USAID Cuts & TB: Increased Financial Burden for Families in Low-Income Countries

The ripple effects of significant cuts to U.S. Foreign aid, particularly impacting programs run by the United States Agency for International Development (USAID), are now being quantified in terms of potential financial hardship for families battling tuberculosis (TB) globally. A recent analysis suggests these reductions could translate to an $80 billion increase in out-of-pocket expenses for families in low- and middle-income countries (LMICs) affected by the disease.

More than a year after the second Trump administration initiated a restructuring of USAID – including a near-total freeze on foreign aid and the placement of many employees on administrative abandon – the full scope of the disruption is becoming clearer. The cuts aren’t simply about a lack of medication or treatment programs; they represent a substantial shift in the financial burden onto those least equipped to handle it.

The Financial Strain of a Preventable Disease

Tuberculosis, caused by bacteria that most often attack the lungs, remains the world’s leading infectious killer. In 2023 alone, it caused 1.25 million deaths worldwide, according to the World Health Organization (WHO). While treatable and preventable with the right healthcare and drugs, the cost of treatment can be prohibitive for many families in LMICs. USAID-funded programs have historically played a crucial role in providing free or subsidized TB care, reducing this financial burden.

The new study, led by researchers at Boston University School of Public Health, highlights how the loss of this support will disproportionately affect vulnerable populations. The $80 billion figure represents an estimate of the increased direct costs – including transportation to clinics, lost wages due to illness, and the price of medication when programs are unavailable – that families will face. This doesn’t account for the broader economic consequences of increased TB prevalence, such as reduced productivity and strain on healthcare systems.

USAID’s Disruption: A Timeline of Change

The changes to USAID began in January 2025, with President Trump issuing an executive order calling for a 90-day review of foreign aid, followed by a “stop-work order” freezing payments and services. This was followed by the dissolution of USAID itself, with significant staff and contractor reductions, and the cancellation of many foreign assistance awards. While a waiver was issued to allow for life-saving humanitarian assistance, access to these funds proved difficult for program implementers. As detailed in a KFF fact sheet, these actions have disrupted U.S. Global health programs, including those focused on TB.

The impact has been acutely felt on the ground. Ratna Jamni, a TB patient in Pakistan whose USAID-funded care was interrupted, described the hardship of traveling to clinics for treatment when home visits were halted. As reported by CNN, Jamni’s story is representative of the challenges faced by millions of TB patients whose treatment has been disrupted by the funding cuts.

Understanding the Study’s Methodology and Limitations

The Boston University study used modeling techniques to estimate the financial impact of the USAID cuts. While the specific methodology isn’t detailed in readily available summaries, it’s significant to understand that these are projections based on assumptions about TB prevalence, treatment costs, and the effectiveness of USAID programs. The study’s findings are therefore subject to uncertainty. It’s crucial to note that the $80 billion figure is an estimate, and the actual financial burden could be higher or lower depending on various factors.

the study doesn’t account for the potential for increased drug resistance. Interrupted treatment regimens can lead to the development of multi-drug resistant TB (MDR-TB), which is far more expensive and difficult to treat. The spread of MDR-TB could significantly exacerbate the financial burden on families and healthcare systems.

TB: A Global Health Crisis in Context

Before the recent disruptions, significant progress had been made in the fight against TB. U.S. Government efforts had contributed to a 29% decline in TB incidence and a 47% decline in TB mortality in USAID priority countries since 2000. But, these gains are now at risk. TB is particularly devastating for people living with HIV, being the leading cause of death among this population. The cuts to USAID funding threaten to reverse decades of progress and undermine global efforts to end TB.

The situation is further complicated by the fact that TB is often a disease of poverty and marginalization. Those living in crowded conditions, with limited access to healthcare and nutrition, are at the highest risk of infection. The increased financial burden imposed by the USAID cuts will disproportionately affect these vulnerable populations, exacerbating existing inequalities.

What Comes Next: A Shifting Landscape for Global Health

The restructuring of USAID and the cuts to foreign aid have prompted legal challenges, but limited legal remedies have been secured to date. The long-term consequences of these changes remain to be seen. The Department of Health and Human Services is also undergoing changes, including proposed cuts and reorganization, which are likely to further affect global health programs.

Currently, the focus is on assessing the full extent of the damage and advocating for the restoration of funding. Organizations like the WHO and the Global Fund to Fight AIDS, Tuberculosis and Malaria are working to mobilize resources and support countries affected by the cuts. However, the scale of the challenge is immense, and a sustained commitment from the international community will be required to mitigate the impact and prevent a resurgence of TB.

Ongoing surveillance of TB incidence and mortality rates will be crucial to track the effects of the funding cuts. Further research is needed to understand the long-term consequences of interrupted treatment regimens and the potential for increased drug resistance. Addressing the TB crisis requires a comprehensive approach that includes increased funding, improved healthcare access, and a commitment to addressing the social and economic factors that drive the disease.