These USAID Awards Were Saving Lives. Reverse the Cuts or Reissue Them.

There is bipartisan concern—shared across the administration and Congress—in ensuring the US continues supporting highly effective lifesaving programs worldwide. The available evidence suggests that these programs were cut considerably less than other elements of USAID’s portfolio in the last few months. Nonetheless, a number of lifesaving programs have been halted, people are already dying, and the annual death toll may amount to half a million lives.

As one starting point toward limiting further deaths, Project Resource Optimization (PRO) created an “Urgent and Vetted” list that highlights several of the most cost-effective, life-saving USAID programs that have been cancelled. Given that the PRO team focused on awards that could feasibly be picked up by smaller philanthropic funding, the original PRO list excluded supply chain and commodity procurement awards. To keep the dataset manageable for manual analysis, they also excluded awards with publicly available descriptions that were too vague to determine the project’s focus; these were instead labeled as “maybe” in their database. For the purposes of this exercise, I re-examined these larger supply chain, commodity procurement, and “maybe” awards, and took a brief look at the full list of cancelled projects for any other potential additions.

Below I list twelve large, lifesaving awards from that exercise, which involve $50 million or more in obligations, that are cancelled and not being transferred to the State Department to oversee after the demise of USAID. The total obligated value of these awards is $2.5 billion, with a total estimated cost (TEC) of $4.2 billion. The awards span maternal and child health; humanitarian assistance; vaccines, other prophylactics, and treatments; pandemic surveillance; and global health research. And there is little doubt the activities listed were saving lives or will save lives if reinstated: the programs prevent deaths from post-partum hemorrhage, diarrheal dehydration, severe acute malnutrition, and HIV/AIDS, to name a few.

The list is far from comprehensive—an informal estimate suggests it covers less than a third of the lifesaving activities that were cut. I plan to add more examples in a future blog and would welcome suggestions. But reversing or reissuing these 12 awards would be an important step towards the administration and Congress ensuring as few additional people as possible die as a result of the foreign assistance cuts.

Maternal and Child Health and Nutrition

• Award AID-OAA-TO-15-00010: Global health supply chain support for delivery of family planning and reproductive health to Chemonics. Obligated: $816m, total estimated cost: $982m
• Award AID-OAA-TO-16-00018, Global health supply chain support for delivery of maternal and child health to Chemonics. Obligated $227m, total estimated cost: $256m
• Award 7200AA20CA00011: Momentum3A support for maternal and child health to Engender Health. Obligated: $71m, total estimated cost: $80m
• Award 7200AA20CA00017: Momentum Immunization Technical Assistance to JSI Institute. Obligated: $145m, total estimated cost: $300m

Some administration language has suggested that reproductive health programs “are antithetical to American interests,” but this appears based on a misunderstanding of the major services provided: not just contraceptives, but also facilities to ensure safe childbirth, neonatal care, and support for basic vaccinations.

There is no doubt this is lifesaving support for both mothers and children. The Guttmacher Institute estimates that US -supported family planning services alone prevented 8,340 maternal deaths a year because of complications from unwanted pregnancies. Given what appears to be a high rate of cancellation of USAID family planning programs, these deaths will occur in the absence of remedial action.

In addition, under child and maternal health programs, USAID staff estimated that 16.8 million women were given potentially lifesaving support during pregnancy, 11.3 million newborns received critical postnatal care and 14.7 million were treated for pneumonia and diarrhea thanks to USAID programs in 2024 alone.

Meanwhile the US supported treatment for about one million malnourished children in 2024. The cost per life saved of nutrition interventions can be between $1,600-4,300. Given an estimated $133 million cut to nutrition programs, this suggests the potential for more than 31,000 additional deaths (and the number is potentially higher).

USAID’s support for global health supply chains is vital to delivering the drugs and equipment required for basic health care in these areas across a range of countries. Alongside bednets, malaria pills, antiretroviral medicines, condoms, and HIV test kits, the USAID-sponsored supply chains also provide ready-to-use therapeutic food to treat severe malnutrition at about 30 cents a sachet, amoxicillin at about 36 cents a dose, benzathine penicillin at about 28 cents a dose, ciprofloxacin at 25 cents a pill, and oral rehydration salts to prevent diarrheal dehydration at 8 cents a sachet.

