US Funding Cuts Threaten Global Tuberculosis Progress

An abrupt decision to stop U.S. government funding for global tuberculosis (TB) programs has opened a severe threat to care and prevention in countries that depend on outside aid. Carel Pretorius and colleagues examined how exposed high-burden TB countries are to that withdrawal and what it could mean for patients and health systems. The team starts from the fact that in 2023 external funding made up 21% of total TB spending, and that the U.S. provided more than 55% of those external funds. Those dollars support essential services—diagnostics, treatment, interventions for TB-HIV coinfection, and research efforts linked to reaching the 2030 Sustainable Development Goals (SDGs) and the End TB targets. To quantify risk, the researchers focused on 26 high-burden TB countries (HBCs) and grouped them by how much of their TB budgets depended on U.S. money. They then modeled how interruptions to services would translate into extra cases and deaths under different recovery assumptions. The aim was to provide a clear, evidence-based picture of what the loss of U.S. support could mean for global TB control.

The study classified the 26 HBCs into three dependency groups based on three years of expenditure data: low (0–22%), moderate (23–37%), and high (>37%). The team used a deterministic compartmental model to simulate what happens when services are disrupted and then recover under three scenarios: minimal impact (services recover within three months), moderate impact (recovery within one year), and worst-case scenario (permanent service reduction). They extrapolated results from representative countries in each dependency category to estimate effects across all 26 HBCs. For a high-dependency country, the model projects cumulative TB cases could rise by 2.1% (CI 1.5 – 2.5), 5.4% (CI4 – 6.5), or 36% (CI 25 – 47), and TB deaths by 2.9% (CI 2.2 – 3.5), 7.8% (CI 5.9 – 9.2), or 68% (CI 45 - 86), depending on the severity of service disruptions. Applied to all 26 countries, additional TB cases are estimated at 0.63 million (CI 0.45 – 0.81) for minimal impact, 1.66 million (CI 1.2 – 2.1) for moderate impact, and 10.67 million (CI 7.85 – 13.19) in the worst-case. Corresponding extra deaths are 99,800 (CI 65,200–130,000), 268,600 (CI 185,800–337,900), and 2,243,700 (CI 1,570,800–2,807,300), respectively.

The findings paint a stark picture: losing U.S. funding threatens to reverse progress against TB and could derail global targets. The researchers emphasize that while some countries may be able to adapt or draw on other resources, short-term disruptions will have the heaviest toll on people who are already most vulnerable—those living with HIV, people in poor or rural communities, and others who rely on public programs for diagnosis and care. Beyond immediate patient care, cuts would weaken prevention programs and research efforts that underpin long-term control and innovation. Pretorius and colleagues conclude that urgent alternative funding is needed to sustain diagnostics, treatment, TB-HIV services, and research initiatives; without it, the End TB goals and the 2030 SDG commitments are at serious risk. The study calls for rapid mobilization of new resources and policy attention to prevent the catastrophic outcomes outlined in the models.