Health authorities are calling attention to a looming consequence of the Trump administration’s gutting of the U.S. Agency for International Development: the risk of a global surge in tuberculosis cases and deaths.
The World Health Organization warned this week that the sweeping funding cuts could endanger millions of lives, since many countries depend on foreign aid for TB prevention, testing and treatment.
“Without immediate action, hard-won progress in the fight against TB is at risk,” Dr. Tereza Kasaeva, director of the WHO’s Global Programme on TB and Lung Health, said in a statement Wednesday.
Globally, tuberculosis is responsible for the most deaths of any infectious disease. Around 1.25 million people died from the bacterial infection in 2023, the latest data available, and new cases hit an all-time high that year, with around 8.2 million people diagnosed, according to the WHO.
Until recently, USAID provided about a quarter of the international donor funding for tuberculosis services in other countries — up to $250 million annually, according to the WHO. The agency operated tuberculosis programs in 24 countries.
The WHO said that because of the U.S. funding cuts, drug supply chains in other countries are “breaking down,” laboratory services are “severely disrupted” and surveillance systems are “collapsing,” making it difficult to identify, monitor and treat tuberculosis cases. Some research trials have been halted, as well.
That has incapacitated some national tuberculosis programs, with the WHO warning of devastating impacts in 18 countries with the highest burden of disease, many of which are in Africa.
In Uganda, the rollback of USAID funding has made it hard to pay community health workers, leading to understaffing, said Dr. Luke Davis, a clinical epidemiologist at the Yale School of Public Health. Such workers play a critical role in notifying people who test positive for tuberculosis, getting them treatment and screening their close contacts for infection.
“Patients may get a diagnosis of TB after they’ve left the clinic because they’re waiting for the results, and they may be at home with TB and not know they have TB. There’s literally not the resources to go out and reach those people,” he said. “People are dying because they have disease that hasn’t been diagnosed, hasn’t been treated, hasn’t been prevented.”
Since Jan. 24, the discontinuation of USAID funding may have led to an estimated 3,400 additional tuberculosis deaths and 6,000 additional infections, according to a project modeling the impact of the cuts. The model is coordinated by the Stop TB Partnership, a United Nations organization that aims to eliminate tuberculosis as a public health problem.
Any increase in the disease’s spread could affect the U.S., since it would allow more people who live or travel abroad to bring the disease in. Already, tuberculosis cases in the U.S. have risen: The Centers for Disease Control and Prevention recorded more than 9,600 cases in 2023, a nearly 16% increase from the year prior and a 9% increase over prepandemic levels in 2019.
A persistent outbreak in Kansas has led to 68 active cases since January 2024.
“What happens when we travel overseas? I’ve known servicemen and -women who come back with multidrug-resistant TB after a tour of duty. I’ve known of bankers, people from Silicon Valley who work overseas, come back with the disease,” said Dr. Kenneth Castro, a professor of global health at Emory University’s Rollins School of Public Health.
“The problem with all these infectious diseases is that they know no borders, and neither should our efforts stop at the border,” he said.
A resurgence of tuberculosis in the U.S. from 1985 to 1992 was attributed, in part, to a decline in tuberculosis control programs and rising global cases.
The White House did not provide a comment in time for publication.
People with active TB usually develop a bad cough and chest pain. They may cough up blood and mucus and have difficulty breathing. Left untreated, the bacterial infection can damage the lungs and spread to other parts of their body such as the brain, kidneys and spine. It can be fatal for up to two-thirds of people with active cases who aren’t properly treated, according to the WHO.
But treatment is no quick matter: Tuberculosis patients must usually take antibiotics for six months, and stopping in the middle can lead a person to become resistant to the antibiotics, then spread that drug-resistant TB strain to others.
Until the recent cuts, USAID had been instrumental in conducting surveillance to identify new tuberculosis cases, improving supply chains to get medicine to sick patients, and investing in clinical trials for new therapies and diagnostic tests. In communities that lacked radiologists to read X-rays, USAID also funded portable X-ray systems that use artificial intelligence to make diagnoses.
Additionally, the agency helped countries procure drugs at lower costs, in part by funding the Global Drug Facility, a group that negotiates drug prices with suppliers.
Many of those efforts came to a halt when the Trump administration stripped the agency down to bare bones. After firing or furloughing contractors in January, the administration laid off 1,600 staffers, then placed thousands more on administrative leave last month. The State Department slashed nearly 5,800 of USAID’s foreign aid awards — more than 90% of the total — according to a lawsuit filed by nonprofits and businesses that receive USAID funding. The awards totaled $54 billion, according to The Associated Press.
Secretary of State Marco Rubio issued a waiver in January allowing USAID’s lifesaving humanitarian programs — including tuberculosis prevention and treatment — to continue, despite a 90-day freeze on foreign aid. But in a memo to staffers last month, a USAID official said that nearly all of the funding needed to keep those programs going had been terminated.
The official warned of “preventable death, destabilization, and threats to national security on a massive scale,” then was placed on administrative leave after sending the memo.
The downsizing of USAID has been part of the broader effort to reduce federal spending led by Elon Musk and the Department of Government Efficiency. Musk said on X last month that he was “feeding USAID into the wood chipper,” and that he and Trump agreed the agency should be shut down.
So far, federal judges have denied requests from USAID staffers and contractors to continue their work while lawsuits challenging their terminations play out. The Supreme Court on Wednesday, however, said the Trump administration had to pay USAID contractors $2 billion for work already completed.
The WHO has a goal to reduce tuberculosis cases by 80% and deaths by 90% by 2030. That was already aspirational but is even further out of sight now, said Dr. Priya Shete, an associate professor of medicine and epidemiology at the University of California, San Francisco.
USAID played a significant role in getting diagnostic tools and treatments over the “last mile” to patients, Shete said. That included finding ways to transport drugs when road conditions were poor and funding mobile clinics that offered X-rays and bacterial testing.
“The loss of resources to get across the finish line is what’s really disturbing to some people, and will end up costing millions of lives potentially,” she said.
Experts worry the disruption to clinical trials will also hinder the development of treatments for drug-resistant infections and of new ways to detect cases in children, who are often hard to diagnose.
“The innovations do come back and benefit the U.S. as well,” Davis said.
This story first appeared on NBCNews.com. More from NBC News:
