Donald Trump’s cuts to global health programs will be lethal in the fight against tuberculosis, the infectious disease that causes the most deaths in the world but is nevertheless preventable. The World Health Organization (WHO) estimates, in projections published in the Global Tuberculosis Report 2025 released this Wednesday, that if funding provided by the US government to USAID and the Global Fund is not replaced, two million people who were not expected to die prematurely will die between now and 2035. Additionally, 10 million unexpected new cases would occur.
For Tereza Kasaeva, director of the WHO’s HIV and Tuberculosis Department, the 2025 cuts represent “a serious challenge”. “It is essential to have strong political leadership to drive greater national investment in countries with the highest (tuberculosis) burden. Decisions made today will determine whether we accelerate progress or settle for limited progress,” he said in a virtual press conference this Tuesday.
The cuts threaten the timid recovery in the fight against the disease after the ravages of the pandemic. WHO estimated that disruptions in tuberculosis diagnosis and treatment in the context of Covid-19 and the health systems crisis killed 700,000 more people than expected between 2020 and 2023.
As of 2024, 10.7 million people have contracted the disease and 1.23 million have died. Although it is the first time since 2020 that morbidity and mortality have reduced, by 1% and 3% respectively compared to 2023, the data is still higher than that recorded before the appearance of covid-19.
The decisions made today will determine whether we accelerate progress or settle for little progress.
Tereza Kasaeva, director of the WHO Department of HIV, Tuberculosis, Hepatitis and Sexually Transmitted Infections.
Cuts in international aid for global health would be far more damaging than the pandemic. In August this year, the reduction in aid impacted teams of community workers carrying out prevention tasks, screening and diagnosis activities, preventive treatments, data management and transporting samples to laboratories, according to the WHO.
Africa has managed to reduce tuberculosis incidence by 28% and deaths by 46%. Another good news, now in danger, is the progress in the development of new vaccines and drugs. The WHO highlighted in its report that there are 18 vaccines against tuberculosis in clinical development and that, of these, six are in phase III trials. Additionally, 63 new diagnostic tests and 29 drugs are under development. The problem, the agency warns in its report, is that “much NIH (the National Institutes of Health, a US agency) funding for health research has been canceled and a 40% reduction in the NIH budget for 2024 has been proposed.”
One of the vaccines affected is, in fact, the one under development in Spain. Carlos Martín, a microbiologist at the University of Zaragoza and one of the researchers of the vaccine, explained to EL PAÍS last May that one of the experiments conducted in South Africa had been interrupted due to decisions by the United States government.
The 2025 cuts worsen an already critical financial situation. The global response to tuberculosis has stagnated since 2020. In 2024, funding in low- and middle-income countries amounted to $5.9 billion, representing just 27% of the $22 billion that needs to be invested annually, according to targets set by the United Nations, through 2027 to tackle the disease.
Although 82% of resources generally come from national budgets, there are countries that are much more dependent on international donors. For example, 26 countries with high tuberculosis rates are 54% dependent on external resources. In low-income countries, dependency rises to 63%.
The United States has thus far been the largest contributor to tuberculosis treatment programs in the world. Between 2015 and 2024, it provided nearly 50% of resources through USAID and the Global Fund. Countries such as Zambia, Cambodia, Malawi, Ethiopia, and the Philippines are some of the countries that were most dependent on USAID funds to address this disease.
Peter Sands, executive director of the Global Fund, warns that the world cannot afford “another setback” like the one that occurred during the pandemic. “Any funding gap now puts us at risk of reversing the gains that have cost us so much to achieve, especially in the most vulnerable communities,” he said in a statement this Wednesday after learning of the data from the WHO report. Next week the Global Fund will celebrate the replenishment of resources for the 2027-2029 cycle. More than 70% of global funds to fight tuberculosis depend on this organization.
In this scenario, the WHO has called on states to increase national funding to try to fill financial gaps. Countries such as Nigeria and South Africa, the report points out, have already increased their budgets for this purpose.
We need to ensure that new tools arrive faster, that they are accessible and that countries adopt them as quickly as possible
Yogan Pillay, director of HIV and tuberculosis programs at the Gates Foundation
Yogan Pillay, director of HIV and tuberculosis programs at the Gates Foundation, added during the press conference that innovations will also play a key role. Pillay, for example, highlighted the foundation’s study on asymptomatic tuberculosis, which affects 50% of people with tuberculosis.
The expert also celebrates progress in the development of low-cost molecular tests for identifying the parasite that causes the disease, prevention through digital means to reduce the impact of stigma and the help of artificial intelligence in diagnoses. “We need to change the way we do things to be able to maintain the gains made in 2024. We need to ensure that new tools arrive faster, that they are accessible and that countries adopt them as soon as possible,” Pillay underlined.
