Health officials are paying attention to the looming consequences of the Trump administration, the US International Development Agency. The risk of a global surge in tuberculosis cases and deaths.
The World Health Organization warned last week that drastic cuts in funding could put millions of lives at risk as many countries rely on foreign aid for tuberculosis prevention, testing and treatment.
“Without immediate action, the fierce progress in the fight against tuberculosis is at risk,” Dr. Teleza Casaeva, director of the WHO’s Global Program on TB and Lung Health, said in a statement Wednesday.
Globally, tuberculosis is the cause of most deaths from infectious diseases. According to the WHO, around 1.25 million people died from bacterial infections in 2023, with the latest available data available, with new cases that year at an all-time high and around 8.2 million diagnosed.
Until recently, USAID provided about a quarter of international donor funding for tuberculosis services in other countries, according to the WHO. The agency ran tuberculosis programs in 24 countries.
The WHO said other countries’ drug supply chains are “broken” due to US funding cuts, laboratory services are “severely confused” and surveillance systems are “collapsed” and it is difficult to identify, monitor and treat cases of tuberculosis. Several research trials have also been suspended.
It neutralizes several national tuberculosis programmes, and the WHO has warned of catastrophic effects in the 18 countries with the highest disease burden, many of which are in Africa.
In Uganda, USAID funding rollbacks have made payments to community health workers difficult and led to staffing shortages, said Dr. Luke Davis, a clinical epidemiologist at Yale University School of Public Health. These workers play an important role in notifying those who test positive for tuberculosis, getting treatment and screening for intimate contacts of infection.
“Participants may be diagnosed with tuberculosis after leaving the clinic as they are waiting for results, they may be at home with tuberculosis and they may not know what tuberculosis is. They literally don’t have the resources to go out and get to those people,” he said. “People are almost dying because they are not diagnosed, untreated, and not prevented.”
Since January 24, the cancellation of USAID funds could have resulted in an estimated 3,600 additional TB deaths and 6,400 additional infections, according to a project modeling the impact of the cut. This model is coordinated by the STOP TB Partnership, a United Nations organization aimed at eliminating tuberculosis as a public health issue.
An increased spread of disease could affect the United States as more people can live or travel abroad. The number of cases of tuberculosis in the United States is already rising. It recorded 9,600 cases in 2023, an increase of 16% from the previous year, and 9% in 2019 than the kindergarten level.
The persistent outbreak in Kansas has resulted in 68 active cases since January 2024.
“What happens when we travel abroad? I know the military and women who return with multidrug-resistant tuberculosis after a mission tour. Dr. Kenneth Castro, professor of global health at the Rollins School of Public Health at Emory University, said:
“The problem with all these infectious diseases is that they don’t know the border and our efforts should not stop at the border either,” he said.
The revival of tuberculosis in the United States from 1985 to 1992 was partly due to a decline in TB control programs and an increase in global cases.
The White House declined to comment.
People with active tuberculosis usually develop bad coughs and chest pain. They exhale blood and mucus, which can make breathing difficult. Without treatment, bacterial infections can damage the lungs and spread to other parts of the body, such as the brain, kidneys, and spine. According to the WHO, up to two-thirds of people with active cases that are not properly treated can be fatal.
However, treatment is not a quick issue. Tuberculosis patients usually have to take antibiotics for six months, and if stopped in the middle, a person becomes resistant to antibiotics and spreads its drug-resistant tuberculosis strain to others.
Until the recent cuts, USAID was conducting surveillance to identify new cases of tuberculosis, helping to improve the supply chain to intake medicine in sick patients, and investing in clinical trials for new treatments and diagnostic testing. In a community that lacked radiologists to read x-rays, USAID also funded portable x-ray systems that use artificial intelligence to perform diagnostics.
Additionally, the agency helped the country raise drugs at a low cost by funding global drug facilities, a group that negotiates drug prices with suppliers.
Many of these efforts came to a halt when the Trump administration stripped the agency to its naked bones. After firing or attacking contractors in January, the administration laid off 1,600 staff and placed thousands more on administrative leave last month. Secretary of State Marco Rubio said Monday that the administration cancelled 83% of the USAID program after a six-week review, with the rest of the program being absorbed by the State Department.
In January, Rubio issued a waiver that allowed USAID life-saving humanitarian programs, including tuberculosis prevention and treatment, despite a 90-day freeze on foreign aid. However, in a note to staff last month, USAID officials said almost all the funds needed to maintain these programs have been completed.
Officials warned of “preventable deaths, destabilizations and threats to national security on a large scale,” and then placed on administrative leave after sending memos.
USAID’s downsizing was part of a broader effort to reduce federal spending led by Elon Musk and government efficiency. Musk said last month in X that he “supplies Uside to Wood Chipper,” and he and Trump agreed that the agency should be shut down.
So far, federal judges have rejected requests from USAID staff and contractors and have continued their work while the lawsuit challenges the end of the matter. However, the Supreme Court on Wednesday said the Trump administration must pay $2 billion to USAID contractors for the work already completed.
WHO aims to reduce the number of cases of tuberculosis by 80% and 90% by 2030. It was already enthusiastic, but it’s not even visible now, said Dr. Priya Shette, an associate professor of medicine and epidemiology at the University of California, San Francisco.
USAID played a key role in getting patients diagnostic tools and treatments via “the last mile,” Shete said. That includes finding ways to transport drugs when road conditions are poor and funding a mobile clinic that offers x-rays and bacterial testing.
“The loss of resources to pass the finish line is truly intrusive for some people and ultimately ends up sacrificing millions of lives,” she said.
Experts worry that disruptions in clinical trials will hinder the development of treatments for drug-resistant infections and new ways to detect cases in children that are often difficult to diagnose.
“Innovation is back and benefits the US,” Davis said.
