More than a year after the second administration of Donald Trump began dismantling the United States Agency for International Development, concerns are continuing to emerge about the broader global health effects of reduced international aid. A new study led by a researcher at the Boston University School of Public Health suggests that cuts to foreign assistance could significantly increase the financial burden on families affected by Tuberculosis (TB) in low- and middle-income countries.

The study, published in PLOS Medicine, estimates that the loss of USAID funding alone could create approximately $7.5 billion in additional costs for households in low- and middle-income countries that include at least one person diagnosed with TB. Researchers also warn that nearly four million more households could face what the World Health Organization describes as “catastrophic costs,” a term used when medical and related expenses exceed 20 per cent of a household’s annual income under the WHO End TB Strategy.

In the most severe scenario considered in the research, the financial consequences could be far greater. If all international funding for TB programmes were eliminated, the economic burden placed on affected households could climb to nearly $80 billion worldwide. Such a scenario would represent a dramatic increase in the costs families must absorb while coping with the disease.

Before 2025, international aid played a critical role in maintaining access to TB prevention, diagnosis, and treatment services, particularly in countries with limited healthcare resources. USAID alone accounted for almost 20 per cent of funding for TB services in many countries.
Meanwhile, the Global Fund to Fight AIDS, Tuberculosis, and Malaria supplied roughly 76 per cent of international TB funding, with the United States contributing more than a third of that support. These investments were associated with measurable progress: between 2023 and 2024, the global TB infection rate declined by nearly two per cent, while deaths fell by around three per cent.

The new analysis arrives as the world approaches World Tuberculosis Day on March 24, an annual event intended to raise awareness about the disease and the efforts to eliminate it. Researchers say the findings highlight the urgent need for sustained international support to maintain access to TB services and prevent further health and economic hardship.

The study’s lead author, Dr Allison Portnoy of BUSPH, emphasised that international funding has been central to expanding access to TB diagnosis and treatment. Without continued support from donors such as USAID and the Global Fund, many countries could experience disruptions to essential services. According to Portnoy, such disruptions would not only worsen health outcomes but also place severe financial strain on households, particularly those already living in poverty.

To conduct the research, Portnoy and colleagues from the Harvard T.H. Chan School of Public Health, the London School of Hygiene & Tropical Medicine, and the University of Glasgow School of Health and Wellbeing used epidemiological and economic models covering 79 low- and middle-income countries. Their projections examined several possible funding scenarios, ranging from maintaining 2024 aid levels to eliminating major donor contributions.

The researchers note that a TB diagnosis often creates multiple financial pressures for families. These can include direct medical expenses such as tests, medicines, or consultations, as well as non-medical costs like transportation to clinics, accommodation during treatment, and additional nutritional needs. However, the largest burden frequently comes from lost income when patients are unable to work during lengthy treatment periods. The study suggests that without stable international support, many families may be forced to deplete savings, borrow money, or sell assets, increasing the risk of long-term poverty and economic instability.

More information: Allison Portnoy 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. DOI: 10.1371/journal.pmed.1004946

Journal information: PLOS Medicine Provided by Boston University School of Public Health