Tuberculosis in Today’s World

Although the data is from 2023, it remains relevant in understanding how tuberculosis effects different parts of the world (WHO).

In comparison with other preventable and curable bacterial diseases (for example, Salmonella or Strep), Tuberculosis (TB) seems monstrously uncontained. The World Health Organization (WHO) reports that not only 1.3 million people die each year, but 10.7 million people contract it. The infection is caused by a bacterium called Mycobacterium Tuberculosis entering the lungs through air, spit, or close contact with a carrier. It manifests as coughing, chest pain, weakness, fatigue, fever, and other common symptoms. When the disease is “active,” it will spread to other parts of the body. In simple cases, where treatment is easily accessed, 4 months of medication will rid you of bacteria. In bad cases, where treatment is poor or interrupted, it becomes resistant to drugs. In this case, it has a mortality rate of roughly 50%. When looking at the facts, it’s clear to see that (though monstrous) Tuberculosis is contained, just economically. As John Green puts it in his most recent book, Everything is Tuberculosis (2025), “the cure is where the disease is not, and the disease is where the cure is not.”

Tuberculosis affects, at extremely disproportionate rates, low-income countries. WHO estimates that 87% of new cases are in the same thirty “TB burden countries,” with eight of them holding two-thirds of the total global number of cases. In fact, Partners in Health, a non-profit dedicated to partnering with local governments to bring health care to some of the poorest countries, says it has been referred to in the past as “The Disease of Poverty.” One of the biggest reasons for this is the overwhelming malnutrition rates in low-income countries, almost directly tied to the high number of Tuberculosis cases. Dr. KJ Seung, a technical advisor and co-leader to endTb (a project seeking better treatment for drug-resistant TB), says that malnutrition weakens the immune system, making people more prone to infection and less able to fight it off. 

In low-income countries, health care infrastructure is often not suitable for the needs of Tuberculosis treatment. Treatment can be both intensive and expensive. In many less developed or low-income countries, health budgets aren’t enough to provide the funding for proper treatment. In An Introduction to Global Healthcare Delivery, Dr. Joia Mukherjee explained that the history of loans with the World Bank only allowed many countries in Africa and Asia to provide “less than $5 per person per year” in the late 80s. Nowadays, in countries like Sierra Leone, where the World Bank reports the federal government as only able to provide $39.32 in health care per capita (2022), drug-resistant TB can be a death sentence. The WHO reports that 50% of people who receive care for any level of Tuberculosis receive “catastrophic” medical bills, meaning the cost of care is over 20% of their yearly household income. According to the most recent U.S. Census, the median household income for Americans is $83,730. The WHO says the median cost of treatment for TB in the U.S. is $1,245, about 1.4% of the yearly household income. 

The cost of care itself isn’t the only financial barrier. The infrastructure for travel and the distance required to travel for adequate care are often unsustainable for the duration of time Tuberculosis needs. People are not as likely to return or be able to return for multiple rounds of long-term treatment. Until recently, getting tested for TB was even a multiple-day process. Steve Tokar, a student from UCSF, reported that “in developing countries such as Uganda, up to half of all patients never come back to the health center after the first visit, because they live too far away and can’t afford to take the time to return.” The time off work and money spent on travel are just as negatively influencing as the medical bills themselves. 

Testing for TB has since become easier, now taking only a day, where new technology has been implemented, but the solutions to this problem have been slow coming, especially with the disappearing aid programs from the U.S. that have largely driven the fight against Tuberculosis. 

What aid does the U.S. provide?

In 1998, the United States Agency for International Development (USAID) created a global TB control program. Until recent years, this program was bilateral, supporting twenty-four “priority” countries through technical support from the Centers for Disease Control and Prevention and the National Institute of Health, contributing in large parts to the research and development of Tuberculosis treatment. Previously, the United Nations held two high-level meetings in 2018 and 2023 to address the issue of Tuberculosis, agreeing on a global strategy for TB research and innovation. This strategy, EndTB, hopes to stop Tuberculosis by 2030. In 2022, the USAID released its eight-year global strategy to end Tuberculosis, including the statistics they hoped to reach for low-income countries. These efforts have lowered TB mortality rates in the U.S. priority countries by 47%. Before the Trump administration, the United States was one of the main contributors to the global fund for TB control, making up almost one-third of the donations.

What’s happening to U.S. foreign aid?

Immediately kicking off his second term, President Trump issued executive orders to halt the USAID programs, stopping payments and services to countries the U.S. was actively helping. Following the executive orders, the federal government dissolved USAID (later announcing its leftovers would be absorbed by the Bureau of Global Health Security and Development), cancelling most foreign aid awards. Around 86% of USAID awards were canceled, and, according to KFF, 79% of those were tuberculosis-related. This “stop work” order froze the bilateral programs, meaning implementers across the world had to let go of thousands of workers and end services in many countries. This has massive implications beyond medical care; thousands of community health workers, who have previously bridged the gap between medicine and people in need, have been left jobless. In February of this year, some services were allowed to continue, but with heavily reduced funding and manpower. A USAID internal memo released in the New York Times says that the dissolution of USAID will increase global TB rates by 28-32%. The interruption of care will also have a similar increase in cases of drug-resistant TB, which need more money, time, and attention to treat. A study from PLOS Global Public Health says that in a worst-case scenario, there could be 2.2 million more Tuberculosis deaths in the next five years.

It’s hard to say what the future of Tuberculosis treatment will be, but the U.S. certainly has a massive influence. The current administration released a new “America First Global Health Strategy” in September, meant to be fully implemented by April of next year. This new strategy, as posted on the United States Department of State website, plans to renegotiate with all twenty-four countries previously heavily reliant on USAID for help with Tuberculosis. The renegotiation will result in new multi-year bilateral agreements that aim to have the partner country fully self-reliant, though many are unsure of the stability and clarity of the plan. For a complete analysis of the plan, click here for a Think Global Health article. 

Tuberculosis treatment has likely been changed forever by this massive halt in funding. As Mike Frick, co-director of a group working to stop TB, HIV, and AIDs deaths, said, “It really did feel like we were on the precipice of transformative change…and to cut it off now just feels incredibly wasteful and shortsighted.” There seems to be, among many, a lack of hope for the future of TB; many attitudes have been shifting in how Americans think of foreign aid. In a recent interview for the New York Times, John Green, author and advocate for public health reform, said that the “U.S. is directly responsible for saving tens of millions of lives [through many of its aid programs], it's something, traditionally, Americans have had real cause to feel proud about,” and Americans must wonder where that pride is going to go now. With a shifting political climate, it’s hopeful that international aid for Tuberculosis will be revisited.

To donate and help Tuberculosis treatment in countries affected by the change in U.S. policy, click this link to donate.