Historically, the United States (US) government has
played a crucial role in global TB elimination efforts
through funding mechanisms such as the United States
Agency for International Development (USAID), the
President’s Emergency Plan for AIDS Relief (PEPFAR)
and the Centers for Disease Control and Prevention
(CDC). These investments have been among the most
cost-effective tools in the U.S. global health arsenal –
every dollar spent on global TB care and prevention
both saves lives abroad but also reduces the risk of TB
transmission to the U.S., where the cost of treating
drug-resistant TB can exceed $500,000 per patient.1 On
January 20th 2025, President Trump issued an executive
order to freeze all foreign aid for 90 days. These cuts
are part of a broader restructuring effort that has reportedly
eliminated over 80% of USAID’s programs,
affecting not just TB but also global HIV/AIDS, food
security and humanitarian assistance.2.3 In Africa, the
withdrawal of USAID and PEPFAR funding has already
led to staff layoffs, service reductions, and procurement
delays for essential medicines and diagnostics.4,5 The
WHO and global health leaders have warned that these
funding cuts could severely impact TB care and prevention,
with potential increases in drug-resistant TB
and setbacks in national TB programs (NTPs).6-8
To assess the immediate effects of the US funding
cessation on TB services, we conducted a rapid survey
across 52 countries, primarily in Africa, and received
responses from 17 (33%) NTPs (see Table). Of these,
11 (65%) reported that cessation of US funding has
already negatively affected TB care and prevention.
Reported effects included: i) disruption in financial
support for TB case detection (and consequently reduced
capacity for active case finding and diagnostic
expansion); ii) decreased availability of essential TB
diagnostic tools, affecting laboratory operations and
delaying patient diagnosis; iii) layoffs of key TB service
personnel, especially contract-based workers funded
through external support; and iv) reduced financial
resources for patient outreach and adherence monitoring,
thus impacting treatment success rates. Ten
(59%) countries expected further disruption to TB
services within the next three months. Anticipated
consequences include reduced diagnostic capacity,
limited procurement of medical supplies and weakened
supervision of treatment adherence programs.
Despite funding cessation, countries indicated that
they could still currently procure TB treatment medications
and diagnostic consumables, at least in the
short term. However, patient access to diagnosis and
treatment has already been affected in 4 (24%)
countries, particularly in settings where laboratory
operations depend on US-funded initiatives. Six (35%)
countries have experienced disruptions in monitoring,
evaluation, reporting and supervision. In 11 (65%)
countries, TB-related training activities for established
staff through refresher courses have been affected and
courses for new staff have been suspended. Eleven
(65%) countries noted that implementing partners,
including international non-governmental organizations
such as KNCV and The Institute of Human
Virology, Nigeria, have reduced their operational
scope, resulting in downsizing of staff working in TB
programs, cessation of TB outreach and advocacy
activities and reduced financial support for decentralized
TB service delivery. WHO plays a vital role in
technical assistance and program oversight for NTPs.
Nine (53%) countries reported that WHO’s countrylevel
support to TB programs has been affected, the
most common disruptions including i) suspension of
consultant recruitments responsible for capacity
building and monitoring; ii) reduction in technical
support for NTP program evaluation and policy
implementation, and iii) delays in procurement processes
for essential TB-related resources. This survey
highlights the fragility of TB control efforts in countries
where NTPs depend on external financing. As
Dr. Tereza Kasaeva, Director of WHO’s Global
Program on TB and Lung Health announced on March
5th ‘Any disruption to TB services, whether financial,
political or operational, can have devastating and
often fatal consequences for millions worldwide’.9
Our findings align with recent literature highlighting
the consequences of US funding withdrawal. Ndjeka
et al. describe how recent funding cuts and stop-work
orders have severely disrupted TB services and research
in South Africa threatening the substantial
progress achieved over the past decade.10 The termination
of USAID and PEPFAR support has led to the
suspension of key programs in prevention, diagnosis,
treatment, and digital surveillance, with an estimated
580,000 fewer TB tests and 35,000 fewer individuals
expected to receive treatment in 2025 in that country
alone.10 Ongoing research efforts, including clinical
trials, are also under threat.10 The authors conclude
that these disruptions not only jeopardize national TB
control efforts but may also reverse hard-won global
gains, particularly in addressing drug-resistant TB,
unless urgent alternative support is secured.10 In the
same vein, Boffa et al. critically examine the progress
and ongoing challenges toward TB elimination in
Eswatini, Mozambique and South Africa.

tuberculosis; USAID; global public health