Tuberculosis is the world’s most deadly infectious disease, killing more than a million people a year and infecting many millions more, even though treatment in the form of antibiotics has existed for seventy years. TB predominantly affects the poor in the Global South. As Paul Farmer wrote in Infections and Inequalities (1999), ‘the “forgotten plague” was forgotten in large part because it ceased to bother the wealthy.’
The work to end the world’s oldest pandemic needs funding to pay for drug regimens that are effective against multidrug-resistant strains of TB; for rapid molecular tests to allow people to be diagnosed faster and more easily at the point of care; to undertake research and development, such as for new vaccines;and for the salaries of health workers.
Ending the TB epidemic by 2030 is one of the sustainable development goals adopted by the United Nations in 2015, and recent years have seen an increase in both attention and political will, but far more still needs to be done to address both the medical solutions and the structural inequality that allows TB to thrive.
The task has been made a lot harder by the collapse of the United States Agency for International Development (USAID). In January, the Trump administration ordered a stop to all global health funding, with some emergency humanitarian waivers later issued (and then revoked) for lifesaving medicines and medical devices.
What was billed as a ninety-day freeze to undertake a review ended last week in the formal termination of thousands of projects across the world, including HIV treatment programmes that supported millions of people, malaria control programmes in some of the worst hit African countries, and TB programmes that provided lifesaving care. In all, 90 per cent of USAID’s grants have been terminated.
The Stop TB Partnership’s Global Drug Facility enables worldwide access to affordable TB treatments and diagnostics. It’s the largest global provider of TB products to the public sector. But funding for the facility’s operating costs and 10 per cent of its drug budget – which last year provided TB treatment to nearly three million people, including 300,000 children – has been cancelled.
Meanwhile, the withdrawal of funds has caused widespread alarm in high-burden countries. Dr Lucica Ditiu, the executive director of the Stop TB Partnership, told me that while no country has yet run out of drug stocks, there are problems with distribution, which was mostly done by USAID across Africa and Asia.
In a twelve-page report, the organisation has detailed the toll from the dismantling of USAID in more than twenty countries. Active case finding in half of Cambodia has stopped; direct TB service delivery in eighteen regions of Tanzania has stopped; regional laboratories in Bangladesh have stopped working; TB treatment in Ukraine has been disrupted because of drug supply issues.
‘TB is airborne and if people are not diagnosed, it will continue to spread,’ Dr Ditiu told me. Her organisation has had to suspend $11 million in funding to civil society and community-based groups in 38 countries. ‘If the slogan is to keep America safe,’ she said, ‘I don’t think walking away from investing in TB is going to do that. No one will be safe; transmission will increase, and cases will likely be more complicated to treat. Never in my darkest moments did I think this would happen.’
