The recent modeling study published in PLOS Global Public Health sheds an alarming light on the potential global health consequences that could unfold following the withdrawal of U.S. financial aid for tuberculosis (TB) programs. Tuberculosis remains one of the world’s deadliest infectious diseases, and the cessation of American funding threatens to reverse decades of progress in controlling its spread. Between 2025 and 2030, this withdrawal could precipitate as many as 2.2 million additional deaths in just 26 high-burden countries (HBCs), an outcome that reflects both the critical importance and fragility of current TB control efforts worldwide.
The study draws on complex epidemiological models to simulate the trajectory of TB incidence and mortality in these nations under different funding scenarios. These countries, collectively representing a significant proportion of the global TB burden, would face difficulties maintaining essential diagnostic, treatment, and prevention services without American monetary support. The model accounts for varied healthcare infrastructure capabilities, demographic changes, and underlying co-morbidities such as HIV, which exacerbate TB risk. Findings demonstrate that cutting funding leads to a deterioration not only in treatment coverage but also in timely diagnosis, fueling increased transmission and drug resistance.
U.S. aid has historically been a cornerstone of global TB control, supporting multifaceted programs that incorporate modern diagnostic technologies, such as GeneXpert MTB/RIF assays, and directly observed therapy approaches. Cutting this lifeline threatens these tools’ sustainability, particularly in resource-limited settings. The result is likely to be an erosion in treatment success rates, which currently play a vital role in containing multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB). The model highlights how even small reductions in effective treatment coverage can exponentially increase transmission within communities, potentially igniting new outbreaks.
A critical aspect of the study is its nuanced incorporation of social determinants of health. TB disproportionately affects marginalized populations, including those with poor access to healthcare, malnutrition, and crowded living conditions. The funding cut’s ripple effects could exacerbate these vulnerabilities, as programs that address nutrition support, community outreach, and socioeconomic barriers may be scaled back. This weakening of comprehensive TB management threatens progress made in addressing systemic inequities underlying the disease’s persistence.
The analysis also contextualizes the implications within the broader landscape of global health security. Tuberculosis is not just a regional health issue; it poses persistent threats to international efforts aimed at containing infectious diseases and preventing pandemics. The resurgence of TB in high-burden countries risks spillover into regions where TB prevalence has been markedly reduced, driven by global mobility and interconnected economies. Moreover, drug-resistant strains pose a particularly formidable challenge, given their difficulty to treat and the limited development of new anti-TB drugs.
Notably, the modeling delineates time-sensitive consequences. The projected 2.2 million additional deaths are forecasted over a six-year horizon—2025 to 2030—underlining an urgent timeline for action. This underscores that the impact of funding decisions will be felt rapidly and intensely, demanding immediate policy and financial interventions to avert catastrophic public health outcomes. The prospective rise in mortality highlights a moral and practical imperative for sustained international investment.
Scientific rigor underpins the study’s methodology: it integrates diverse epidemiological data and stakeholder inputs, ensuring that projections are grounded in current realities. The model draws not only on TB incidence data but integrates social contact patterns, health system capacities, and projected demographic shifts. These multidimensional inputs provide a comprehensive, dynamic view of future trajectories under different funding scenarios, helping elucidate the nuances of intervention impacts beyond simple case counts.
The authors emphasize that the consequences of funding withdrawals cannot be mitigated easily by reallocating resources locally. Many high-burden countries rely heavily on external aid to supplement limited domestic budgets and infrastructure. The loss of U.S. funding would therefore leave significant gaps in service delivery that domestic systems are currently unequipped to fill. This gap risks undermining fragile health systems’ resilience and could lead to systemic failures in TB control efforts lasting well beyond 2030.
In addition to direct health impacts, the study highlights broader economic and societal costs. An increase in TB mortality translates into loss of human capital, reduced productivity, and heightened healthcare expenditures as drug-resistant forms become more prevalent. These factors collectively impose a substantial economic burden on already strained health and social systems. The modeling alludes to indirect consequences including increased poverty and social dislocation in communities disproportionately affected by TB.
The withdrawal of U.S. TB aid also carries geopolitical implications. American funding has historically served as a mechanism of international health diplomacy, fostering collaboration and shared responsibility in global health crises. A retraction of support may weaken these partnerships and unsettle decades-long progress in multilateral approaches to infectious disease control. This could fragment coordinated response efforts and hinder the global capacity to mount unified TB eradication campaigns.
However, the findings are not purely pessimistic. The detailed modeling clarifies the crucial importance of sustained, targeted funding as a tool to bend the curve of the epidemic downward. It highlights pathways for intensified interventions where they will matter most, reinforcing the message that strategic investment yields outsized returns in terms of lives saved and disease averted. The study advocates for urgent action to maintain and increase global TB financing in alignment with Sustainable Development Goals.
In closing, the study serves as a stark reminder of the delicate balance underpinning global TB progress. The potential loss of millions of lives due to funding cuts is a tragic and preventable outcome. It calls the global community, policymakers, and philanthropy to reaffirm their commitment to ending tuberculosis. As an infectious disease deeply intertwined with poverty and inequalities, TB requires sustained, science-driven, and collaborative response to build resilient health systems capable of protecting vulnerable populations against resurgent threats.
Subject of Research: Impact of U.S. funding withdrawal on tuberculosis mortality in 26 high-burden countries
Article Title: A deadly equation: The global toll of US TB funding cuts
News Publication Date: 10-Sep-2025
Web References: https://doi.org/10.1371/journal.pgph.0004899
References: Mandal et al., 2025, PLOS Global Public Health, CC-BY 4.0
Image Credits: Carel Pretorius, adapted from Mandal et al., 2025, PLOS Global Public Health, CC-BY 4.0
Keywords: Tuberculosis, U.S. funding cuts, high-burden countries, epidemiological modeling, TB mortality, drug resistance, global health security, infectious diseases, public health policy, health disparities, sustainable development
