIDS Relief (PEPFAR), which provides antiretroviral therapy to millions. Interrupting treatment could cause a spike in AIDS-related deaths, particularly in southern Africa.
- Nutrition and famine response: In fragile states, USAID has been the primary responder to famine and acute malnutrition. Without it, food insecurity is likely to lead to widespread starvation.
These categories often overlap. A malnourished child is more likely to die from measles or pneumonia. A mother without access to skilled birth attendance is more likely to lose her newborn. The cascading effects make the total number larger than the sum of individual programs.
Implications for global health
Global health experts have expressed alarm at the projection, even as they caution that models are inherently uncertain. The study does not account for potential mitigation by other donors, private charities, or affected governments. In practice, some programs may be replaced by alternative funding sources, but the authors note that USAID’s scale is so vast that replacement would be slow and incomplete.
Already, the effects of the shutdown are visible. Clinics in several African countries have closed, antiretroviral supplies have run low, and immunization campaigns have been suspended. The study’s forecast of 14 million deaths assumes a complete and sustained withdrawal of USAID support, which is not yet entirely the case. However, the trajectory is concerning.
The study also highlights the longer-term consequences: children who survive will face stunting, cognitive impairment, and increased susceptibility to disease. The loss of health workers, supply chains, and data systems will set back progress by decades. The impact extends beyond mortality to economic growth, education, and political stability.
Musk’s focus on efficiency
Elon Musk, known for his roles at Tesla and SpaceX, has positioned himself as a technocrat committed to eliminating government waste. His Department of Government Efficiency, an advisory body created by the administration, has targeted USAID as one of its first major victories. In public statements, Musk has argued that cutting foreign aid will save taxpayer money and allow the US to focus on domestic priorities.
That framing has resonated with some voters, but the Lancet study suggests a heavy hidden cost. Each dollar saved in aid spending could translate into measurable losses of human life. For a figure who often speaks of his desire to “make life multi-planetary,” the irony has not been lost on critics: while Musk looks to Mars, his cuts may accelerate death on Earth.
SpaceX, meanwhile, continues to thrive. The company’s shares now trade above their IPO price, reflecting investor confidence in its dominance of satellite launches and its role in NASA missions. But the stock price is a fragile measure of legacy. Musk will likely be remembered not only for rockets and electric cars, but also for his role in the dismantling of one of the world’s most effective humanitarian agencies.
An ongoing debate
Whether the 14 million figure becomes reality depends on factors that are still in play. Lawsuits, congressional resistance, and public outrage could partially restore USAID funding. The administration’s policy may also shift under pressure from allies and international institutions. Yet the study serves as a baseline — a warning of what will happen if the agency’s work is not restarted.
For now, the data are clear. Two decades of USAID interventions have saved lives. Reversing them will cost lives. The only open question is how many.
Correction: A previous version of this article referred to the journal article’s estimates as “new.” It was published in 2025.
Source:The Verge News