{"id":4682,"date":"2025-07-17T01:59:22","date_gmt":"2025-07-17T00:59:22","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=4682"},"modified":"2025-11-03T01:54:00","modified_gmt":"2025-11-03T00:54:00","slug":"usaid-cuts-a-moral-failure","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2025\/07\/17\/usaid-cuts-a-moral-failure\/","title":{"rendered":"USAID cuts: A moral failure"},"content":{"rendered":"

By G. Owen Schaefer<\/p>\n

The effects of recent massive cuts to USAID are still unfolding, but the likely catastrophic consequences for the globe are evident. \u00a0A recent analysis<\/a> estimated that the program prevented over 90 million deaths in the past two decades due to efforts in treatment and prevention of HIV\/AIDS, malaria, tuberculosis and other diseases. But the converse of this success is that cuts may result in the deaths of 14 million people over the next 5 years that could otherwise have been prevented.<\/p>\n

In light of the magnitude of impact, we should recognize that the cuts to USAID constitute a clear moral failure on the part of the US \u2013 along with other wealthy countries like the UK, France and Germany also enacting aid cuts.<\/p>\n

To be sure, all national governments reasonably prioritize the interests and well-being of their own people over those in other countries. Some degree of nationalism is well-justified<\/a>, on a number of grounds. \u00a0Political legitimacy is often seen as grounded on the expectation that governments will act in its people\u2019s interests. When a population is subject to the coercive force of a government\u2019s actions, the government has a special duty to promote the interests of its people in return. Governments\u2019 resources typically derive from its people\u2019s, often through taxation, and so the people have a special claim to those resources. Governments are also often the best placed to understand, act on and protect the interests of the people they govern, in contrast to foreign populations.<\/p>\n

However, even with some reasonable national priority, countries still have significant obligations to the global community. This obligation is especially strong for wealthy nations like the US, for at least two reasons. Firstly, there is a massive asymmetry between the benefits of a given dollar spent domestically in wealthy countries compared to those resources spent in much lower-resourced countries. As such, even with governments significantly prioritizing the interests of their own people, the interests of those abroad will remain very weighty. Secondly, high-income countries\u2019 wealth did not emerge in a vacuum; there is a long history of colonialism, exploitation and hegemonic domination that has significantly causally contributed to that wealth. Such wealthy countries have duties of reciprocity and remediation<\/a> in light of that history.<\/p>\n

A pertinent and vexing question is what, exactly, is a reasonable quantum for wealthy countries to devote to international aid. One prominent benchmark, arguably already incredibly low, was set by the UN: devote .7% of Gross National Income (GNI) to official development aid. Even before the USAID cuts, the US was woefully short<\/a> of this benchmark: a mere .22% of GNI in 2024 went to aid. The US\u2019s shortcoming is sometimes missed, as due to the sheer size of the US economy, devoting even such a small percent of its wealth has made it the world leader in terms of absolute dollars in aid. But by the same token, the US could more than any other country in the world afford to devote more resources to life-saving aid.<\/p>\n

Rather than correct this shortfall, cuts to international aid have exacerbated it. \u00a0A question often raised is, what next for the global health community in the face of this moral failure? Many productive proposals have been made, including commitments to devote a substantial research agenda<\/a> to documenting the impacts of the cuts; reorienting<\/a> what funding remains more squarely around the priorities of affected populations; accelerate<\/a> efforts to reduce donor-dependency; and advance crisis response research<\/a> into effective interventions under conditions of extreme scarcity.<\/p>\n

To this list, I will add: the need to be clear and honest about the moral unacceptability of these cuts. Millions will die; millions more suffer unnecessarily. The scale of such statistics is difficult to wrap our heads around, so it may help to consider one recent report: Babagana Bukar Mohammed<\/a>, a 7-year-old Nigerian boy with sickle cell disease, came down with fever on 2 February. His mother dutifully spirited him to a nearby clinic for care. That clinic, however, was closed due to a stop-word order from its USAID funders. Though his condition was treatable, Babagana died that night. His story is a tragic microcosm, a version of a story that is being repeated over and over around the world.<\/p>\n