While the HIV and malaria supply chain services continue, those covering maternal and child health alongside family planning have been cut. Supply chain projects were procuring and delivering family planning and reproductive health commodities to 14 countries and supporting 19 countries with distribution assistance. In maternal and child health, the supply chain project was ensuring mothers had access to drugs to prevent postpartum hemorrhage and pre-eclampsia, newborns could be saved with resuscitation equipment to sustain breathing (preventing up to 25 percent of newborn deaths), and young children received amoxicillin to treat pneumonia as well as gentamicin against sepsis and oral rehydration salts against diarrheal dehydration.

The Momentum project was a group of activities specifically designed to deliver and scale-up maternal, newborn, and child health services alongside voluntary family planning and reproductive health care in fragile and conflict-affected settings globally. The Engender Health and JSI Institute awards were part of this effort covering maternal and child health and vaccination programs. PRO’s “urgent and vetted” list suggests JSI’s vaccine projects in particular would be providing childhood immunization services for approximately 91,000 children across five Nigerian states and 438,000 children in Côte d’Ivoire from May 2025–June 2026.

Beyond the four awards highlighted above, PRO’s list suggests there are other specific and highly cost-effective lifesaving interventions in this area that need to be restarted, including a project implemented by PSI in Mali that delivers basic emergency obstetric and newborn care services, supporting an estimated 40,000 safe deliveries alongside family planning services to an estimated 44,000 women.

Humanitarian Assistance

• Award 720BHA24IO00161: Food assistance to severely food-insecure households in Yemen to World Food Programme. Obligated: $76m, total estimated cost: $76m

Earlier cuts to humanitarian assistance to Somalia, Syria, Lebanon, Jordan, Iraq, and Ecuador were largely reversed, but US cuts to the World Food Programme’s operations in Yemen remain. This ended lifesaving food assistance to 2.4 million people and stopped nutritional care for 100,000 children.

Note in addition that total cuts of $562 million for Afghanistan remain in place. And other humanitarian programs, including highly cost-effective interventions, have seen cuts as demonstrated by PRO’s “urgent and vetted” list of projects that need funding as a result:

• Catholic Relief Services’ Darfur Emergency Response Assistance project delivers health, nutrition, and food assistance to women, children, and vulnerable households in conflict-affected areas of Darfur, Sudan through 11 health and nutrition facilities that reach tens of thousands with antenatal care, treatment for malnutrition and infectious diseases, and emergency food aid.
• The International Rescue Committee’s program integrated health, WASH, shelter, and multi-purpose cash assistance to 69,000 internally displaced persons (IDPs) and conflict-affected individuals in Burma (Myanmar).

Tuberculosis (TB)

• Award 72038820CA00002: Improve TB care - prevention, detection, diagnosis, and treatment to The International Center for Diarrheal Disease Research. Obligated: $55m, total estimated cost: $75m

Before the cuts, US assistance for the fight against tuberculosis saved about 300,000 people each year. The cut in support may reduce this by about 72,000 lives. Bangladesh is among the seven most TB-prevalent countries worldwide. With the support of USAID, TB deaths fell from 81,000 a year in 2010, to 44,000 in 2023. The cancelled award was to further improve TB prevention detection and care in Bangladesh.

HIV/AIDS

• Award 72061723F00005: Procure and deliver HIV commodities to Medical Access Uganda Ltd. Obligated: $83m, total estimated cost: $118m

Before the cuts, US assistance for the fight against HIV saved about 1.6 million lives each year. The cuts to support may reduce this by about 200,000 lives. The award above was to support procurement and delivery of a range of commodities including medicines, tests, equipment for circumcision, and tests in Uganda. Reports from the country suggest that the USAID cuts have led to shortages in both antiretrovirals (ARVs) and the personnel to deliver them.

