How to Prevent 9 Million Deaths

    Rich countries must understand foreign aid can actually be popular—if people see the results.

    By , the president of the Rockefeller Foundation and the author of Big Bets: How Large-Scale Change Really Happens.

    About a dozen Afghan men stand beneath a clear blue sky among stacks of blankets and sacks of flower piled in rows alongside other boxes of supplies.
    Afghan men stand next to food aid and household kits, distributed by the U.N. migration organization and World Food Program, in the Daman district of Afghanistan’s Kandahar province on April 13. Sanaullah Seiam / AFP
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    Last year, international aid from wealthy nations fell by 23.1 percent, the largest one-year drop in modern history. The data comes from the Organization for Economic Cooperation and Development (OECD), a collection of wealthy countries that is seen as the most authoritative source on the subject. The decrease in foreign aid far exceeds even the OECD’s own earlier predictions of between 9 and 17 percent. In all, nearly $40 billion has been taken away from the poor, the sick, and the hungry. This reduction is measured in dollars not spent, but the decline can hardly be about saving money: It represents less than a 10th of a percentage point of global GDP and less than the cost of 10 of the rockets that carried NASA’s Artemis missions to space. The historic decline in foreign aid is a deliberate policy choice being made by the United States, Britain, Germany, and other wealthy countries.

    The OECD’s numbers are stark, but we didn’t need a spreadsheet to know the devastating impact of aid cuts. Last year in Kenya’s Kakuma refugee camp, 136,000 people abruptly stopped receiving the food they needed to survive after the United States halted its funding to the World Food Program. At least 54 children died of malnutrition. While U.S. Secretary of State Marco Rubio has maintained that “no children are dying on my watch” from aid cuts, the heartbreaking stories from Kakuma and other refugee camps and clinics tell a different story—and that’s just the beginning. A recent study in the Lancetestimated that another 9 million-plus people, including 2.5 million children like those at Kakuma, could die as a result of cuts in aid (and that was assuming more modest cuts than the ones just reported).

    Last year, international aid from wealthy nations fell by 23.1 percent, the largest one-year drop in modern history. The data comes from the Organization for Economic Cooperation and Development (OECD), a collection of wealthy countries that is seen as the most authoritative source on the subject. The decrease in foreign aid far exceeds even the OECD’s own earlier predictions of between 9 and 17 percent. In all, nearly $40 billion has been taken away from the poor, the sick, and the hungry. This reduction is measured in dollars not spent, but the decline can hardly be about saving money: It represents less than a 10th of a percentage point of global GDP and less than the cost of 10 of the rockets that carried NASA’s Artemis missions to space. The historic decline in foreign aid is a deliberate policy choice being made by the United States, Britain, Germany, and other wealthy countries.

    The OECD’s numbers are stark, but we didn’t need a spreadsheet to know the devastating impact of aid cuts. Last year in Kenya’s Kakuma refugee camp, 136,000 people abruptly stopped receiving the food they needed to survive after the United States halted its funding to the World Food Program. At least 54 children died of malnutrition. While U.S. Secretary of State Marco Rubio has maintained that “no children are dying on my watch” from aid cuts, the heartbreaking stories from Kakuma and other refugee camps and clinics tell a different story—and that’s just the beginning. A recent study in the Lancetestimated that another 9 million-plus people, including 2.5 million children like those at Kakuma, could die as a result of cuts in aid (and that was assuming more modest cuts than the ones just reported).

    We know how to prevent these 9 million deaths. The 20th-century humanitarian system, which was built after World War II and lifted hundreds of millions of people out of poverty and starvation, is falling apart. It was built in and for a more cooperative and more generously resourced era. What we need now is a new humanitarianism capable of delivering results in today’s harder, more competitive, more transactional, and more militaristic world. We should prioritize aid dollars more narrowly on the people and places at greatest risk, help countries invest in their own growth, and show the public the returns on our humanitarian and development investments.  Doing so will lay the groundwork for a nimbler, more cost-effective system that can save lives now while rebuilding political support for more assistance in the future.

    Here’s how. First, the $174 billion in aid that wealthy countries are still providing needs to be prioritized to support humanitarian and development needs in places suffering from conflict, disasters, weak governance, and other poverty traps. This is well within our collective fiscal capacity. Greater efficiency and new technologies, such as ready-to-use therapeutic food, that are the fruits of nutrition science could have—but for the lack of funding—saved many of those 54 children in Kakuma.

    Second, for countries with greater capacity, we need a new model of development cooperation that’s country-led, results-oriented, public-private, and politically relevant. Many developing nations are already pursuing it. For example, Brazil, Indonesia, Kenya, and more than 100 others are leading and largely funding school meal programs that are a proven safety net for hungry children against price and supply shocks. And delivering these meals is politically popular. The Iran war alone drove up diesel prices by 45 percent and fertilizer prices by 20 percent, and the International Monetary Fund this week plans to downgrade its forecast for global growth, which otherwise would be increasing, as a result of the war. Meanwhile, as food and energy get more expensive, countries in sub-Saharan Africa, South Asia, and Latin America are also using their own resources to work with development banks, philanthropies, and companies to create jobs—a political urgency for young people around the world—by connecting communities to electricity. In today’s digitally enabled 21st century, unreliable power supply reduces the probability of employment by 35 percent. To avoid massive youth unemployment in these volatile parts of the world, wealthy countries can follow the leads of these nations, including by giving relief from devastating cycles of indebtedness that prevent investment in long-term growth—in 2024, low- and middle-income countries paid a record $415 billion in interest, enough to pay the salaries of 10 million teachers.

    These two steps represent a more efficient, less donor-driven, more technologically advanced, and more politically palatable approach to humanitarian and development cooperation that will deliver measurable results in an era of transactional foreign policy.

    That brings us to the third part of what we could call a humanitarianism for the 21st century: We must show people that this works and serves our collective security and prosperity. There’s a lot more support for development cooperation than people assume: Recent polls show that 9 out of 10 people want countries to cooperate on poverty, hunger, conflict prevention, and disease—but the support is closely linked to seeing results. People need to see what’s working and be reminded why expanding the reach of human dignity to prevent war has been a core feature of national and international politics for 85 years—from British Prime Minister Winston Churchill and U.S. President Franklin D. Roosevelt’s Atlantic Charter to the bipartisan U.S. foreign and security policy consensus to multilateral institutions. This must include renewing the faith-based commitment to treating one another as family instead of strangers, something Pope Leo XIV has done with admirable moral clarity. And it means engaging younger generations, who are animated by philanthropy to help some of the world’s poorest people: For instance, one of YouTube’s most popular videos in February was about MrBeast’s charitable work to build 10 schools around the world, including in rural Ghana.

    We need to shift humanitarian cooperation—and its public image—toward modern, technologically informed investments that bring in the private sector and recipient countries, deliver measurable results, and help those at home as well as those abroad. Especially in today’s more competitive, transactional world, these investments in global health, disaster relief, and feeding the hungry—if done right—are an effective, cost-efficient way to compete for national security, particularly compared with expensive wars and tit-for-tat dealmaking over territory, minerals, or maritime access.

    The future is rife with opportunity and also meaningful threats to our security. Lifting up the dignity of those abroad is a proven response to both. This is not a call to reinstate the 20th-century model of humanitarian and development cooperation. Instead, the world needs to invest what we have in a new model that delivers results today and inspires new investments in the years ahead.

    Rajiv J. Shah is the president of the Rockefeller Foundation and the author of Big Bets: How Large-Scale Change Really Happens. He served as administrator of the U.S. Agency for International Development from 2010 to 2015.

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