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Info Service on Health Issues (Mar25/03) Penang, 21 Mar (Kanaga Raja) — Early reports reveal that severe disruptions in the tuberculosis (TB) response are being seen across several of the highest-burden countries following the recent “drastic and abrupt” cuts in global health funding, according to the World Health Organization (WHO). Countries in the WHO African Region are experiencing the greatest impact, followed by countries in the WHO South-East Asian and Western Pacific Regions, it said. In a news release issued on 20 March on the occasion of World Tuberculosis Day, marked on 24 March, WHO called for an urgent investment of resources to protect and maintain tuberculosis (TB) care and support services for people in need across regions and countries. Pointing out that TB remains the world’s deadliest infectious disease, WHO said: “Global efforts to combat TB have saved an estimated 79 million lives since 2000.” “However, the drastic and abrupt cuts in global health funding happening now are threatening to reverse these gains,” it warned. Rising drug resistance especially across Europe and the ongoing conflicts across the Middle-East, Africa and Eastern Europe, are further exacerbating the situation for the most vulnerable, said WHO. “The huge gains the world has made against TB over the past 20 years are now at risk as cuts to funding start to disrupt access to services for prevention, screening, and treatment for people with TB,” said Dr Tedros Adhanom Ghebreyesus, the WHO Director-General. “But we cannot give up on the concrete commitments that world leaders made at the UN General Assembly just 18 months ago to accelerate work to end TB,” he added. “WHO is committed to working with all donors, partners and affected countries to mitigate the impact of funding cuts and find innovative solutions,” said the WHO chief. As a result of the funding cuts, WHO said 27 countries are facing crippling breakdowns in their TB response, with devastating consequences. These include: human resource shortages undermining service delivery; diagnostic services severely disrupted, delaying detection and treatment; data and surveillance systems collapsing, compromising disease tracking and management; community engagement efforts, including active case finding, screening, and contact tracing, are deteriorating, leading to delayed diagnoses and increased transmission risks. Nine countries report failing TB drug procurement and supply chains, jeopardizing treatment continuity and patient outcomes, said WHO. The 2025 funding cuts further exacerbate an already existing under-funding for global TB response. In 2023, only 26% of the US$22 billion annually needed for TB prevention and care was available, leaving a massive shortfall, it pointed out. TB research is in crisis, receiving just one-fifth of the US$5 billion annual target in 2022 – severely delaying advancements in diagnostics, treatments, and vaccines, WHO further said. WHO is leading efforts to accelerate TB vaccine development through the TB Vaccine Accelerator Council, but it said that progress remains at risk without urgent financial commitments. In response to the urgent challenges threatening TB services worldwide, the WHO Director-General and the Civil Society Task Force on Tuberculosis issued a joint statement this week demanding immediate, coordinated efforts from governments, global health leaders, donors, and policymakers to prevent further disruptions, said WHO. “This urgent call is timely and underscores the necessity of swift, decisive action to sustain global TB progress and prevent setbacks that could cost lives,” said Dr Tereza Kasaeva, Director of WHO’s Global Programme on TB and Lung Health. “Investing in ending TB is not only a moral imperative but also an economic necessity – every dollar spent on prevention and treatment yields an estimated US$43 in economic returns,” Dr Kasaeva pointed out. In an earlier statement issued on 5 March, WHO said that in the past two decades, TB prevention, testing and treatment services have saved more than 79 million lives – averting approximately 3.65 million deaths last year alone from the world’s deadliest infectious disease. This progress has been driven by critical foreign aid especially in low- and middle-income countries (LMICs), particularly from the US Agency for International Development (USAID), it said. However, abrupt funding cuts now threaten to undo these hard-won gains, putting millions – especially the most vulnerable – at grave risk, it added. In addition, it said USAID, the world’s third-largest TB research funder, has halted all its funded trials, severely disrupting progress in TB research and innovation. According to WHO, the US government has provided approximately US$200-250 million annually in bilateral funding for the TB response at the country level, representing approximately one quarter of the total amount of international donor funding for TB. The 2025 funding cuts will have a devastating impact on TB programmes, particularly in LMICs that rely heavily on international aid, given that the US has been the largest bilateral donor, it said. These cuts put 18 of