More than a year has passed since the Trump administration embarked on the unprecedented dismantling of the US Agency for International Development (USAID), a move that has sent ripples throughout the global health landscape. The ramifications of this decision are now crystallizing, revealing a grim forecast for tuberculosis (TB) care and control efforts in low- and middle-income countries (LMICs). A recent computational modeling study spearheaded by Dr. Allison Portnoy at Boston University School of Public Health exposes the profound economic burdens that funding cuts to USAID and other international donors impose on families grappling with TB.
This pioneering research, published in PLOS Medicine, meticulously quantifies the potential financial fallout from scaled-back global donor support, estimating an additional $7.5 billion in household costs annually in the 79 LMICs studied. These elevated costs encompass direct medical expenses, ancillary non-medical charges such as transportation and nutrition, and often overlooked but critical indirect costs — chiefly income lost during prolonged illness and treatment. Alarmingly, the World Health Organization’s End TB Strategy defines “catastrophic costs” as those exceeding 20% of household income, and the study projects that an additional four million households could cross this devastating threshold.
USAID historically accounted for roughly one-fifth of all international TB funding, playing an indispensable role in catalyzing and sustaining TB prevention and treatment initiatives globally. The Global Fund to Fight AIDS, TB, and Malaria, still a leading benefactor, provides over 75% of international TB financing, a substantial portion of which originates from the United States. Together, these agencies have been credited with preventing approximately 75 million TB deaths worldwide.
Between 2023 and 2024, positive strides were observed globally, including a near 2% decline in TB infection rates and a 3% reduction in mortality. Yet, these gains now face jeopardy with diminishing donor contributions. Should the worst-case scenario arise—where all international TB funding abruptly halts—the economic burden borne by households could escalate near $80 billion, a staggering surge that threatens not only public health achievements but could plunge millions into poverty.
The study utilizes sophisticated linked epidemiological and economic simulation models, incorporating a range of scenarios reflecting varying degrees of donor withdrawal. These scenarios include maintaining 2024 funding levels, removing USAID support alone, and successive combinations of USAID and Global Fund funding reductions, culminating in the total cessation of external financial aid. The models reveal a striking 32% increase in household TB-related costs in the worst-case context compared to pre-2025 levels, disproportionately impacting the poorest 20% of the population.
Dr. Portnoy highlights the multifaceted nature of TB-related household expenses. Direct medical costs, though sometimes subsidized, still burden families through diagnostic fees, consultations, and medications. Non-medical costs, often less visible, significantly include logistics such as transportation and temporary accommodation during treatment. More devastating are indirect costs — particularly lost earnings — as TB frequently incapacitates patients for prolonged periods.
The economic consequences of these costs are severe and far-reaching. Families often resort to depleting their savings, incurring debt, or liquidating assets to cover expenses. Such financial strain reverberates beyond immediate medical realms, hindering children’s education, undermining food security, and entrenching long-term economic instability within vulnerable communities.
While the study acknowledges limitations stemming from assumptions about the costs faced by untreated or undiagnosed patients and future healthcare dynamics, it robustly conveys the dire economic consequences of reduced international aid. Prior research, including a BUSPH study, already forecasts catastrophic health outcomes from funding cuts, predicting an additional 9 million pediatric TB cases and 1.5 million child deaths linked to the withdrawal of US support alone.
Faced with the prospect of dwindling global financial backing, the study authors emphasize the imperative for LMICs to fortify domestic health financing mechanisms and enhance primary healthcare system integration for TB services. Innovative financial protection strategies—ranging from direct cash transfers to subsidized transportation and social protection schemes—must be scaled up to counterbalance the indirect economic shocks of TB illness and therapy.
Crucially, donor withdrawal strategies require careful calibration. Sudden funding terminations can destabilize national TB programs, potentially reversing hard-won public health progress. Instead, phased, coordinated transitions incorporating blended finance models—combining governmental funding, private sector involvement, and targeted donor assistance—offer a pragmatic pathway to sustain TB control efforts amidst shifting fiscal landscapes.
As the global health community approaches World TB Day on March 24, this study serves as a clarion call: restoring and reinforcing international support for TB programs is essential not only to safeguard public health but also to alleviate the profound financial hardships faced by millions of vulnerable families worldwide. Sustained donor investment, coupled with strategic domestic reforms and innovative financing, is critical to realizing the promise of the End TB Strategy and ending the tuberculosis epidemic.
Subject of Research: People
Article Title: The potential impact of reduced international donor funding on the household economic burden of tuberculosis in low- and middle-income countries: A modeling study
News Publication Date: 20-Feb-2026
Web References:
References:
Portnoy A. et al., “The potential impact of reduced international donor funding on the household economic burden of tuberculosis in low- and middle-income countries: A modeling study,” PLOS Medicine, February 2026.
Keywords: Tuberculosis, Respiratory disorders, Infectious diseases, Public health, Epidemics, Medical economics, Health care industry, Health care costs, Drug costs, Economics
