Cuts to health aid could cause millions of childhood TB cases and deaths

Tuberculosis disproportionately harms children, who face higher risks of becoming ill and dying from the disease. Nicolas A. Menzies and colleagues set out to estimate how many extra pediatric TB cases and deaths might occur over the decade 2025–2034 if programmes supported by major international health funders were discontinued. The team focused on services funded by United States bilateral health aid and the Global Fund to Fight AIDS, Tuberculosis, and Malaria, which underwrite diagnosis, treatment and prevention programmes in many low- and middle-income countries. To make these estimates they gathered data on who pays for TB and HIV programmes across countries and then built scenarios that represent reductions in health aid starting in 2025. Using mathematical models that simulate how TB spreads and how services affect exposure and treatment, they projected the likely trajectory of pediatric TB when services are withdrawn or restored. Their work translates funding decisions into potential child illnesses and deaths, offering a clear picture of the human consequences of cutting international support.

To produce their projections the researchers collated data on funding sources for TB and HIV programmes in low- and middle-income countries and constructed scenarios representing reductions in health aid from 2025. They used calibrated transmission-dynamic models for 130 countries to project what would happen if TB and HIV treatment services supported by those funds were discontinued under several funding-reduction scenarios, and how those changes would affect pediatric TB exposure and access to treatment. They then projected pediatric TB incidence and mortality over 2025–2034 to calculate the impact of funding reductions. Their results show that withdrawal of services currently supported by US bilateral health aid was projected to lead to an additional 2.5 million (95% uncertainty interval: 1.8–3.3) pediatric TB cases and 340,000 (240,000–460,000) deaths over 2025–2034 compared with maintaining pre-2025 service levels. Withdrawal of US support to the Global Fund and reductions in non-US contributions were projected to result in an additional 8.9 million (6.9–11.5) pediatric TB cases and 1.5 million (1.1–2.0) deaths — more than double the number expected with continued service levels. The largest impacts were in Sub-Saharan Africa and South-East Asia. The models also showed that restoring services in 2026 would lead to a substantially smaller number of additional deaths than permanent withdrawal.

The findings make clear that decisions about international health financing can have direct and large effects on children’s lives. Without actions to restore discontinued services, cuts to health aid for TB and HIV programmes could result in very large numbers of childhood TB deaths over the next decade. The study’s country-level modelling highlights where service disruptions would hit hardest, signalling regions that might need urgent attention if funding is reduced. Restoring services quickly, as the models note, reduces harm compared with prolonged withdrawal. For policymakers, donors and global health agencies, these projections translate budget and partnership choices into human terms: many thousands or millions of children could be spared illness and death if treatment and prevention programmes are maintained or rapidly reinstated.