Barack Obama and George W Bush have criticised the closure of the US Agency for International Development (USAID), as a study warned it could result in “a staggering number” of avoidable deaths – more than 14 million over five years.
The former US presidents made rare public criticisms of the Trump administration as they took part in a video farewell for USAID staffers on Monday on its last day as an independent organisation.
In March, the US secretary of state, Marco Rubio, announced that 83% of USAID’s programmes had been cancelled. The agency is being folded into the state department, where it is to be replaced by a successor organisation called America First.
A study published in the Lancet found the cuts could cause more than 14 million additional deaths by 2030, with a third of those among children.
USAID funding for health care, nutrition, humanitarian aid, development, education and related sectors have helped prevent more than 91 million deaths in low- and middle-income countries over the past two decades, the multinational group of researchers calculated.
They concluded: “Unless the abrupt funding cuts announced and implemented in the first half of 2025 are reversed, a staggering number of avoidable deaths could occur by 2030.”
For many of the world’s poorer countries “the resulting shock would be similar in scale to a global pandemic or a major armed conflict”, they said, but “would stem from a conscious and avoidable policy choice”.
“From our experience on the ground, we have witnessed how USAID support has strengthened local health systems’ ability to respond to diseases like HIV, malaria, and tuberculosis,” said Francisco Saúte, general director at the Manhiça Health Research Centre and co-author of the study. “Cutting this funding now not only puts lives at risk –it also undermines critical infrastructure that has taken decades to build.”
The researchers said reductions in spending by other international donors would potentially lead to even more additional deaths.
USAID was founded six decades ago by president John F Kennedy and had, until recently, enjoyed broad bipartisan support.
However, it was aggressively targeted by the current administration. Donald Trump claimed the agency was run by “radical left lunatics” and rife with “tremendous fraud”. Elon Musk called it “a criminal organisation”.
In a recorded message played in a video conference for USAID staffers on Monday, Obama said that dismantling the agency was “a colossal mistake”.
The call was closed to the media, but parts of the video were shared with the Associated Press.
“Gutting USAID is a travesty, and it’s a tragedy. Because it’s some of the most important work happening anywhere in the world,” said Obama, crediting the organisation with saving lives and playing a role in economic growth that turned recipients into US trade partners.
He predicted that “sooner or later, leaders on both sides of the aisle will realise how much you are needed”, adding: “your work has mattered and will matter for generations to come.”
In his message, Bush spoke about cuts to the President’s Emergency Plan for Aids Relief (Pepfar), which is credited with saving more than 25 million lives. He said: “Is it in our national interests that 25 million people who would have died now live? I think it is, and so do you.”
He told attendees: “You’ve showed the great strength of America through your work – and that is your good heart.”
Pepfar was due to play a big role in the rollout of new, long-acting drugs to prevent HIV in poorer countries later this year; the cuts have left global health advocates unsure whether the plans will go ahead as hoped.
The video conference was reportedly attended by thousands, including many joining from overseas.
Singer Bono recited a poem he had written for the occasion, telling staffers: “They called you crooks/When you were the best of us.”
The Trump administration’s closure of USAID has faced legal challenges and been criticised for its abrupt nature, with organisations that had received grants ordered to stop work with immediate effect in February, and staff terminated via mass emails.
Monday’s call also featured former Liberian president Ellen Johnson Sirleaf, former Colombian president Juan Manuel Santos and former US ambassador to the UN Linda Thomas-Greenfield.
Humanitarian workers also participated, including one who told the story of the welcome appearance of USAID workers with food when she was a frightened 8-year-old child in a camp for Liberian refugees.
USAID was the world’s leading donor for humanitarian and development aid. In 2023, funding from the US accounted for 43% of government donations to the humanitarian system, the Lancet authors said.
“These findings come at a critical moment,” said Davide Rasella, ICREA research professor at ISGlobal and coordinator of the study, pointing to a UN summit in Seville this week discussing financing for development.
“If we want to achieve the SDGs [sustainable development goals], we cannot afford to dismantle funding mechanisms – like USAID – that have already proven to save millions of lives. Now is the time to scale up, not scale back.”
