When the foreign aid cuts were announced in January 2025, headlines focused on political implications and dollar amounts.
What wasn’t visible to most was the human reality unfolding within hours at health facilities around the world – doctors receiving immediate orders to suspend life-saving treatments, community health workers being told to stand down, and vital prevention programs grinding to an abrupt halt.
“That very evening we received our first suspension notices,” revealed Ciarán Donnelly, SVP of Crisis Response, Recovery and Development at the International Rescue Committee (IRC) during a recent webinar. “On January 28th, I had to convene a meeting to talk about the 41 stabilization centers that treat malnourished kids that we operate with US government funding.”
The impossible choice facing IRC staff was stark:
“Do we close the doors of those centers in compliance with the US government instructions and send those kids home to a literal death sentence in their communities with their families, or do we somehow find a way to keep them open?”
Voices from the Front Lines: The Hidden Impacts
The Rapid Response Fund was created to address these urgent needs. However, the true scale of the crisis remains largely invisible to the public. Beyond the headline figures are the detailed stories of disruption, innovation, and resilience that reveal the full human impact of these funding cuts.
Beyond the Medical Crisis: Economic and Social Aftershocks
In Malawi, the effects extend far beyond individual health programs. Niek Versteegde, Founder and CEO of Goal 3, has observed devastating ripple effects throughout the economy:
“It has impacts way beyond the health system. We see a depreciation of the kwacha of 50% because aid is pulling back and a lot of their forex is coming from U.S. organizations.”
This economic destabilization threatens to reverse years of progress.
“You can’t underestimate the impact that it has on the societies,”
Versteegde emphasized, noting that the health system challenges his organization addresses are now complicated by broader economic instability.
The Invisible Threats: When Prevention Programs Disappear
Not all health crises make dramatic headlines, but their impact is no less severe. Dr. Werner Schultink, Executive Director of the Iodine Global Network (IGN), explained how years of progress in preventing developmental issues through iodine fortification now hangs in the balance.
“In 2022, it was shown that the overall majority of households in Madagascar had achieved access to well-iodized salt,” he noted – a major public health victory that prevents cognitive impairment in newborns. But with U.S. support abruptly cut off, “We’re in a situation where the survey results have not yet been completely analyzed… and the government does not exactly know how to handle a revolving fund to buy the fortificant.”
Without continued support, Dr. Schultink fears a regression to the conditions of 2014, when “women suffered from severe iodine deficiency and about 43% of school-age children had goiters” – a visible swelling of the thyroid gland indicating severe deficiency.
IGN is also experiencing the impact of U.S. aid cuts in Lebanon, Iraq, Egypt, Sri Lanka, and Bangladesh, illustrating the global reach of this funding crisis.
The Rapid Response Process: Inside the Decision Making
The creation of the Rapid Response Fund represented a significant departure from the usual operating models of both The Life You Can Save and Founders Pledge. How do organizations typically focused on careful, long-term evaluation adapt to an urgent crisis requiring immediate action?
“We’re really focused on marginal cost-effectiveness inclusive of all factors,” explains Matt Lerner, Managing Director – Research at Founders Pledge. “At a simple level, that just means that our main consideration is just what a dollar can accomplish that wouldn’t have been accomplished if we didn’t spend it.”
This fundamental principle guides their work even in crisis. Matias Nestore, Research and Evaluation Manager from The Life You Can Save, elaborated on their three core evaluation criteria:
“The ability to have high impact at scale, the ability to deliver a cost-effective intervention, and deliver an intervention that is backed by rigorous evidence.”
For the Rapid Response Fund, urgency creates a new calculus. “In terms of balancing these needs, we’re really focused on marginal cost-effectiveness inclusive of all factors,” Lerner explained. “If we see a program that can save 10 lives next week but we’re unsure whether the program will exist next year, that doesn’t necessarily mean it’s a bad idea.”
When Minutes Matter: Real-time Crisis Response
For organizations accustomed to months-long evaluation processes, the speed required for the Rapid Response Fund presented new challenges. Jessica La Mesa, co-CEO of The Life You Can Save, noted that they anticipated more obstacles than they actually experienced.
“Obviously executing really quickly because we know the need is so urgent… I think we’re grateful to everyone who has given to the fund and to be surpassing 3 million in such a short amount of time is amazing, but the reality is the gap is still so massive.”
The partnership with Founders Pledge proved essential for rapid deployment.
“Founders Pledge has this incredible infrastructure set up so they are really taking the lead on the operational side of things, and it’s been incredibly smooth and impactful. Very fast. We’ve been really successful at getting money in and getting money out to those who need it.”
