At the end of 2024, global tuberculosis (TB) control showed some signs of recovery after setbacks caused by the COVID-19 pandemic. Shorter and less toxic regimens for drug-resistant TB improved treatment success rates, while rapid diagnostic advances and promising vaccine developments provided hope that countries might meet global TB reduction targets. Despite this, TB remained severely underfunded, with an estimated 10.8 million people infected and 1.3 million deaths in 2023, according to the World Health Organization (WHO).
The situation worsened dramatically in January 2025 when the Trump administration froze USAID funding for foreign aid, followed by the dismantling of the agency. USAID had contributed $406 million to global TB programs in 2024, funding a wide array of services from diagnostics to patient adherence programs. The sudden funding loss left TB programs in many countries at risk, disrupting case-finding, diagnostic testing, treatment initiation, and ongoing research into vaccines and new therapies.
Analyses indicate that the long-term consequences could be severe. A modeling study by Avenir Health and Stop TB Partnership projects that, without replacement funding, the 26 high-burden countries relying on USAID support could see an additional 10.7 million TB cases and 2.2 million deaths over five years. Community health organizations worldwide reported severe disruptions to essential services, including active case-finding and preventive treatment, particularly in vulnerable populations such as children and drug-resistant TB patients.
Countries like Cambodia, Pakistan, Ethiopia, and Nigeria have already experienced immediate impacts, including halted screenings, suspended outreach programs, and unemployed community health workers who were essential for patient support. The loss of USAID funding also jeopardizes TB preventive treatment, which is critical for children living with infected family members. Experts warn that undiagnosed cases and interrupted treatment could worsen disease transmission and increase mortality.
TB research has similarly suffered. Major initiatives like SMART4TB, clinical trials for new diagnostic tests, and the development of shorter treatment regimens for children have been curtailed due to funding cuts. USAID was the third-largest funder of TB research, and its withdrawal has left projects uncertain, with some key studies on drug-resistant TB and vaccine development stalled. Additional constraints have emerged from NIH policy changes affecting international collaborations.
Experts emphasize that these funding cuts come at a critical moment when global TB control was beginning to show transformative progress. Advances such as rapid molecular diagnostics, shortened drug-resistant TB treatment regimens, and promising vaccines like M72/AS01E risk being undermined. Even partial restoration of funds will face challenges due to the loss of local expertise and long-established partnerships, delaying progress in high-burden countries.
The uncertainty is compounded by potential future cuts, including a proposed $228 million reduction in the U.S. FY2026 budget for TB. Other major donor nations are also scaling back contributions, leaving national programs and organizations like Médecins Sans Frontières struggling to fill gaps. Experts warn that without urgent alternative funding, the global fight against TB—already the world’s leading infectious disease killer—faces significant setbacks, putting millions of lives at risk.
