First it already happened. And it was Trump’s decision assisted by Musk. The number is controversial, probably not quite as much as many hundreds of thousands. And not killing people directly.
It is about removing funding that saved lives and doing it so suddenly that much of the very weak health system of the Congo collapsed and throughout Africa many doctors and nurses lost their jobs, a lot of medicine couldn’t be delivered and hospitals and clinics had to shut down. Some of the wealthier countries with stable governments stepped up for instance Nigeria and South Africa stepped in quickly to rescue their health care and had less effect but for sure large numbers of people did die.
Trump made the decision, Musk helped him. USAID was the US AID for Africa and other countries. It supported health systems in many African countries. When Trump stopped USAID many hospitals and health clinics collapsed throughout Africa. They could no longer pay for their staff or buildings and it happened suddenly they didn’t have enough time to transition.
The agency that was overseeing much of U.S. foreign aid was USAID, which had a budget of $63 billion in 2023. The exact amount of aid carried out by USAID varied from year to year, but until 2025 it has been less than one percent of the federal budget, which worked out to about $105 per U.S. citizen per year.
- Musk helped remove funding that has saved millions of lives over the last few decades in Africa
- The funding supported hospitals, doctors, nurses, medicines, vaccines, etc.
- It was very sudden with little warning, there was sometimes some funding to keep going for a while but many doctors and nurses lost their jobs and hospitals and health clinics shut down because there wasn’t enough time to get other funding in place to keep going
- In some countries especially the Congo the entire health system almost completely collapsed leaving local people without access to much by way of doctors, nurses, medicine or treatment
So anyway this is a very crude calculation. It just takes lives saved per dollar and multiplies by the dollars cut and gets a million lives potentially lost total. But it then talks about all the caveats which means the number that actually were lost is likely far less.
First the cuts did to some extent avoid the most life saving of the funding
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The estimates compared to FY2024 are pessimistic. We are applying average cost effectiveness figures to current cuts, and lifesaving assistance has been at least somewhat prioritized. There is also some evidence of modifications to still extant awards to pick up the slack from cancelled activities, including improving the supply of HIV medications in Kenya, for example.
https://www.cgdev.org/blog/update-lives-lost-usaid-cuts
Some governments rapidly stepped up:
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In South Africa, the country with the largest absolute number of people receiving treatment under PEPFAR awards that have been cancelled, the government has pledged additional funding to maintain treatment provision.
In Nigeria, lawmakers responded quickly to USAID’s suspension of health programs with a supplemental health budget of $200 million, with a focus on immunization and epidemic response. Minister of Health Mohammed Pate noted, “We appreciate the billions of dollars in support from the US government over the years, but the responsibility to provide healthcare for our citizens ultimately rests on us.”
The speed and scale of Nigeria’s response has been fairly exceptional among countries at similar income levels. Even so, it is only partial. According to (again, partial) data from foreignassistance.gov, from FY24 to FY25 the flow of American health aid to Nigeria may have fallen by about $500 million.
https://www.cgdev.org/blog/update-lives-lost-usaid-cuts
So the conclusion is we don’t know.
The enormous caveat that must be attached to any discussion of the health and humanitarian impacts from aid cuts is that we lack direct, systematic data from the ground on what has happened to the pipeline of US lifesaving assistance. Aggregate information on delivery of the two largest US bilateral global health programs remains unavailable: for malaria, the PMI.gov website is still down, and for HIV/AIDS there is no recent monitoring and evaluation data for PEPFAR.
Without this information and representative survey work of beneficiaries, any estimates of lives lost remain guesswork. But there has been well-documented and extensive disruption of life-saving programs, and destruction of implementation capacity both within USAID and implementing partners, which is not well-captured in aggregate spending figures. While quantification is difficult, there is little doubt many people have died as a result, and without action many more will die in the future.
https://www.cgdev.org/blog/update-lives-lost-usaid-cuts
Many countries rebuilt their health system e.g. Kenya and put precautions in place to make sure they are more resilient if a foreign donor suddenly pulls the plug
Some countries couldn’t do that especially the Congo, their health care just collapsed.
Starting early this year the US started restoring the funding but only if the countries agreed to certain conditions such as that they would help with medical trials - but that they would not be given any guaranteed access to any vaccines or other medications that the US companies developed as a result of the trials.
That is a sore point because during the COVID pandemic Africa didn’t even get vaccines for their health workers and doctors or their most elderly vulnerable people until the fall in 2021 a year after they got access in the wealthier economies and by then almost everyone who wanted a COVID vaccine had one in the stronger economies. By 2022 the vaccine manufacturers caught up especially with Astravenica and now anyone who wants a COVID vaccine can get it at a reasonably affordable price for their economy.
