Cuts to global TB aid could push millions into poverty

Recent changes in global health financing have put critical tuberculosis (TB) services at risk in low- and middle-income countries (LMICs). Allison Portnoy is the corresponding author on a modelling study that quantifies how reductions in international donor funding could affect the money households must spend because of TB. The researchers focused on the dismantling of the United States Agency for International Development (USAID) and possible reduced contributions to the Global Fund to Fight AIDS, TB and Malaria (Global Fund), and used linked epidemiological and economic models calibrated to 79 LMICs. They compared four possible futures: continuation of 2024 funding levels (baseline); termination of USAID; termination of USAID plus announced reductions in Global Fund contributions; and full elimination of external funding for TB. The study tracked total TB-attributable household costs and the number of households experiencing catastrophic costs, defined as disease-related costs greater than 20% of annual income, over the period 2025–2050. By framing the issue in household terms, the team aimed to show not just health impacts but how funding shifts translate into immediate economic harm for families.

To produce quantitative estimates, the authors combined an epidemiological model of TB with an economic model that calculates patient-incurred costs and the likelihood of catastrophic spending, calibrating both to country data from 79 LMICs. Under the scenario where USAID funding is terminated, the model projected an additional US$7.5 billion (95% uncertainty interval: $6.1–8.9 billion) in patient-incurred costs and 3.9 million (3.1–4.6 million) additional households experiencing catastrophic costs across 2025–2050. Announced further reductions in Global Fund contributions added an estimated $21.2 billion ($16.6–25.6 billion) in patient costs and 10.7 million (8.4–13.0 million) additional households facing catastrophic costs. The authors also modeled a worst-case scenario of full elimination of external TB funding: that produced a projection of $79.7 billion ($60.0–99.2 billion) in additional patient-incurred costs and 40.5 million (30.9–50.7 million) additional households experiencing catastrophic costs, described as a 32% increase over baseline. A related comparison showed that if all external TB funding were terminated, $72.2 billion ($53.9–90.4 billion) in patient costs and 36.6 million (27.7–46.1 million) households could be affected compared with the impact of USAID cuts alone.

The study highlights serious equity and financial protection concerns if donor funding for TB is reduced or withdrawn. Impacts are disproportionately borne by the poorest: more than half of the additional catastrophic costs would fall on the poorest 20% of households, according to the modelling. The authors warn that abrupt reductions in international donor funding may reverse recent progress toward financial risk protection and health equity in LMICs, and that disruptions to TB services could increase both disease and household economic hardship. Their conclusions call for urgent strategies to reduce disruption from funding cuts and to protect vulnerable populations, emphasizing that policy choices about international financing will have direct, measurable consequences for millions of families over the coming decades.