Tuberculosis (T.B.) is a fully treatable disease, yet in 2023 alone, it tragically claimed over 1.25 million lives. Despite the importance of providing this life-sustaining treatment, there are currently prevention and treatment efforts that are stymied due to funding cuts, which can cause incredible damage to patients and healthcare systems across the world where tuberculosis runs rampant. The cuts to international aid, specifically U.S.A.I.D., are unthinkable, putting lifesaving prevention and care for tuberculosis patients worldwide at severe risk. According to The World Health Organization (W.H.O.), in the past 20 years, prevention and treatment services have saved more than 79 million lives. The 18 countries most affected by T.B. now have healthcare systems that are at great risk with these cuts, as they depend on 89% of the United States’ funding for T.B. care and prevention. The W.H.O. has reported that these funding cuts are already being felt at a severe level. With thousands of healthcare workers facing layoffs in these countries and technical assistance roles being dismantled, T.B. programs are being crippled nationally in the affected areas. The supply chains that help deliver lifesaving drugs to patients in these countries are already breaking down in terms of both treatment and diagnosis. This effort to treat those already with disease is not the only thing at risk; the main research effort which tests new diagnostic methods and therapies has also been terminated, according to the New York Times. Though the United States does not fund all T.B. care, the role it plays is vital, and necessary.
Defunding T.B. treatment and research programs puts millions of people at risk and represents a short-sighted and harmful miscalculation for global health policy. The problem persists, not because the tools to solve it are unavailable, but because global leaders have turned away as the disease continues to claim lives that could have been saved. Tuberculosis predominantly affects the poor and the socially marginalized. The disease most greatly affects countries that may not be deemed politically viable, and as a result lack the political urgency to drive the necessary sustained investment to combat it.
The decision by the United States to slash U.S.A.I.D.’s tuberculosis funding reflects a broader retreat from global responsibility. T.B. is persistent and it is increasingly resistant to drug treatment. When treatment programs begin to fall behind in a region due to situations such as medicine shipments being delayed, diagnosis falling behind, and limited healthcare staff to administer treatment, the risk of T.B. mutating and becoming drug resistant increases. This mutation increases the chances for the disease to spread regionally and across borders, and it is both inaccurate and dangerous to believe that a disease cannot be contained within the borders of a country without proper support. The efforts to control T.B. on a global scale have historically suffered from a lack of proper funding and outdated global health strategies. T.B. initiatives by international aid organizations are not just about charity, but those investments lend way to strategically strengthening global stability, preventing the further spread of tuberculosis, and sustaining entire healthcare systems that are already in fragile states. Cutting this funding now after the COVID-19 pandemic slowed progress in T.B. treatment is especially dangerous. According to the W.H.O., the COVID-19 pandemic led to service interruptions, consequently causing over 700,000 excess deaths from T.B. between 2020 and 2023. The increased death toll was also exacerbated by inadequate social protection measures. The lack of valuable support and budgetary constraints undermine the long-running partnerships with N.G.O.s, global institutions, and national health ministries – partnerships that were invaluable in building foundational infrastructure and healthcare capacity in vulnerable countries in the fight against tuberculosis. The withdrawal of funding also fails to address the important structural drivers of the increased rate of tuberculosis. Some examples of drivers of T.B. in these countries are poverty, inadequate housing conditions, malnutrition, and lack of proper healthcare access. These societal determinants in vulnerable countries cannot be addressed through programs that are fragmented or reactive. The U.S.A.I.D. funding was intended to support long-term preventative care and research but will instead ensure that T.B. will remain entrenched in these countries where communities are already being pushed to the brink. This failure is not just that of budget, but that of solidarity. These cuts represent not just a fiscal decision to save some funds, but a moral and long-term strategic failure to recognize that the fight against tuberculosis is not just an earmark for global health, but is indeed a necessary fight for the lives being affected.
Tuberculosis thrives in conditions of war, displacement, and state collapse. Where war and state instability rages, T.B. has the opportunity to spread rapidly. In South Sudan, T.B. programs funded by U.S.A.I.D. were one of the few functioning public health services during years of civil war. In Yemen, U.S.A.I.D.’s technical support and diagnostic tools helped prevent T.B. outbreaks in refugee camps that are overcrowded and at higher risk for disease spreading. In Ukraine, after the Russian invasion in 2022, U.S.A.I.D. support provided drug-resistant T.B. treatment to areas that Ukrainian health services could not reach. All these efforts were more than just public health; they were infrastructure for peacekeeping efforts and were integral to maintaining stability. The United States withdrew T.B. funding in the nations in which those services provided a lifeline. The budget cuts not only leave people at higher risk for disease, but they leave societies more vulnerable to deeper fragmentation. T.B. treatment is conflict resolution, violence prevention, and it is hope for countries that crave stability to their country and their lives. At the core of these funding cuts, tuberculosis is not a global health issue, but it is proving to be a health issue in countries that one of the most powerful countries in the world is able to turn a blind eye to. Deaths from T.B. in the United States in 2022 stood at 565, while globally T.B. deaths in 2022 were at 1.3 million. In John Green’s newest book, Everything is Tuberculosis: The History and Persistence of Our Deadliest Infection, he writes, “tuberculosis has come to be seen as a disease of poverty, an illness that walks the trails of injustice and inequity, that we blaze for it.” These funding cuts are part of that very trail, the inequity we are continuing to pave.
The United States should not just reinstate all U.S.A.I.D. funding, but it should also increase funding and research efforts when it comes to combating T.B. globally. There are many gaps with long-term T.B. prevention. U.S.A.I.D.’s global T.B. programs should be embedded into every post-conflict reconstruction package alongside food and shelter. T.B. thrives in war zones and no peace agreement is sustainable without a functional healthcare system long-term. Secondly, T.B. research should be elevated to a security priority. With the slowdown from the COVID-19 pandemic and the current funding cuts, a globally spreading and drug-resistant T.B. strain is a looming possibility every day that funding is not reinstated and increased. Finally, because T.B. is a global issue and its prevention and treatment are a global benefit, with many of T.B.-burdened states spending more on debt service than public health, the United States and the International Monetary Fund should pursue health-for-debt swaps. This would convert sovereign debt payments into health system investments, as well as rebuild trust in war-torn regions by investing in T.B. clinics and healthcare systems instead of collecting on interest payments. We have the science to treat this disease, we have the means to treat this disease, and it is not a disease that stops itself on a country’s border. We can choose to blaze a different trail if we act now: a trail for solidarity, science, and global health.