But they worry about what will happen for the next vaccine. The WHO has done a big boost in AFrica’s ability to develop its own vaccines but it’s still lagging a long way behind.
So, Kenya refused those conditions.
But Congo accepted them because its health situation was so dire.
In more detail:
The US signed a new $1.2 billion health care deal with the Congo on 26th February 2026. This is based on their new policy of replacing the USAID funding which was distributed through NGOs with new biliateral deals with individual countries that have return benefits to American pharmaceutical companies.
https://borgenproject.org/us-drc-health-partnership/
These new deals have been rejected by several African countries because they required the countries to provide data that could be used to develop vaccines, but the US negotiators weren’t prepared to add clauses to ensure that the countries could use the vaccines that American companies develop using their data.
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The big payoff for the US, says Secretary of State Marco Rubio, will be greater security, as America’s health engagement with foreign countries, including access to health data, will let it detect disease outbreaks earlier and counter them before they reach the US. So for instance the MOU with Kenya aims to ensure the country acquires the ability ‘to detect infectious disease outbreaks with epidemic or pandemic potential within seven days of emergence’ and to notify the US within one day.
The aim is also to give US health companies an advantage by providing them with pathogen data they can use to develop vaccines and treatments before their competitors.
The deals do incorporate longstanding and theoretically worthy goals: to get countries to match donor funds, reduce dependency on aid, and eventually pay for their own health systems. But several African countries say the deals are ‘exploitative.’ And so the Zimbabwe-US MOU appears to have collapsed as the US has pulled out because of misgivings expressed by Harare.
‘Zimbabwe was being asked to share its biological resources and data over an extended period, with no corresponding guarantee of access to any medical innovations – such as vaccines, diagnostics, or treatments – that might result from that shared data,’ said Nick Mangwana, Information, Publicity and Broadcasting Services Secretary.
‘In essence, our nation would provide the raw materials for scientific discovery without any assurance that the end products would be accessible to our people should a future health crisis emerge.’
https://issafrica.org/iss-today/trump-s-african-health-strategy-falters
However the health care system in the Congo is in such a difficult state they had no hesitation agreeing to the contract for $1.2 billion over a 5 year period.
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Beyond supporting the fight against infectious diseases, the deal also aims to strengthen maternal and child health services, improve national epidemiological surveillance and enhance preparedness and response to health emergencies. If implemented effectively, it could represent progress in addressing recurring public health emergencies.
…
Despite concerns raised by other governments, the Democratic Republic of the Congo may view the agreement through a different strategic lens. The country faces one of the highest infectious disease burdens in Africa, including persistent outbreaks of Ebola, measles and cholera alongside high rates of malaria and tuberculosis.
Combined with ongoing conflict in eastern provinces and decades of underinvestment in public health infrastructure, these pressures have left the national health system heavily dependent on external support.
For Kinshasa, the scale and stability of the U.S. commitment may outweigh potential concerns surrounding oversight provisions. The agreement promises sustained investment over a five-year period and requires increased domestic spending, potentially helping stabilize long-term health financing rather than relying on short-term emergency interventions. In addition, strengthening diplomatic ties with Washington may carry broader strategic benefits for a government navigating regional insecurity and economic constraints. In this context, the deal may represent not only a health partnership but also an effort to secure critical resources for a fragile health system.
…
The U.S.–DRC health partnership illustrates the evolving nature of global health diplomacy.
For the DRC, the agreement offers an opportunity to strengthen disease surveillance, expand health care services and build resilience against future outbreaks.
At the same time, the hesitation shown by other countries highlights the balance between securing vital funding and protecting national sovereignty over sensitive health data and research resources.
https://borgenproject.org/us-drc-health-partnership/
So they are going to get help from the USA over the next 5 years. But no longer on the basis of helping them because they need help or because the US is stronger if other countries are stronger. It’s on the basis there has to be some direct payback to the USA for their help. In this case data for vaccine and medication trials for US companies.
That is just the way the Trump administration works and it’s not even about the payback paying for all the aid. It’s more about the appearance of things. The trials may well be very lucrative but it’s not like they have to provide the exact billions of dollars worth of data for US companies to pay for the billions of dollars of aid they get. But they have to pay something back.
It is just this current president’s approach to almost everything. It may well change under the next president. It is because of his business background. He sees everything through the lens of business deals.
Anyway it has had some positive effects with African countries deciding that they need to make sure that the funding they get is linked to making their health care system more resilient and less dependent on funding from donors. So that this doesn’t happen again. Which is helping them to build their systems up in a more resilient way. And gets their governments more involved.
So long term it has had a positive effect and who knows how many lives that saves in the future but short term it undoubtedly led to many people dying whose lives would otherwise have been saved.
