When Brooke Nichols heard early one morning in January of 2025 that the Trump administration was putting a 90-day freeze on all humanitarian assistance from the U.S. Agency for International Development, she was in disbelief. As a professor of global health at Boston University, Nichols had worked on a USAID project in South Africa, and knew how efficient and impactful those investments are.
“I was terrified. Livid,” Nichols said. “I mean, I just, I couldn’t fathom what the world was going to look like if this actually happened. You can’t just stop these things for 90 days without people dying.”
She got to work using statistical modeling to calculate just how many people would die as a result of withdrawing USAID funds from the U.S. President’s Emergency Plan for AIDS Relief – also known as PEPFAR – which has invested nearly $110 billion to fight AIDS since 2003, and is credited with saving more than 25 million lives.
By 5 p.m. that day, Nichols had published estimates in an online tracker. She estimated that a one-year funding freeze for PEPFAR would result in more than 150,000 adult deaths, as well as the deaths of nearly 17,000 children.
Nichols soon heard from colleagues working in other humanitarian areas, asking her to expand her tracker beyond PEPFAR. Ultimately, the expanded tracker estimated that in one year, 262,000 adults and 518,000 children would die as a result of the cuts to USAID.
“The purpose was to try to get these numbers in the hands of people that could advocate for something like a waiver or for stopping the pause and to get some more conversation going and advocacy to make sure that this didn’t happen,” Nichols said.
As she feared, the funding pause did become permanent. In July, an international team of researchers published an even more dire estimate in the medical journal The Lancet. That study calculated that by 2030, 14 million people would likely die as a result of the funding cuts, including 4.5 million children.
Nichols said she tries to focus on these staggering numbers as just statistics, but it’s hard.
“Probably about once a week, I look at those numbers and feel what they mean, and I cry,” she said. “None of this had to happen. And we made this choice … I’m so surprised that people aren’t more angry, more upset, more outraged.”
Over the last year, the USAID cuts have hit global health programs in several ways, said Michael VanRooyen, director of the Harvard Humanitarian Initiative.
“The real impact is, first of all, on community level clinical services for healthcare delivery, and the shutdown of clinics and hospitals and dispensaries,” VanRooyen said. “The other one is procurement and commodities. How do you move and get supplies of medications, vaccinations, water sanitation treatment and other things to populations that depend on it? Those have also been disrupted.”
Food and nutritional assistance were also cut, he added.
“The sheer reduction of food distribution leads to increases in severe malnutrition and lives lost,” VanRooyen said.
Until recently, the Harvard Humanitarian Initiative had been contracted to support the work of non-governmental organizations, providing services like medical training and technical assistance.
“Most of the work that we had has dried up because it was USAID funded and those organizations are not getting it,” VanRooyen said. “So we don’t have access to get our medical teams in Gaza or the West Bank or in Yemen or Syria or Ukraine. And because of that, then we don’t have the ability to do training and to assist in aid delivery.”
Unfortunately, the U.S. withdrawal of funding is coming at a time when other donor nations around the world are also retrenching, said Fatema Sumar, executive director of the Harvard Center for International Development.
“There were some assumptions last year as we saw what was happening in Washington that if the U.S. were to step back, then others would step up to the plate to partially compensate,” Sumar said. “What we now know in 2026 is that is not happening ... What we’re seeing happen is a fundamental reshift and a broader shift of aid now being judged much more by near-term domestic politics and a very transactional foreign policy.”
Before the cuts last January, Waltham-based Education Development Center was working in 19 USAID-funded programs involving education, youth development and global health.
“And since that time, all of those programs have been terminated, said Alisha Keirstead, who leads EDC’s Global Health Team.
“So we were required to let go over 600 staff in those countries around the world as well as a large number of our headquarters-based staff who are managing and supporting those programs,” she said. “Needless to say, it’s been a tough year to lose so many amazing colleagues and to see such impactful, meaningful programs disappear.”
EDC was forced to cancel programs in countries like South Sudan, the Philippines and Liberia, that connected young people with job training and employment opportunities.
“We have hundreds of thousands of youth that were enrolled in those programs who have now been forced to make their own way in the world without that education, training and support for finding good employment,” Keirstead said.
It’s hard to quantify the impact of the loss, she said, since there obviously are no funds available to study it.
“The reality is we don’t know, and we may never know what the cost has been of withdrawing from these countries and removing those types of programs from the fabric of communities,” she said.
For those working on the ground, there are personal stories attached to the statistics. Dr. Joia Mukherjee is the senior clinical and academic advisor for Partners in Health. She says a lot of the basic supplies that USAID provided, like testing kits and medication for treating malaria, are no longer available.
“What you see then is children coming into hospital with much more severe malaria. Because if you catch it early, the children, you know, they’re okay, because you can treat it,” she said.
On a recent trip to Sierra Leone, Mukherjee saw first hand children coming into the hospital extremely sick or in coma.
“I saw one child who became blind from very severe malaria, and the child could have been treated easily with no disability at all had they been treated earlier,” she recalled. “But because there were no malaria tests, the [medical clinic] could not initiate treatment.”
Mukherjee said she hopes the war in Iran does not distract the American public from what’s happening elsewhere in the world due to the USAID cuts. She points to President George W. Bush’s administration, saying that the U.S. still showed leadership on global health even while engaged in the wars in Iraq and Afghanistan.
“Yes, we are at war,” she said. “And at the same time, we can say, ‘there’s this other urgent thing that needs to happen now.’ I just don’t think it’s an either or … we always have to raise our voice to support poor people.”
And that’s something everyone can do, Mukherjee says.
“People can take action … we believe that contacting your representatives does make a difference because they do still care on both sides what their constituents think.”