the highest burden countries at risk, as they depend on 89% of the expected US funding for TB care, it noted. “Any disruption to TB services – whether financial, political or operational – can have devastating and often fatal consequences for millions worldwide,” said Dr Kasaeva, Director of WHO’s Global Programme on TB and Lung Health, in the news release issued on 5 March. “The COVID-19 pandemic proved this, as service interruptions led to over 700,000 excess deaths from TB between 2020 and 2023, exacerbated by inadequate social protection measures. Without immediate action, hard-won progress in the fight against TB is at risk,” the WHO official said. “Our collective response must be swift, strategic and fully resourced to protect the most vulnerable and maintain momentum toward ending TB,” Dr Kasaeva added. Last October, WHO released its Global Tuberculosis Report 2024, finding that approximately 8.2 million people were newly diagnosed with TB in 2023 – the highest number recorded since WHO began global TB monitoring in 1995. WHO said this represents a notable increase from 7.5 million reported in 2022, placing TB again as the leading infectious disease killer in 2023, surpassing the COVID-19 pandemic. Meanwhile, an update issued by the Stop TB Partnership, grouping together some 2,000 partner organizations and hosted by the United Nations, on 3 March said that the US government funding halt, particularly through USAID, has significantly disrupted the TB response efforts in several high TB burden countries. For instance, it said that in Cambodia, active case finding in half of the country has halted, resulting in 100,000 people missing TB screening, while in India, USAID-funded TB screening projects in vulnerable groups (urban slums, and poor populations) have also stopped. In Ethiopia, 5,000 health staff funded by USAID are not working, severely affecting TB screening and detection, it added. CHILDREN WITH TB Also ahead of World Tuberculosis Day on 24 March, Medecins Sans Frontieres (MSF) called on all countries and international donors to prioritise and ensure sustained investments for diagnosing, treating, and preventing tuberculosis (TB) for all, and especially children, who remain the most vulnerable. Pointing out that every 3 minutes, a child dies of TB, MSF noted in a press release issued on 20 March that the World Health Organization (WHO) estimates that 1.25 million children and young adolescents (0-14 years) fall ill with TB each year, but that only half of these children are diagnosed and treated. Against this backdrop, MSF said that it is gravely concerned about the recent US funding cuts. It said the US is the largest financial contributor for TB programmes, accounting for half of all international and bilateral donor funding, according to the WHO. “For years, we have witnessed the deadly gaps that children face to access diagnosis and treatment for TB in countries where we work,” said Dr Cathy Hewison, Head of MSF’s TB working group. “Children at risk of having TB are often overlooked, either going undiagnosed or facing delays in diagnosis. Now, with the recent US funding cuts, these gaps in identifying and treating children with TB will only widen further which threatens to roll back years of progress in TB care,” she added. “We urgently call on all countries and international donors to step up and ensure sustained funding for TB care for all, especially young children. No one should die or suffer from this preventable and treatable disease,” Dr Hewison said. MSF said its teams in Sindh province, Pakistan, are witnessing the US funding cuts leading to the disruption of community-based services, which play a key role in a country that has a high burden of TB, especially in active screening of people in the community, which increases the diagnosis, the screening of families at high risk and the provision of TB preventive treatment for children. “Children are already highly vulnerable to TB, and we are worried that the US funding cuts that have impacted the community-based services will have a disproportionate effect on children, leading to more children with TB and more avoidable deaths,” said Dr Ei Hnin Hnin Phyu, the Medical Coordinator with MSF in Pakistan. “We cannot afford to let funding decisions cost children’s lives,” Dr Phyu emphasized. MSF said children with weakened immune systems, for instance, due to HIV infection or malnutrition, are the most vulnerable, hence will be disproportionately affected by disruption of TB, HIV and nutrition services. Children with TB are often excluded from research and development trials being carried out on new tools for TB. The recent US funding cuts have halted numerous clinical trials, setting back TB research and innovation, with many of them being critical for children with TB, said MSF. This is a major step back in the fight against TB, as it delays the development of much-needed diagnostics and treatments for children, it added. MSF called on the pharmaceutical industry and international donors to ensure sustained investments in the development and evaluation of medical tools that can improve TB care for children. +
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