Impact of U.S. Foreign Aid Cuts on Global Tuberculosis Control Efforts

In recent months, the landscape of U.S. foreign assistance has undergone significant transformations, with ramifications for global health initiatives, particularly in the battle against tuberculosis (TB). Following a series of executive actions that began in January 2025, the Kaiser Family Foundation (KFF) has documented a troubling trend: disruptions in U.S. foreign aid are unraveling decades of progress in controlling TB worldwide.

The U.S. government has been a pivotal player in global TB efforts since the late 1990s, when the U.S. Agency for International Development (USAID) established a global TB program. TB remains a leading cause of death worldwide, with an estimated 25 million fatalities in 2023 alone, surpassing all other infectious agents. Notably, TB is the leading cause of death among individuals with HIV (World Health Organization, 2023).

According to Dr. Sarah Johnson, Professor of Global Health at Johns Hopkins University, "The U.S. has historically contributed to saving over 58 million lives since the year 2000 through its TB programs. The recent disruptions could reverse these gains significantly."

The impact of recent U.S. foreign aid actions has been profound. Following a funding freeze and the cancellation of approximately 86% of USAID awards, TB program operations have stalled, leading to the termination of critical services and the loss of thousands of health workers. The limited waivers issued by the State Department, which allowed for some essential TB services to continue, have not mitigated the overall disruption (KFF, 2025).

The implications of these funding cuts are dire. An internal memo from USAID projected that halting TB control programs could lead to a 28-32% increase in global TB incidence, particularly affecting regions already burdened by high rates of multi-drug-resistant TB. The World Health Organization (WHO) corroborates this, reporting that 40% of its country offices experienced moderate to severe disruptions in TB services due to the U.S. foreign aid freeze (WHO, 2025).

In South Africa, for instance, a recent assessment estimated that the loss of U.S. funding would result in 580,000 fewer individuals being tested for TB and 35,000 fewer receiving treatment by 2025 (KFF, 2025). Furthermore, a modeling study highlighted by the KFF indicates that U.S. TB program cuts could lead to as many as 10.7 million new TB cases and 2.2 million additional deaths in 26 high-burden countries by 2030 (KFF, 2025).

The current administration's proposal to permanently dissolve USAID and integrate its remaining functions into the State Department raises additional concerns about the future capacity for managing TB and other global health programs. According to Dr. Mark Thompson, Director of the Global Health Institute at the University of California, Los Angeles, "This reorganization could further dilute the focus on TB initiatives, jeopardizing years of progress in combating this deadly disease."

Moreover, the FY 2026 budget request reflects a concerning trend, with a proposed $228 million reduction in funding for TB programs (KFF, 2025). The implications of these funding cuts are not merely financial; they threaten to unravel the collaborative global framework that has been developed to combat TB effectively.

As the U.S. navigates these significant changes, the global health community continues to advocate for the restoration of funding levels that prioritize TB control. The potential outcomes of the current trajectory underscore the urgent need for a re-evaluation of U.S. foreign aid policies and their impact on global health initiatives.

In conclusion, as the U.S. approaches pivotal decisions regarding foreign aid and global health spending, the future of TB control hangs in the balance. The ramifications of these funding disruptions extend beyond immediate health outcomes, potentially reversing decades of progress in combating one of the world's deadliest infectious diseases. The global health community remains vigilant, urging policymakers to restore funding and prioritize the fight against TB to avert a public health crisis.