New Delhi, March 13 By 2050, cuts in US foreign aid could generate an additional cost of approximately USD 7.5 billion for households in low- and middle-income countries (LMICs) that include at least one person diagnosed with tuberculosis (TB), according to a new study.
Researchers, including those from Boston University in the US, said that an additional four million households could experience "catastrophic costs," defined by the World Health Organization's (WHO) End TB Strategy as costs including related medical and non-medical costs, along with indirect costs, exceeding 20 per cent of one's annual household income.
The economic burden on households could reach almost USD 80 billion, according to the worst-case scenario, where all international funding for tuberculosis ceased, findings published in the journal PLOS Medicine suggest.
In March 2025, the administration of US President Donald Trump announced an 83 per cent cut to all programs at the United States Agency for International Development (USAID) -- the world's largest funding agency for humanitarian and development aid.
"Abrupt reductions in international donor funding for TB may reverse recent progress toward financial risk protection and health equity in LMICs," the authors wrote.
"The termination of USAID was projected to generate USD 7.5 billion in additional patient-incurred costs and 3.9 million additional households experiencing catastrophic costs over 2025-2050," they said.
The team added that strategies to reduce the disruption caused by funding cuts and protect vulnerable populations are urgently needed.
"These findings highlight how international funding has played a critical role in expanding access to TB diagnosis and treatment," Allison Portnoy, lead and corresponding author, assistant professor of global health at Boston University's school of public health, said.
"Without sustained support from donors such as USAID and the Global Fund, many countries could see disruptions in essential TB services, leading not only to worse health outcomes, but also to severe financial hardship for families—particularly the poorest households," she said.
The researchers said that prior to 2025, international aid played a significant role in ensuring access to TB prevention and treatment services, particularly for patients and families in limited-resource settings.
USAID, credited with helping prevent nearly 75 million deaths, provided nearly 20 per cent funding for TB services in other countries, they said.
International programs such as the Global Fund to Fight AIDS, TB, and Malaria (Global Fund) supplied 76 per cent of funding, more than one third of which was also supplied by the US.
The support resulted in quantifiable progress: Between 2023 and 2024, the global rate of people being infected by TB declined by nearly two percent and deaths from TB fell by three percent, the researchers said.
"Countries may need to strengthen domestic financing and health system capacity to reduce reliance on external donors over time," Portnoy said.
"This could include increased government investment in national TB programs and stronger integration of TB services into primary healthcare systems. Financial protection measures for patients -- such as transportation support, cash transfers, or social protection programs -- can help offset the indirect costs of illness and treatment," she said.