Donald Trump’s excerpts from the Global Health Program will be deadly in the fight against tuberculosis, an infectious disease that is killing more people worldwide, yet it is preventable. In projections published in its 2025 Global Report on Tuberculosis, the World Health Organization (WHO) calculates that millions of people who should not have died prematurely will die from this point by 2035 unless this one million spread and the funding provided by the U.S. government to USAID and the Global Fund is replaced. In addition, there will be 10 million new unexpected infections.
For Tereza Kasaeva, WHO’s head of HIV and tuberculosis, the 2025 results represent a “serious challenge”. “It is essential that we have strong political leadership to support increased national investment in countries with the highest burden[of TB]. The decisions made today will determine whether we accelerate progress or settle for less progress,” he asserted in a virtual press release this month.
The clippings soothe the timid recovery in the fight against the disease after the devastation of the pandemic. WHO predicts that an additional 700,000 people will die between 2020 and 2023 due to interruptions in tuberculosis diagnosis and treatment due to Covid-19 and the health system crisis.
In 2024, 10.7 million people are expected to contract the disease and 1.23 million people will die. Although this is the first time since 2020 that morbidity and mortality rates have decreased by 1% and 3% compared to 2023, this data is still higher than that recorded before the emergence of COVID-19.
The decisions we make today will determine whether we accelerate progress or settle for little progress.
Tereza Kasaeva, Director of HIV, Tuberculosis, Hepatitis and Sexually Transmitted Diseases at WHO, said:
The loss of international aid to global health will be far more harmful than the pandemic. According to the WHO, aid cuts in August affected regional staff groups responsible for prevention work, testing and diagnostic activities, preventive treatment, data management and transporting samples to laboratories.
In Africa, we were able to reduce tuberculosis incidence by 28% and mortality by 46%. The other good news is that despite the current crisis, new vaccines and medicines are being developed. In its report, WHO highlighted that there are 18 vaccines against tuberculosis in clinical development, six of which are in phase III trials. 63 new diagnostic tests and 29 therapeutic drugs are also being developed. The problem, the group warns in its report, is that “many NIH grants for health-related research have been discontinued, with the agency’s 2024 projections proposing a 40% cut.”
One of the affected vaccines is currently being developed in Spain. Carlos Martín, a microbiologist at the University of Zaragoza and one of the vaccine researchers, explained to EL PAÍS in May that one of the trials in South Africa had been suspended due to a decision by the EE-UU government.
The cut-out from 2025 further worsened an already critical fiscal situation. The global response to tuberculosis has stalled since 2020. In 2024, low- and middle-income countries will need $5.9 billion in financing, just 27% of the $22 billion they must invest annually by 2027 to fight tuberculosis under the goals set by the United Nations.
In general, 82% of resources come from national assumptions, but some countries rely heavily on international donors. For example, the 26 countries with the highest burden of tuberculosis are 54% dependent on external resources. In low-income countries, dependence rises to 63%.
EE UU is now the largest contributor to global tuberculosis treatment programs. Between 2015 and 2024, we contributed approximately 50% of our funding through USAID and the Global Fund. Countries such as Zambia, Cambodia, Malawi, Ethiopia, and the Philippines are some of the countries most dependent on USAID funding to combat this disease.
Peter Sands, executive director of Fond Mundial, warned that the world cannot afford “new adversities” like those that occurred during the pandemic. “Carquier’s budget deficit now risks reversing the gains that have helped us achieve so much, especially in the most vulnerable communities,” he asserted in a statement this month after learning of the WHO report’s data. Next week, the Global Fund will celebrate the reallocation of resources for the 2027-2029 cycle. More than 70% of the world’s funding for the fight against tuberculosis relies on this organization.
In this scenario, WHO is asking countries to increase national funding to fill the funding gap. The report highlights that countries such as Nigeria and South Africa are expanding their assumptions to this end.
We need to ensure that new tools come out faster, that they are feasible, and that countries can adopt them as quickly as possible.
Yorgan Pillay, Gates Foundation HIV and Tuberculosis Program Director
Innovation also played a key role, Yorgan Pillay, head of the Gates Foundation’s HIV and TB program, announced at a press conference. For example, Professor Pillay highlighted research that advances the fundamentals of asymptomatic tuberculosis, which affects up to 50% of people with tuberculosis.
Experts also praise progress in developing low-cost molecular tests to detect disease-causing parasites, digital means of prevention to reduce the impact of stigma, and artificial intelligence to assist in diagnosis. “We need to change the way we do things if we are to be able to maintain the gains we saw in 2024. We need to be able to deliver new tools faster, which is necessary, and we need to enable countries to introduce them as quickly as possible,” Pillay stressed.
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