Combatting TB: With the US Funding Freeze, International Aid Organizations Must Intensify Efforts

The U.S. spending freeze on foreign aid presents a significant challenge for global health initiatives, raising concerns about a potential resurgence of infectious diseases. As uncertainty looms over the future contributions of the world’s largest donor, the Global Fund remains a vital force in the fight against deadly diseases. Since its inception, this Geneva-based multilateral organization has played a crucial role in combating malaria, HIV, and tuberculosis through strategic funding and innovative approaches. While it has made remarkable strides against malaria and HIV, there is now an urgent need to intensify efforts against tuberculosis.  

From 2023 to 2025, nearly one-third of the Global Fund’s allocations—approximately $4.17 billion—have been directed toward malaria control. These investments have enabled large-scale distribution of insecticide-treated bed nets and rapid diagnostic tests, significantly reducing transmission in countries like Rwanda and Zambia. Similarly, $6.48 billion has been allocated to HIV programs, providing millions with access to antiretroviral therapy (ART) and transforming HIV from a fatal disease into a manageable condition. Through education and prevention, the Global Fund has empowered communities to take control of their health, saving countless lives in the process.  

Despite these successes, tuberculosis remains underfunded, receiving just $2.4 billion—only 18% of the Global Fund’s budget. Yet, tuberculosis now claims more lives than HIV and malaria combined, making it the world’s deadliest infectious disease. Despite its staggering death toll, tuberculosis receives far less funding and media attention, often being overlooked in global health discussions.  

Historically, tuberculosis was one of the most feared diseases, ravaging populations across Europe and the U.S. in the 19th century. In New York City alone, tuberculosis once caused more deaths annually than the city’s total death rate today. Over the past 200 years, it has likely killed over a billion people. However, in wealthier nations, the disease has largely disappeared due to antibiotics, vaccines, improved living standards, and public health measures. As a result, tuberculosis has faded from the collective memory of developed countries, despite continuing to devastate the world’s poorer regions.  

Today, tuberculosis remains a disease of poverty, thriving in overcrowded slums, migrant communities, mining towns, and prisons—places where healthcare is inaccessible and living conditions are dire. The most vulnerable populations, lacking a political voice, bear the greatest burden. Although tuberculosis is preventable and curable, it continues to claim 1.3 million lives annually, surpassing the combined death toll of HIV/AIDS and malaria.  

The global community cannot afford to ignore this crisis. Research from the Copenhagen Consensus think tank indicates that an additional $6.2 billion investment per year could save a million lives annually in the coming decades. Expanding tuberculosis diagnosis and ensuring treatment adherence could reduce deaths by 90% by 2030, delivering an exceptional 46:1 return on investment.  

As the Global Fund approaches the midpoint of its replenishment cycle, there is an urgent need for increased global contributions. The Fund has demonstrated its effectiveness in combating deadly diseases, making it one of the best channels for development funding. Now, it must prioritize tuberculosis—the disease that takes the most lives—where targeted investments can yield unparalleled impact. The world must act decisively, ensuring that no one dies from a preventable and curable disease simply because of poverty and neglect.