Neglected Tropical Diseases (NTDs)

• Award 7200AA18CA00011: Control and Elimination Program for Neglected Tropical Diseases (CEP-NTD) to Family Health International. Obligated: $266m, total estimated cost $319m
• Award 7200AA18CA00040: USAID's Act to End NTDs | East program to Research Triangle Institute. Obligated $277m, total estimated cost: $421m

RTI and FHI lead USAID's Act to End Neglected Tropical Diseases program. The program targets seven NTDs: lymphatic filariasis (more commonly called elephantiasis), trachoma (a major cause of blindness), onchocerciasis (river blindness), schistosomiasis (a river snail that causes organ damage, infertility, bladder cancer, and death), and three soil-transmitted intestinal worms (roundworm, hookworm, whipworm). The support is highly cost-effective because every dollar of USAID expenditure attracts $26 in donated drugs. Fourteen countries have eliminated at least one disease with USAID support: Niger was the first African country to eliminate onchocerciasis in 2026, and in 2023, Mali eliminated trachoma.

NTDs, which affect 1 billion people worldwide, do not directly kill in large numbers. But they shorten lifespans and can be a factor in mortality from other causes. And USAID withdrawal has already delayed 47 drug distribution campaigns, together affecting more than 142 million people. Former progress against NTDs is now in significant danger of reversal unless the cuts themselves are reversed.

Polio

• Award 7200GH22IO00003: Polio and immunization to the World Health Organization. Obligation: $240m, total estimated cost: $1,020m

The US has been a major partner in the Global Polio Eradication Initiative (GPEI) that has helped to achieve a 99.9% reduction in global polio cases alongside elimination of polio in multiple regions. This has prevented 20 million cases of paralysis and 900,000 deaths. While US policy may no longer be to support this effort through the World Health Organization, it should reformulate financing to ensure critical detection and vaccination efforts continue towards global eradication.

Pandemics/Surveillance

• Award 200AA24C00092: Strengthening Infectious Disease Detection System (STRIDES) to FHI. Obligated $17m, total estimated cost: $245m.

Although the US is in the process of leaving the World Health Organization and reducing funding to that organization for implementation of the International Health Regulations, it is still both lifesaving and strongly in the US national interest to directly support strong global surveillance of emerging disease threats. The STRIDES program was designed to support host country partners to enhance the capacity of national and sub-national laboratory networks and surveillance systems; develop and strengthen data collection, analysis, and reporting relating to surveillance and detection systems; and provide technical support during outbreaks for detection, surveillance, and data analysis and management.

Global Health Research

• Award AID-OAA-A-16-00032: New - HIV Vaccine and Biomedical Prevention Research Project to the International AIDS Vaccine Initiative. Obligated: $238m, total estimated cost: $319m

Vaccine research on diseases including HIV and malaria could not only save millions of lives worldwide, but also considerably reduce future US financial commitment to lifesaving assistance for these diseases—at home as well as abroad in the case of HIV. Cutting such finance is therefore extremely shortsighted, and an issue that extends beyond USAID as the National Institutes of Health is also cutting support to HIV vaccine research.

PRO’s list suggests other ongoing and very valuable health research has been halted midstream as a result of the cuts:

• The Magee-Women’s Research Institute (MWRI) are finalizing three clinical trials to test new HIV prevention for women in South Africa, Zimbabwe, and Kenya. $1,000,000 is required to complete sample analysis, fulfill regulatory obligations, and publish results.
• PATH has a $3 million project to support phase 1/2 clinical trials, to test a next-generation blood-stage malaria vaccine.

Conclusion

An estimated 515,000 lives will be lost a year due to awards that were cut in the start of 2025 that were providing lifesaving support. Under the US administration’s FY2026 budget, the potential loss of life is approximately twice that. The recent decision not to fund Gavi, the global vaccines alliance, would add to the toll if not reversed. In order to meet its commitment to lifesaving aid, the administration should reverse award cancellations that are clearly lifesaving, including those listed above, and ensure sufficient funding for their continuation next fiscal year.

Most significantly for humanitarian assistance (where awards respond to emergencies) the fact that there is apparently no procurement capacity to issue new awards at the moment is an urgent and growing challenge. This will also affect forthcoming pledged contributions to multilateral efforts including the Global Fund to Fight AIDS, TB and Malaria. The administration should work with Congress to rebuild lost capacity to design, issue, and oversee awards, and adequately finance those awards to ensure no more lives are lost.

Thanks for detailed and very helpful suggestions and comments on the blog from Markus Goldstein and the PRO team.