Aid cuts could cause hundreds of thousands more tuberculosis deaths by 2035

Tuberculosis services in many low- and middle-income countries depend heavily on money from international donors. In 2025 the United States Agency for International Development (USAID) was dismantled and other countries announced cuts to overseas development assistance. To understand what this might mean for people at risk of tuberculosis, Rebecca A. Clark and colleagues used a mathematical approach to estimate the possible health consequences. They calibrated a deterministic tuberculosis model to existing epidemiological indicators across low- and middle-income countries and then projected future trends under different funding scenarios. The study focused on how reductions in donor budgets would affect the ability of health systems to start people on tuberculosis treatment, and how that would change the number of symptomatic tuberculosis episodes and tuberculosis deaths over time. By modelling realistic funding cuts and measuring their likely effects at a population level, the team aimed to give policy makers and the public a clearer sense of the human cost of shrinking international support for tuberculosis services.

The researchers calibrated a deterministic tuberculosis model to epidemiological indicators in low- and middle-income countries and projected three future scenarios: a) levels of funding in 2024 continue through 2035, b) termination of USAID funding from 2025, and c) additional reductions in funding through The Global Fund in line with current donor announcements from 2025. They assumed a reduction in tuberculosis treatment initiation rates proportional to budget reductions for each scenario, and used the model to estimate cumulative excess incident episodes of symptomatic tuberculosis and tuberculosis deaths. The team modelled 79 countries, representing 91% of global tuberculosis incidence and 90% of global tuberculosis mortality in 2023. Their results suggested that termination of USAID funding may lead to 420 500 excess tuberculosis deaths by 2035. Further reductions in funding in line with current announcements by the United States, France, the United Kingdom, and Germany may lead to an additional 699 200, 63 100, 50 500, and 30 500 TB deaths, respectively. The analysis also found that impacts would be greatest in low-income countries. Funding: This work was unfunded.

The findings point to substantial potential increases in tuberculosis illness and death if international donor support is reduced. Because the model links budget cuts to lower rates of treatment initiation, fewer people would get timely diagnosis and care, which drives both more illness and more deaths. The study highlights that the effects are not spread evenly: low-income countries would bear the heaviest burden, where donor funding often fills crucial gaps in prevention, diagnosis, and treatment capacity. The authors conclude that expanded support from domestic and international donors is essential to address immediate gaps and to prevent a rise in tuberculosis cases and fatalities. While models are simplified representations of reality, this work provides a clear warning that policy decisions about aid levels can translate into large numbers of avoidable deaths over the coming decade if gaps are not filled.