US aid cuts could create untreatable TB bug ‘resistant to everything we have'

The Guardian

10-03-2025

Dangerous new forms of tuberculosis (TB) for which there is no treatment could emerge as a result of US aid cuts, a top doctor has warned.
Dr Lucica Ditiu, who heads the Stop TB Partnership, said she feared that interruptions to people's treatment would allow the airborne bug to mutate into a new, untreatable form.
Moreover, a lack of diagnostic services, which have also been badly affected by the Trump administration's aid cuts, would allow TB to spread more easily, she said.
Programmes working to detect, treat and research new ways to fight TB are among nearly 10,000 health projects worldwide that received notices at the end of February that the US was terminating their funding after a review of aid spending.
The US has historically provided between $200m (£155m) and $250m a year in bilateral funding to poorer countries for their work on TB, the World Health Organization said last week, warning that 'abrupt funding cuts' would 'cripple TB prevention and treatment efforts, reverse decades of progress, and endanger millions of lives'.
In a statement, the organisation said: 'Early reports to WHO from the 30 highest TB-burden countries confirm that funding withdrawals are already dismantling essential services, threatening the global fight against TB.'
That included layoffs of health workers, drug supply chains breaking down, disruption to laboratory services, and collapsing data and surveillance systems, it said.
The Stop TB Partnership – a UN-hosted network of organisations working to fight the disease – received a notice that the US was terminating its funding, before a second message saying the termination was rescinded. However, Ditiu said funding flows had yet to resume, and that she still worried about the effect of wider cuts on the fight against TB.
The US state department has said its strategy was now that 'every dollar we spend, every programme we fund and every policy we pursue must make America safer, stronger, and more prosperous'.
But Ditiu said: 'Stopping the TB response doesn't do any of this. First of all, for sure it makes none of us safe, because TB is airborne. You cannot stop it at the border. It's spread through air – as long as you breathe, you will get it. And not just TB, but also drug-resistant TB and extreme drug-resistant TB.
'The current measures will probably create additional strains because there are people with interrupted treatment, there are people not diagnosed and so on,' she said.
Ditiu said 2024 was the 'best year on record' in terms of diagnosing and treating people with TB. Those achievements would now 'roll backwards', she added.
The world now faced a 'very grim' situation, she said. Drug-resistant tuberculosis remains hard to treat, with even modern six-month regimens coming with significant side-effects.
'I know that there were groups doing research on extreme drug resistance, including in South Africa, that were stopped right away,' she said. 'That means that the people receiving whatever treatment there are now out of treatment.
'So you can potentially create a bug with extreme drug resistance – you create a bug that is virtually resistant to everything we have,' she said. 'And this is the scary picture.'
In 2023, there were 10.8m new TB cases and 1.25 million people dying from the disease. The US itself has had two tuberculosis outbreaks in the past three months, in Kansas and North Carolina. The WHO and UN have set targets of eradicating the disease by 2030, but even before the US aid decision, there was an $11bn shortfall in the global response.
Disrupted treatment and diagnosis during the Covid pandemic resulted in doctors seeing 'more complicated' forms of TB in their patients, Ditiu said, including some with holes in their lungs. It was a pattern she expected to see repeated, particularly among the poor and vulnerable, she added.
'We did a lot of work with civil society and communities, and they were supporting people to get a diagnosis, to continue their treatment – and none of that is there now.'
Ditiu said there could be drug shortages later in the year as countries used up their supplies.
Some countries with high levels of TB, such as Indonesia, the Philippines, Nigeria, India and South Africa, may be able to find their own resources, Ditiu said, but others were likely to struggle, 'especially in Africa'. She hoped institutions such as the African Development Bank or World Bank would be able to help but thought people would die as a result of the cuts.
It was 'heartbreaking', she said. 'I'm very upset that we were a bit trusting that the solidity of a commitment of a country like the US will be there for ever.'