Fourteen million dead

For a figure like Donald Trump, who has turned personal grievances into the foundation of a governing platform, his disinterest in the tragedies of others is striking . Especially those for which his administration bears direct responsibility. The carnage in Gaza is the best known, but since the beginning of this year, another crime against humanity has been quietly perpetrated that threatens to reach biblical proportions: the sudden cancellation of a large portion of the programs of the United States Agency for International Development (USAID) . Armed with an accumulation of lies and inferences, a gang of radical ideologues , a billionaire with a taste for drugs , and a unit of arsonist budget firefighters have made decisions that could result in the deaths of at least 14 million people by 2030. Of these, a third will be children under the age of five.

The estimates of the consequences of the poorly controlled USAID bombing come from an article published this week in The Lancet magazine, co-authored by a group of professionals from the Barcelona Institute for Global Health and nine other scientific institutions from countries such as Brazil, Mozambique, and the United States.

There is no rhetorical pirouette that can disguise the historical gravity of this decision.

Gonzalo Fanjul and Davide Rasella

Using data from 133 low- and middle-income nations, our study estimates the likely impact of an aid cut of nearly 85%, such as the one already being implemented by the Trump administration. The calculations—based on the number of lives saved in the past through various interventions, and based on criteria such as age, sex, and cause of death—paint a devastating picture: the death toll from such a significant and sudden drop in aid for essential programs such as malaria, tuberculosis, HIV, or childhood vaccinations would quadruple the number of civilian deaths during all 21st-century conflicts. The accelerated increases in mortality and morbidity will be felt by some of the poorest countries and populations on the planet, such as those in sub-Saharan Africa, which will see three decades of progress and collective investment undone.

No rhetorical trick can disguise the historic gravity of this decision. The conclusions of our study are in line with some initial impact assessments being published in recent weeks. One of the most recent ominously recalled that the Presidential Malaria Program would have saved the lives of 104,000 people by 2025. Cutting these interventions by 70%, as Trump has already done, means condemning tens of thousands of people to death before next Christmas. In another study , still in pre-publication, researchers from 16 of the world's most prestigious centers raise the figures to pandemic status: in the absence of alternatives, cuts in US global health programs will lead to the deaths of more than 25 million people between now and 2040.

To be clear, the America that wants to be Great Again is a substantial part of the problem, but it is not the only one. The United Kingdom and France —two of the planet's main donors, in the hands of much less histrionic governments—have announced cuts of 40% and 30% in their funds, respectively. The "savings" in aid are justified in both countries by the mediocre economic outlook. This has not, however, prevented the runaway increase in defense spending , which before these decisions was already five times more than the budget allocated to international development cooperation . As in the case of the United States, this game of communicating vessels reflects a short-sighted and reductionist vision of collective security. The cuts by major donors will have immediate effects on the uncontrolled spread of infectious diseases, the most serious health and economic consequences of which this generation need hardly be reminded of. They will also mean the abandonment of deeply unstable regions that could intensify global movements of forced displacement.

To be clear, the America that wants to be Great Again is a substantial part of the problem, but it is not the only one.

Gonzalo Fanjul and Davide Rasella

In the medium term, the withdrawal of donors will weaken their soft power in countries—in the Sahel, the Horn of Africa, and Central Asia, for example—whose authorities have already begun to use this decision as an opportunity to disengage from the model of liberal democracy their former metropolises swear to pursue. China and Russia are rubbing their hands from the sidelines .

The question is obvious and concerns all the leaders of rich countries who patted themselves on the back at the NATO summit : is it possible to claim that a sudden, disproportionate and ill-justified increase in defense spending to 5% of GDP will save more lives than the development aid—and so many other social expenditures—that this decision is about to wipe out?

The answer is no. In fact, there is a risk that this climate of collective hysteria in which we find ourselves will lead us to cross the point of no return, and the frivolous and uncontested destruction of the global cooperation system could be one of the first. Both the cruel nihilism of national populists and the complicit docility of the most centrist governments can lead us to forget what research and direct experience confirm daily: despite all its flaws, and despite the many necessary reforms, development aid works.

Global health, education, food security, and protection programs prevent deaths, dignify people's lives, and offer solace and opportunities where none existed before, sometimes in the midst of hell. Debt relief operations and effective fiscal reforms give the poorest states the leeway to invest in the well-being of their citizens. When these small and imperfect mechanisms for global wealth redistribution evaporate without better alternatives, the consequences are measured in millions of lost lives and far less prosperous and secure societies.

This is the fundamental issue on the negotiating table at the Fourth Summit on Financing for Development being held in Seville these days. The red line must be established with absolute clarity. Any outcome that does not imply a firm stance in defense of international cooperation and all that this entails will be a historic failure. The aspiration for a unanimous, minimal agreement would be unacceptable in this context, because it would be tantamount to sugarcoating the system's starvation. If there are moments in history when every political, social, and business leader should reflect on their own interests, the Seville summit is undoubtedly one of them.