A Deadly Equation: The Global Toll of US TB Funding Cuts

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Summary Background The abrupt discontinuation of U.S. government funding for global tuberculosis (TB) programs has created significant challenges in TB care and prevention. In 2023, external funding accounted for 21% of total TB expenditures, with the U.S. contributing over 55% of these funds. The withdrawal of U.S. support threatens essential TB services, including diagnostics, treatment, TB-HIV co-infection interventions, and research initiatives critical to achieving the 2030 Sustainable Development Goals (SDGs) for TB eradication. Methods This study analyses the dependency of 26 high-burden TB countries (HBCs) on U.S. funding and models the potential impact of funding cuts on TB incidence and mortality. Countries were classified into low (0–22%), moderate (23–37%), and high (>37%) dependency groups based on three-year expenditure data. A deterministic compartmental model simulated service disruptions under three recovery scenarios: (1) minimal impact (services recover within three months), (2) moderate impact (recovery within one year), and (3) worst-case scenario (permanent service reduction). Extrapolations were made for all 26 HBCs based on representative countries from each dependency category. Findings Funding cuts are projected to result in substantial increases in TB cases and deaths across the three scenarios. In a high-dependency country, 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), 68%(CI 45 - 86), depending on the severity of service disruptions. Across all 26 HBCs, additional TB cases are estimated at 0.63 million (CI 0.45 – 0.81) (minimal impact), 1.66 million (CI 1.2 – 2.1) (moderate impact), and 10.67 million (CI 7.85 – 13.19) (worst-case). Corresponding TB deaths are projected to increase by 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 underscore the catastrophic consequences of the funding cut, particularly in countries highly reliant on U.S. support. Interpretation The loss of U.S. funding endangers global TB control, jeopardizing End TB and SDG targets. While some nations may adapt, short-term disruptions will severely impact vulnerable populations. Urgent alternative funding is needed to sustain TB prevention and treatment efforts and mitigate the effects of aid withdrawal.