This article was originally published in The Lancet
Tuberculosis programmes in many settings rely heavily on international donor funding. In 2025, the United States Agency for International Development (USAID) was dismantled, and other countries announced cuts to overseas development assistance. The authors quantified the potential epidemiological impacts on the tuberculosis burden attributable to these reductions in funding.
The authors calibrated a deterministic tuberculosis model of Mycobacterium tuberculosis transmission, progression, and care to epidemiological indicators in selected low-income and middle-income countries. Calibration was done with the history matching with emulation method, implemented with the hmer package in R and the Approximate Bayesian computation Markov Chain Monte Carlo method. The authors projected three future scenarios with the following assumptions: that levels of funding in 2024 would continue, that USAID funding would be terminated from 2025, and that additional reductions in funding through The Global Fund to Fight AIDS, Tuberculosis and Malaria would occur (alongside termination of funding from USAID) in line with current donor announcements from 2025. The authors assumed a reduction in tuberculosis treatment initiation rates proportional to budget reductions for each scenario, estimating cumulative excess episodes of symptomatic tuberculosis and tuberculosis deaths for each scenario.
Key findings
The authors estimate substantial potential impacts on tuberculosis morbidity and mortality due to reductions in international donor funding. Expanded support from domestic and international donors is essential to address immediate gaps in services for prevention, diagnosis, and treatment.