US aid freeze leaves TB survivors in India 'high and dry'

• India has world's highest number of TB cases
• Government targets eradication this year
• Study shows infections, deaths may soar without US funding

AHMEDABAD, India - Sudeshwar Singh, a tuberculosis survivor and health activist, used to coordinate and mentor about 800 advocates in India's eastern state of Bihar, part of a grassroots network that plays a pivotal part in global efforts to end the epidemic by 2030.

But since the United States suspended foreign assistance earlier this year, Singh has had to drop his work ensuring patients get treatment and instead search for a new job as the sole breadwinner in his family of four.

"Most of us ourselves are affected by TB and committed to the TB community, but when our own income is affected, how do we support others?" he said.

Singh, 48, is the founder of TB Mukt Vahini (TMV), which roughly translates as the Army for a TB-Free Community, one of two dozen community-led health organisations in India whose funding has dried up since U.S. President Donald Trump dismantled the U.S Agency for International Development, or USAID, under his "America first" foreign policy.

Singh and other survivors of tuberculosis who were trained as "TB champions" are on the frontline of India's response to the disease, working in their communities to raise awareness, reduce stigma and support patients in a country with the highest number of infections in the world.

USAID has spent more than $140 million since 1998 to fight TB in India, where an estimated 2.8 million people have the disease, more than a quarter of cases worldwide.  

Without groups like TMV, public health experts in India are warning of a spike in infections and deaths from tuberculosis, an infectious disease caused by a bacteria that can kill half of patients who do not receive treatment.

"It is with great difficulty that we found TB survivors who were trained to be TB champions. How can they work without support?" said Blessina Kumar, who is based in New Delhi and is CEO of the Global Coalition of TB Advocates, an organisation with 540 members in 76 countries.

"The TB community is left high and dry, due to the USAID funding problems, and their work (is) left incomplete."

Poorest at risk

Bihar, where TMV worked with TB patients, is one of the country's most impoverished and populous states, with annual per capita income of less than $500.

"With the recent freeze ... we are unable to sustain our operations," said Singh.

The TB champions working with Singh coordinate with government health centres and guide patients through treatment to make sure they receive medication.

These survivor-led networks also provide patients with emotional support amid the challenges of treatment while facing potential discrimination in the community.

India's National Tuberculosis Elimination Programme (NTEP), which has an annual budget of $492 million, is almost entirely funded by the government to procure drugs and provide diagnostics.

USAID awarded grants and contracts to government agencies, non-governmental organisations and the private sector, whose work on controlling TB has helped shape the Indian government's policies on fighting the disease.

But the agency's annual investment of $100,000 in community-based organisations ensured that vulnerable populations, including the urban poor, miners and migrants, were reached.

Filling the gap

Across the world, foreign funding accounts for about a fifth of the money spent fighting TB, and the United States previously contributed more than 55% of those funds, according to the Geneva-based Stop TB Partnership, administered by the United Nations.

Subrat Mohanty, a board member with Stop TB Partnership, said shelters for destitute patients in India and other small organisations were especially hard hit by the collapse in U.S. aid.

"They are not getting any money, neither are any activities happening, like healthcare screening, taking TB patients to the diagnostic facilities or follow-up for the further treatment," he said.

Mohanty now fears that India's goal of ending TB this year is in jeopardy.

"At the end of the day, it is the community that has to use the diagnostic tools and has to come for screening. If they are not going to be sensitised or empowered, how will the (national) programme see results?" he said.

A Stop TB Partnership study showed that USAID's funding cuts could lead to as much as a 36% rise in cases and a 68% jump in deaths to 2.24 million by 2030 in 26 high burden countries.

"The withdrawal of U.S. support threatens essential TB services, including diagnostics, treatment, TB-HIV co-infection interventions and research initiatives critical to achieving ... TB eradication," the study said.

Mohanty said India must now devote more of its own money to curbing tuberculosis and seek assistance from non-traditional TB donors, like Denmark, Sweden, South Korea and Japan.

India is the world's third-biggest producer of pharmaceuticals, putting it in a better position than other countries, especially in Africa, that have relied on USAID to purchase life-saving medication to treat tuberculosis.

But experts said the Indian government has yet to publicly acknowledge the impact of the loss in USAID assistance.

Urvashi Singh, the deputy director general of the NTEP, did not respond to questions sent by text message and email.

"India has enough resources to meet the gap through government and private funding, but it needs to act now,” said Kumar.

(Reporting by Swagata Yadavar; Editing by Ayla Jean Yackley.)