USAID cuts have disastrous consequences for global push to end TB

Dr. Ghulam Nabi Kazi is a senior global health and public policy specialist and is editor-in-chief of Public Health Action - a journal of the International Union Against TB and Lung Disease. 

The U.S. government’s decision to abruptly halt much foreign aid delivered a seismic jolt to programmes to tackle tuberculosis (TB), which killed 1.25 million people in 2023,  15% of whom were children and young adolescents.

Despite being preventable, detectable, and treatable, TB treatment is lengthy – typically lasting six months. With 10 million active TB cases registered across the world, sustainably financing and efficiently providing care and medications is a complex task. 

And now global efforts to fight TB have been disrupted. 

The U.S. government was the largest bilateral donor in the global fight against TB; its sudden discontinuation of support will reverse enormous progress that has been achieved over the past several decades. 

Despite some talk of a limited waiver for life-saving projects receiving funds from USAID, nothing concrete has materialised yet.

The sudden disruption has been devastating.

People undergoing TB treatment have been left without access to their medicines. Teams that identify and track cases are unable to determine where new cases are emerging. Plans to test new and potentially better TB treatment and prevention technologies have been delayed at best and may even be dead in the water.

The U.S. government’s own projections show its foreign aid cuts will increase tuberculosis and its drug-resistant strains by 28-32%.

In mid-February, the TB Community Coordination Hub conducted a global impact survey to measure the impact of the U.S. aid cuts. We received 180 responses from the affected organisations and communities showing that hundreds of agreements had been terminated with thousands of employees shown the door in over 30 countries without any cognizant reason.

Non-governmental or community-based organisations underlined the severe and far-reaching impacts. Around 75% of respondents had terminated staff and nearly a quarter had to close their offices immediately. About a third faced disruptions in procurement of medicines and diagnostic tools, as well as challenges in managing both human and financial resources.

Running a TB programme encompasses the entire health system and there were grave impacts throughout all services. Community workers from Cameroon, Nigeria, Bangladesh, Tanzania and Mozambique have reported the abandonment of poor and critically ill patients, who have been left to fend for themselves.

TB programmes had only just begun recovering from the devastating impacts of the COVID-19 pandemic during which TB cases and deaths increased while the world was distracted.

Most of the global infrastructure enabling a robust COVID-19 response in developing countries existed largely due to previous investment in TB research and control.

TB programmes and research sites quickly became valuable partners in COVID-19 control and research.

Slashing investment for TB control not only risks rolling back decades of progress against TB but makes the world far less prepared for the next major global health threat, whatever it may be and wherever it may originate. 

The withdrawal of U.S. funding will not only impact countries with a high burden of TB cases; it has global ramifications encompassing the United States itself.

The interconnected nature of global health means that TB anywhere is TB everywhere. There have been reports of TB cases emerging in Kansas, North Carolina and Ohio. 

If not prevented, the cost of treating TB could increase to over $11 billion within the United States.

The profound disruption to vital TB services can be reversed by reviving U.S .funding, encouraging other donors and national governments to increase their TB contributions, or by leveraging innovative financing solutions.

Yet, dishearteningly, the U.K. government is reducing its own foreign aid budget - after the French government kicked off this horrible trend at the end of 2024. These cuts will doubtless impact global TB efforts even further.

If TB funding is not forthcoming, the impact will be catastrophic, possibly leading to an additional 2.2 million preventable deaths over the next five years. 

The world must respond now. Every day of inaction increases the risk of lives lost and greater global TB transmission. As we mark World TB Day on March 24, we must invest, deliver and take action, and we must do it now.