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NGOs and other groups that play a critical role in national efforts to stop what is the world’s deadliest infectious disease say the US administration’s recent decisions to first freeze and then cancel huge swathes of foreign aid funding have put countless lives at risk around the world.

And they warn that if that funding gap is not filled, years of progress in fighting TB could be lost.

“The impact of these cuts has been massive. There’s a gaping hole in financing, and if we don’t keep the pressure up on TB it will come back,” Dr. Cathy Hewison, Head of Médecins sans Frontières (MSF)’s TB working group, told IPS.

Every year, 10 million people develop TB, and in 2023 1.25 million died from the disease. It disproportionately affects low- and middle-income countries, with the largest TB burdens being among the world’s poorest states.

While in many states government funding accounts for at least the bulk of first-line treatment, community groups play a crucial and outsized role in national efforts to combat the disease, providing vital diagnosis, prevention, advocacy, and support services.

Many such groups rely heavily or exclusively on foreign funding with financing through US schemes, primarily USAID, predominant. USAID is the largest bilateral donor in the fight to end TB, having invested more than USD 4.7 billion to combat the disease since 2000.

In late January, an executive order from US President Donald Trump put a 90-day freeze on all US foreign aid while a review of funded projects was carried out, and then earlier this month, it was announced that 83% of all USAID projects were to be cancelled.

The effects on community groups on the frontlines of the fight against TB have been immediate and severe.

“Many community organizations have suspended outreach services, such as active case finding, contact tracing, treatment adherence, and psychosocial support,” Rodrick Rodrick Mugishagwe, a TB advocate with the Tanzania TB Community Network (TTCN), told IPS.

“Furthermore, transportation allowances for community health workers conducting home visits have been reduced, resulting in lower TB case detection rates. There have also been job losses among community health workers and peer educators, undermining service delivery,” he added.

Mugishagwe recounted how a woman from the city of Arusha in northern Tanzania who was diagnosed with TB last year had relied on a USAID-supported community programme for transport to a clinic for monthly treatment. But following the funding cuts, her programme shut down, and she could not afford the transport costs.

“She has disappeared from her residence and can no longer be traced, putting her at risk of treatment failure and developing drug-resistant TB, while there is a risk of further transmission to the community,” he said.

Bruce Tushabe, regional training and capacity strengthening lead at the AIDS and Rights Alliance for Southern Africa (ARASA), which works with partners in South Africa on TB interventions, most of whom were supported through USAID, said treatment and access to TB medication had been stopped. There had also been a breakdown in community-led monitoring tracking progress in treatment access and availability, he said.

“There is a high burden of TB – an incidence rate of 468 per 100,000 of the population—and we now expect to see an increase in deaths, and in the long term, [rising] multi-drug resistant TB (MDR-TB) among the populace, as well as increased TB cases since contact tracing is now paused in many areas and facilities,” he told IPS.

The spread of drug-resistant (DR-TB) and MDR-TB in the wake of the funding cuts is a particular concern, especially in poorer countries where DR TB is often widespread, as it is much harder and costlier to treat, putting an even greater burden on limited resources.

“There is a lot of DR-TB here and when people don’t have the right information and don’t take the right medicine or don’t have support during lengthy, sometimes very hard treatment, they might not be able to finish their course or treat their TB properly, and then the disease spreads. People with TB who had been going to TB centers may now turn up and find there is no one to answer their questions or give them the right advice on treatment, and so they might just turn away,” Atul Shengde, National Youth Coordinator—Global Coalition of TB Advocates, India, told IPS.

While TB often affects the poorest and most vulnerable communities, even within those communities there are some groups which are especially at risk, such as children.

“Children’s immune systems are less developed, which makes them more vulnerable to TB. Figures show 25% of the world is infected with TB, but just because someone is infected it does not mean they will get sick from it. But if your immune system is less developed or compromised in any way you are more likely to get TB, more likely to get ill with TB, and more likely to have more severe TB,” Hewison said.

“Children at risk of having TB are often overlooked, either going undiagnosed or facing delays in diagnosis. Now, with the recent US funding cuts, these gaps in identifying and treating children with TB will only widen further which threatens to roll back years of progress in TB care,” she added.

The World Health Organization has issued stark warnings of the devastating effects of the abrupt cessation of US global health funding, and affected organizations have pleaded with the US to reverse its decision.

But community groups who spoke to IPS admitted it appeared unlikely funding would resume any time soon.

And because US funding played such a large role in global TB efforts, they worry it will be very difficult to plug the current financing gap, certainly in the short to medium term, and possibly even long term, especially at a time when governments in high-income countries, such as the UK, Germany, and France, among others, are reducing foreign aid.

“I see no high-income donor countries stepping in to fill the gap left by the US funding cuts. Countries are faced with a lot of resource pressures at the moment; for instance, defense is a big issue now, and to pay for that, cuts are going to have to be made elsewhere, and that usually starts with healthcare,” Dr Lucica Ditiu, Executive Director of the Stop TB Partnership, told IPS.

“In future, low and middle income countries, especially, will have to relearn the hard lesson, as they did with Covid, that they are on their own. They will have to think about reducing their reliance on external donors for their health programmes and put the resources in themselves,” she added.

Buy while some governments may be able to up their financing of national TB programmes, poorer countries are likely to struggle to do so, and new forms of financing need to be considered, experts say.

“Of course, raising funding is impossible for some low-income countries. Innovative forms of funding need to be looked at—for example, financing from the different international development banks, debt swaps between countries, and others,” said Ditiu.

However, even if the funding gap is plugged somehow, or there is an unlikely dramatic reversal of US policy in the near future, there are fears the damage has already been done.

“We are going to see a massive spread of TB, and especially DR-TB, whatever happens now because cases have been missed, people have gone undiagnosed, and treatment has been interrupted,” said Ditiu.

IPS UN Bureau Report

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