Years of progress against tuberculosis, the world’s most deadliest infectious disease are being derailed by the abrupt funding cuts by the United States to the sector, according to a survey of 180 affected organisations released late Wednesday.

As many as a quarter of the 180 survey respondents from 31 countries have had to close in the past few weeks, and 25% have cut back on TB treatment for those already on medication – massively upping the risk of a global explosion of drug-resistant TB.

“Countless people having TB, including its resistant forms, face the imminent threat of losing access to essential medications – further risking an increase in transmission and drug resistance development of mammoth proportions,” according to the TB Community Coordination Hub, which compiled the survey.

Virtually all the projects surveyed had received US “stop work” orders and half reported that their ability to deliver TB services has been “severely” impacted by the orders. 

Over three-quarters (78%) have laid off staff, and community health workers (CHW) have borne the brunt of the layoffs. Half the organisations reported having to lay off their entire community-based staff.

CHW “ensure timely diagnosis and treatment for people with TB and drug-resistant TB”, according to the hub.

As a result of the collapse of funding for CHW, almost half  the projects (46%) have stopped TB screening and outreach and 29% are unable to start people with TB on treatment.

USAID has been the largest bilateral donor in the TB sector, having invested over $4.7 billion since 2000, saving over 79 million lives. 

‘We won’t walk away without a fight’

“[We] strongly condemn this callous, abrupt and totally one-sided act that is unprecedented, and calls upon the US Administration to take immediate measures to restore funding and support projects globally that are crucial to contain and prevent a resurgence of this deadly disease”, the hub added. 

The hub also calls on all countries, global TB leadership and donor organisations to “take urgent measures to gear up alternate funding to enable uninterrupted TB treatment and care to those in need, while upholding commitments to End TB as a global health security priority and a crucial indicator of Sustainable Development Goal 3”.

“Our survey reveals the devastating impact of the US funding cuts on civil society, technical organisations and TB community networks at local and national levels,” said Dr Robyn Waite, part of the hub’s secretariat.

“Now, with termination contracts in place, our findings are but a glimmer of the escalating crisis. As TB activists and advocates, we are shocked and struggling to deal with the fallout. But let’s be clear – we will not walk away without a fight.”

No support for ‘most vulnerable’

Atul Shengde, the National Youth Coordinator of the Global Coalition of TB Advocates in India, said that the cuts meant that his organisation “can no longer reach the most vulnerable – children, women, sex workers, injecting drug users, transgender people, and migrant workers”.

“Previously, when patients struggled with the harsh side effects of TB medication, we were there to support them and keep them on treatment. Now, that critical support system is gone. The voices that once guided people through TB care have been silenced, and without them, I fear we will see TB spread even faster,” warned Shengde.

“In southern African countries, we’re hearing devastating stories: people avoiding TB centers out of stigma attached to lining up in queues, a woman forced to share half of her medication with the husband to ensure continuation, a young person skipping doses to stretch limited supplies, and a patient receiving near-expired drugs,” said Bruce Tushabe of the AIDS and Rights Alliance for Southern Africa (ARASA).

“In the absence of community healthcare workers and other technical staff, we will continue to hear these gruesome stories of stigma, treatment disruptions, and a rise in multi-drug resistant tuberculosis.”

Timur Abdullaev, a board member of TBpeople Global, said that the US funds cut had caught the TB community off guard and also revealed that “some essential elements of national TB programs appeared to be run fully by USAID”. 

“Unfortunately, we see exactly the same overly confident reliance on the Global Fund,” warned Abdullaev. 

“Protecting the lives of a country’s citizens is the responsibility of the country, not that of external donors or technical partners. Not being prepared for the loss of an external donor – even as large as USAID – and the failure to respond quickly to the resulting crisis is simply criminal.”

‘Devastating impact’

The World Health Organization (WHO) said on Wednesday that the 2025 US funding cuts will have “a devastating impact on TB programmes, particularly in low and middle-income countries that rely heavily on international aid, given the U.S. has been the largest bilateral donor”. 

The US has provided approximately $200–$250 million annually in bilateral funding for the TB response at country level, around a -quarter of international donor funding for TB, according to the WHO.

“These cuts put 18 of the highest-burden countries at risk, as they depended on 89% of the expected U.S. funding for TB care. The African region is hardest hit by the funding disruptions, followed by the South-East Asian and Western Pacific regions.”

Dr Tereza Kasaeva, WHO’s Director of the Global Programme on TB and Lung Health, said that “any disruption to TB services – whether financial, political, or operational – can have devastating and often fatal consequences for millions worldwide”.

This was proven during the COVID-19 pandemic, she added,  when “service interruptions led to over 700,000 excess deaths from TB between 2020 and 2023, exacerbated by inadequate social protection measures”.

Image Credits: USAID, Southern Africa/Flickr, Stop TB Partnership, USAID Asia.