We study the mortality cost of political patronage in the context of China’s Great Leap Famine (GLF; 1958-1962). As a direct consequence of a series of radical and misguided policies implemented during a political and economic campaign initiated by China’s top leader Mao, the GLF caused millions of deaths in rural China, with famine mortality varying substantially across provinces. We show that provincial party leaders who were socially connected to Mao 1) pursued Mao’s policies with more zealousness, which led to significantly more famine deaths in their jurisdictions; 2) were more likely to get promoted right before the GLF; 3) had more interactions with Mao during the GLF. Our results point to political patronage as an important contributing factor of the Great Leap Famine.