Secretary of State Marco Rubio announced the official end of the U.S. Agency for International Development (USAID) on Tuesday, after rapidly dismantling the government’s foreign aid arm since President Trump’s return to the White House.

USAID’s official shutdown comes following a study published Monday in the Lancet Medical journal projecting that more than 14 million additional deaths could occur globally as a result of the U.S. aid reductions, including 4.5 million deaths among children. 

The Trump administration defended its shutting down of USAID as rooting out “waste, fraud and abuse” and reorienting American aid dollars to deliver concrete returns. Elon Musk, during his time leading the Department of Government Efficiency (DOGE), bragged about putting USAID through the “wood chipper.” 

Rubio said that decades of U.S. foreign assistance had failed to deliver results for America. 

Development objectives have rarely been met, instability has often worsened, and anti-American sentiment has only grown,” Rubio wrote in a blog post on Tuesday. “This era of government-sanctioned inefficiency has officially come to an end.”

Democrats have roundly denounced USAID’s demise as unconstitutional and cruel. The administration has frozen foreign assistance, issued sweeping stop-work orders to USAID staff and locked out employees from workstations and emails. The moves triggered chaos in the aid community and put lives in danger, according to a lawsuit.

Of the $120 billion in contracts that were in effect at the beginning of January, about $69 billion in programming was kept, according to an analysis by The New York Times.

These include 580 humanitarian aid programs, 167 health programs, 65 economic development programs and 79 other initiatives, according to the Times.