Aid Cuts Jeopardise 2024’s Slight Global Progress Against Tuberculosis

Last year, the global effort to reduce tuberculosis (TB) infections and deaths showed modest signs of recovery following three disruptive years impacted by COVID-19. However, a precipitous drop in development aid this year is likely to cause new setbacks, according to the World Health Organization (WHO).

The Global TB Report 2025, released by the WHO on Wednesday (12 November), revealed that TB killed 1.23 million people and sickened 10.7 million people in 2024. This represented a slight 3% decline in deaths and a 1% decline in new infections last year compared to the previous year.

Crucially, the report, which tracks data from 2024, does not yet reflect the impact of the significant drop in development aid, particularly from the United States since January. It notes only that: “Cuts to international donor funding from 2025 onwards threaten overall funding for the TB response in many countries.”

Speaking at a WHO press conference, Director-General Dr. Tedros Adhanom Ghebreyesus described the decline in new TB cases and deaths as “good news.” He highlighted that “the number of people being tested and treated is increasing and research is advancing for the first time in over a century. New effective TB vaccines for adolescents and adults are within reach,” noting that 18 vaccine candidates are currently in clinical development, including six in Phase 3 trials.

Despite these positive developments, Dr. Tedros emphasized that “TB still killed more than 1.2 million people in 2024, which for a disease that’s preventable and curable is simply unconscionable.” He added that “funding cuts to international aid in many low and middle-income countries threaten to reverse the hard-won gains we see. It’s therefore vital that countries step up domestic resource allocation, alongside international funding.”

Just eight countries account for 67% of global TB cases: India (25%), Indonesia (10%), the Philippines (6.8%), China (6.5%), Pakistan (6.3%), Nigeria (4.8%), the Democratic Republic of the Congo (3.9%), and Bangladesh (3.6%).

The WHO has already observed “some concerning trends” for 2025, especially in the highest-burden, low- and middle-income countries (LMICs) that have been “heavily dependent on international donor funding,” stated Dr. Tereza Kasaeva, WHO director for HIV, TB, Hepatitis, and STIs. These trends include disruptions to access to TB treatment, diagnosis, and prevention; problems with monitoring and reporting, drug delivery, sample transportation, and significantly, community engagement.

Estimates in the report regarding the impact of funding cuts, particularly by the U.S., project “about half a million additional deaths and 1.4 million additional cases in the period 2025–2035 if USAID funding is not replaced.” This increases to “about two million additional deaths and five million additional cases when cuts in contributions to the Global Fund are also considered.”

Even before these recent funding cuts, progress toward achieving TB goals fell significantly short of global targets, with funds mobilization being the worst-performing area for 2024. Only $5.9 billion of the $22 billion target for TB treatment by 2027 had been collected, and slightly more than 20% of the $5.5 billion research target for 2027 has been achieved.

Despite the lack of research funds, the WHO notes a strong development pipeline. As of August 2025, 63 diagnostic tests and 29 drugs were in clinical trials, a significant increase from just eight in 2015. Additionally, 18 vaccine candidates are undergoing clinical trials, including six in Phase 3.

Since 2015, there has been a 29% drop in deaths from TB, though the global target was a 75% reduction by this year. Two WHO regions, however, performed substantially better than the global average: Europe, which cut deaths by 49% by 2024, and Africa, with a 46% reduction, mainly due to better outcomes for people coinfected with HIV.

Similarly, TB incidence has only seen a 12% drop against a global target of 50% reduction between 2015 and 2025. Europe achieved a 39% decrease and Africa a 28% decrease, while incidence rose by 5% or more in Indonesia, Myanmar, and the Philippines. Furthermore, 47% of households with people living with TB face “catastrophic” health costs, against a target of zero.

However, Dr. Kasaeva highlighted that 8.3 million people newly diagnosed with TB in 2024 accessed treatment, representing about 78% of those who fell ill that year. Coverage of rapid testing for TB diagnosis also increased from 48% in 2023 to 54%, and there was an 88% success rate for treatment of drug-susceptible TB.

Dr. Yogan Pillay, Gates Foundation’s director for HIV and TB delivery, noted that several countries are “stepping up, both in increasing domestic financing and looking at other ways of delivering services” in response to aid cuts. He specifically praised Indonesia, Nigeria, and South Africa for boosting domestic funding for TB. Dr. Pillay emphasized the need to focus on developing sustainable systems, including in low and middle-income countries, to “sustain the gains that we’ve seen in the 2024 data, notwithstanding any funding cuts.”

A significant proportion of the TB burden is driven by five major risk factors: undernutrition, HIV infection, alcohol abuse, smoking, and diabetes. The report stresses that “Tackling these issues, along with critical determinants like poverty and GDP per capita, requires coordinated multisectoral action.”

The report concludes by noting that, in the face of anticipated cuts to international donor funding from 2025, “political commitment and domestic funding in high TB burden countries are more important than ever.”