USAID Closed Its Doors a Year Ago, and 600,000 People Have Died — The Price of Severing the Lifeline Kennedy Built

The most realistic threat within the next six months is an epidemic crisis born from surveillance gaps. The key nodes of the global disease surveillance network that USAID sustained — Ebola monitoring stations in West Africa, avian influenza early warning systems in Southeast Asia, drug-resistant tuberculosis tracking systems in sub-Saharan Africa — are already experiencing functional degradation due to staff and equipment shortages. This is not a distant concern. As COVID-19 proved in 2020, a virus that starts in Congo reaches New York and Seoul within two weeks. Weakened surveillance capability translates directly into delayed initial response times, and a difference of days can determine whether thousands or millions die.

In the medium term, over the next six months to two years, the aid vacuum will almost certainly metastasize into food crises and mass displacement. The UN has already classified 87 million people as priority humanitarian cases, yet has secured less than half the $23 billion required. As famine spreads across Sudan, Ethiopia, Somalia, and Yemen, millions of refugees will be generated, moving toward Europe and North Africa. In Europe, anti-immigration sentiment is already fueling far-right politics, and the structural feedback loop — where aid cuts drive migration, and migration drives political justification for further aid cuts — is becoming entrenched. First-line host countries like Turkey, Jordan, and Kenya are reaching the limits of their social absorption capacity.

What also demands attention in the medium-term window is the realignment of aid governance. Who fills the void left by America? The European Union is currently the most active player, increasing its 2026 foreign aid budget by 8 percent year-over-year, but this covers less than 20 percent of the American shortfall. Japan and South Korea have modestly expanded ODA, but the scale is nowhere near sufficient to replace what USAID provided. Multilateral institutions like the World Bank and Global Fund are seeking to expand resources, but with their largest contributing nation pulling back, their operational viability is itself under threat. Meanwhile, China is strategically exploiting this vacuum, expanding infrastructure investment and health aid across Africa and Southeast Asia, rapidly replacing the soft power America built over decades.

Looking at the long-term horizon of two to five years, three scenarios emerge. The most optimistic scenario (bull case) envisions a congressional shift in the 2026 US midterm elections that partially restores aid funding. Representatives Brad Sherman and Gregory Meeks of the House Foreign Affairs Committee are already pushing legislation investigating USAID-related deaths, and if public opinion shifts, PEPFAR restoration could be prioritized. Under this scenario, additional deaths might be held below 5 million — though the 762,000 already lost cannot be reversed.

The baseline scenario (base case) sees the current trajectory of mild cuts persisting. The Lancet's 9.4 million projection becomes reality, including 2.5 million children under five. Global child mortality rates reverse their 2015-2024 downward trend, retreating to early 2000s levels. US global health leadership effectively ends, and while a multilateral system slowly reorganizes, the transitional gap persists for years. The tipping point where Chinese influence in Africa and Southeast Asia surpasses American influence could arrive around 2028-2029.

The worst-case scenario (bear case) sees global aid plummeting to below half of 2025 levels, resulting in 22.6 million additional deaths. In this scenario, a new pandemic emerges from surveillance gaps, or simultaneous large-scale famines erupt across East Africa and the Sahel. Five point four million children under five die, and the UN humanitarian system itself financially collapses. The refugee crisis drives European politics to extremes, accelerating the vicious cycle of further aid cuts. Oxfam's warning of one child dying every 40 seconds becomes the world we inhabit.

Regardless of which scenario materializes, one thing is clear: the consequences of USAID's dissolution have only just begun to manifest. The benefits of aid accumulated over decades, and their absence will wreak destruction over decades as well. The 762,000 deaths we are witnessing today are merely the first wave of the tsunami yet to come.