More than a year after the second Trump administration began scaling back the US Agency for International Development (USAID), the global health impact of reduced international aid is becoming increasingly evident. A new study led by a researcher from Boston University School of Public Health reveals that cuts to USAID funding, along with broader reductions in foreign aid, could significantly increase the financial strain on families affected by tuberculosis (TB) in low- and middle-income countries.
Published in PLOS Medicine, the study estimates that the loss of USAID support alone could result in approximately $7.5 billion in additional costs for households that include at least one TB patient. It also warns that around four million more families could face “catastrophic costs,” defined by the World Health Organization as expenses exceeding 20 percent of a household’s annual income, including medical, non-medical, and indirect costs.
In a worst-case scenario where all international funding for TB services is eliminated, the total economic burden on affected households could rise to nearly $80 billion. Before 2025, global aid played a crucial role in supporting TB prevention and treatment, especially in resource-limited settings. USAID contributed nearly 20 percent of international TB funding, while programs like the Global Fund to Fight AIDS, TB, and Malaria accounted for a majority share, with significant backing from the United States. These combined efforts led to measurable progress, including a decline in global TB infections and deaths between 2023 and 2024.
The study highlights that reduced funding could disrupt access to essential TB services, worsening health outcomes while deepening financial hardship, particularly among the poorest populations. Researchers used epidemiological and economic models across 79 low- and middle-income countries to assess multiple funding scenarios, ranging from maintaining current levels to the complete withdrawal of international support. The findings show that the financial burden could increase by 32 percent compared to pre-cut levels, with the poorest 20 percent of households bearing more than half of the additional catastrophic costs.
Tuberculosis imposes a wide range of financial challenges on affected families. These include direct medical expenses such as diagnostic tests and treatment, as well as non-medical costs like transportation, accommodation, and nutrition. However, the most significant impact often comes from indirect costs, particularly income loss, as patients may be unable to work during prolonged illness and treatment.
The study also emphasizes the long-term consequences of these financial pressures, including depleted savings, increased debt, reduced access to education, and food insecurity. While the estimates are subject to certain limitations, the findings underscore the serious risks associated with declining international support.
As the global community approaches World Tuberculosis Day on March 24, the research calls for urgent action to restore funding and strengthen TB services. Experts suggest that countries may need to increase domestic investment, integrate TB care into primary healthcare systems, and implement financial protection measures such as cash transfers and social support programs. Gradual and coordinated transitions in donor funding, along with blended financing models, could help ensure continuity of care and reduce the economic burden on vulnerable populations.