The Untold Innovation Story: Crisis Driving Reform
An unexpected aspect of this funding crisis is how it’s driving innovation and reform in humanitarian delivery systems. Ciarán Donnelly of IRC sees an opportunity to transform malnutrition programming:
“We’re doing two things. One is we are actively fundraising through a campaign to launch a survival fund which will enable us to essentially replace US government funding in the long term and keep those services running on a more sustainable basis. But secondly, we see an opportunity here to drive real reform in how malnutrition programming is administered in humanitarian settings.”
IRC has already developed “a treatment protocol that is 21% more cost-effective than the standard of care today” and sees an opportunity to address breakdowns in the supply chain of therapeutic feeding products.
“We think we can bring together a coalition of implementers, policy makers, and donors to not just replace what’s been lost through the US funding cuts but also to build a much more effective and responsive system for malnutrition treatment in emergencies.”
Similarly, Goal 3’s business model was designed with sustainability in mind. “Our whole model was designed to achieve sustainable change,” explained Versteegde. “The whole model is that you use grant funding to start and then that there’s a local service model, subscription model, for hospitals to continue after this.”
The Rapid Response Fund grant enables them to bridge the gap while demonstrating the value of their approach.
“We actually see cost savings which are higher than the cost of the intervention itself. Our expectation is that hospitals will be able to continue to pay after the first year so that we can sustain the intervention within these hospitals for a minimum of 5 to 10 years.”
Funding at the Margins: The Projects Left Behind
While the Rapid Response Fund has already allocated US$1.6 million to high-impact interventions, many critically important programs remain unfunded. Matt Lerner highlighted several examples that illustrate the scale of the challenge:
“Against Malaria Foundation had a project which required $27 million in funding from USAID. Because of the infrastructure required, it simply cannot get off the ground without many millions of dollars.” Similarly, “GiveDirectly has a gap of $2 million that they need to just get their program running.”
In a conversation about government efficiency in aid delivery, Lerner noted that GiveDirectly “is a really stark example because it’s about as efficient as it gets in terms of where the money goes. Something like 90% out of every dollar just ends up in somebody’s pocket – the poorest people in the world.”
Other examples include Teaching at the Right Level Africa, which
“implements basically the single most evidence-backed education intervention. They need a million five to continue operations in Uganda.”
Looking Ahead: What Comes Next for Programs and Organizations
As organizations adapt to this new funding reality, their leaders offer a mix of concern and cautious optimism about the future.
Dr. Schultink of IGN suggests that development aid may gain renewed importance due to factors like immigration, with a focus on optimizing costs and supporting government-led national programs.
He notes that the type of work IGN focuses on –
“how can you optimize the use of costs, how can you really work with governments to take on their own national-owned programs” – may become even more important.
Niek Versteegde of Goal 3 remains optimistic about their business model but is really concerned about impacts on vulnerable populations where aid is most needed. “I’m positive about what we do. We were designed for agility, for achieving more with what we can, so the upside is very high. The downside I think is mostly on the vulnerable populations and our ability to help where it’s really needed the most.”
Ciarán Donnelly of IRC outlined both best and worst case scenarios: “Best case is that within the sector – humanitarian development – that we don’t waste the opportunity in crisis to drive real reform in how we work… and that’s accompanied by a reversal of the political consensus that is quite anti-aid these days.”
The worst case, he warned, is “that we trundle along doing business as usual thinking nothing needs to change and we’ll somehow survive, and the prevailing political winds continue to squeeze us on funding and in prolonging conflicts that drive up need around the world.”
IRC itself will be 30-35% smaller next year, having already laid off over 4,000 staff with more cuts to come. They’ll close operations in seven countries where they’ve spent years building a presence. Yet Donnelly maintains a long-term vision:
“I’m setting my teams a challenge of how we can reach 50 million people a year by 2033, which is our 100th anniversary.”
How You Can Help Shape the Future
What emerges from these frontline perspectives is that this crisis, while devastating, may also be transformative for how global health and development work is funded and delivered. Organizations are being forced to innovate, become more efficient, and develop new models of sustainability.
As Jessica La Mesa urged:
“With a challenge of this magnitude, doing it alone isn’t optimal because there’s so much coordination needed, particularly with other funders who are funding similar things that you might be funding. The last thing the ecosystem needs right now is everybody funneling money to the same organization. What we need to be doing is coordinating and ensuring that as many programs as possible and as many organizations as possible are being sustained.”
The Rapid Response Fund continues to accept donations, with 100% of contributions going directly to high-impact interventions in global health, poverty alleviation, and humanitarian aid. By supporting this fund, you join thousands of donors who have already contributed to sustaining critical programs while driving innovation in global health delivery.
The time to act is now. Join us in responding to this hidden crisis and protecting essential services for the world’s most vulnerable communities.
Learn More: Curious about how your support makes a difference? Explore the stories of impacted communities, dive into the fund’s mission, and see the impact of your generosity—visit The Rapid Response Fund page here.
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