A final note: while USAID cuts are a particular moral failure of the US, inadequate aid is not the US\u2019s failure alone. The OECD average of percent of GNI devoted to aid is only slightly higher than the US\u2019s, at .33%. Other wealthy countries like Canada, the United Kingdom, Japan, Australia, Singapore and more beside are also bound by similar obligations, which they are also failing. In the face of the effects USAID cuts will have on the world\u2019s population, those of us in wealthy countries should all call on our governments to step up and fill what gaps they can. It is not a question of ability, or resources, but of our collective will and commitment to global health.<\/p>\n

Author<\/strong>: G. Owen Schaefer<\/p>\n

Affiliation<\/strong>: Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore<\/p>\n

Conflicts of Interest<\/strong>: G. Owen Schaefer is a member of the WHO Ethics and Governance Steering Group and recently contributed to the drafting of \u201cSustaining HIV, viral hepatitis and STI priority services in a changing funding landscape: operational guidance.\u201d All views expressed in this article are solely his own and not representative of any entities with which he is affiliated.<\/p>\n

Social Media<\/strong>: Bluesky: \u202a@owenschaefer.bsky.social\u202c<\/p>\n","protected":false},"excerpt":{"rendered":"

By G. Owen Schaefer The effects of recent massive cuts to USAID are still unfolding, but the likely catastrophic consequences for the globe are evident. \u00a0A recent analysis estimated that the program prevented over 90 million deaths in the past two decades due to efforts in treatment and prevention of HIV\/AIDS, malaria, tuberculosis and other […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":503,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8064,475,403],"tags":[],"class_list":["post-4682","post","type-post","status-publish","format-standard","hentry","category-justice","category-politics","category-rant"],"yoast_head":"\nUSAID cuts: A moral failure - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2025\/07\/17\/usaid-cuts-a-moral-failure\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USAID cuts: A moral failure - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"By G. Owen Schaefer The effects of recent massive cuts to USAID are still unfolding, but the likely catastrophic consequences for the globe are evident. \u00a0A recent analysis estimated that the program prevented over 90 million deaths in the past two decades due to efforts in treatment and prevention of HIV\/AIDS, malaria, tuberculosis and other [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/medical-ethics\/2025\/07\/17\/usaid-cuts-a-moral-failure\/\" \/>\n<meta property=\"og:site_name\" content=\"Journal of Medical Ethics blog\" \/>\n<meta property=\"article:published_time\" content=\"2025-07-17T00:59:22+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-11-03T00:54:00+00:00\" \/>\n<meta name=\"author\" content=\"owenschaefer\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"owenschaefer\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2025\\\/07\\\/17\\\/usaid-cuts-a-moral-failure\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2025\\\/07\\\/17\\\/usaid-cuts-a-moral-failure\\\/\"},\"author\":{\"name\":\"owenschaefer\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#\\\/schema\\\/person\\\/aed22897c55740f89c1ad1508985d1c0\"},\"headline\":\"USAID cuts: A moral failure\",\"datePublished\":\"2025-07-17T00:59:22+00:00\",\"dateModified\":\"2025-11-03T00:54:00+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2025\\\/07\\\/17\\\/usaid-cuts-a-moral-failure\\\/\"},\"wordCount\":915,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#organization\"},\"articleSection\":[\"Justice\",\"Politics\",\"Rant\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2025\\\/07\\\/17\\\/usaid-cuts-a-moral-failure\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2025\\\/07\\\/17\\\/usaid-cuts-a-moral-failure\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2025\\\/07\\\/17\\\/usaid-cuts-a-moral-failure\\\/\",\"name\":\"USAID cuts: A moral failure - 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