The termination of United States funding for HIV and tuberculosis research programmes in South Africa could undo years of progress and fuel a global health crisis, because TB remains a major threat, health experts warned.
TB is the leading cause of death among people living with HIV.
As a diplomatic row simmers between the two countries, US President Donald Trump ended funding for South African HIV and TB research grants — funnelled through the National Institutes of Health (NIH) — after last month announcing Washington was cutting support for local HIV/Aids and TB health programmes.
Health news publication Spotlight estimated that the NIH awarded R803 million in grants to South African research groups in 2024. This covered 102 grants, ranging from R500 000 to R49 million. From 2019 to 2023, the NIH awarded R2.1 billion for TB research.
The research funding cut puts pressure on South Africa’s response to TB and could slow down the capacity to develop new tests, said Ingrid Schoeman, the director of the NGO, TB Proof.
“With funding cuts, the health workforce is under extreme pressure and care cascade gaps will worsen if domestic funding for community-led organisations who can close TB policy implementation gaps is not increased,” she said.
“TB testing should be offered to high-risk groups including PLHIV [people living with HIV], with previous TB in the past two years, and close TB contacts, regardless of having TB symptoms.”
The cuts have disrupted essential TB services, including finding and screening people for TB, sputum collection and transport, initiating and maintaining patients on treatment and drug and diagnostic procurement.
A TB epidemiologist told the Mail & Guardian — on condition of anonymity — that since Trump’s orders, a number of non-profit organisations have had mass retrenchments.
“We don’t have those support staff working doing as much of the community-based activities. So, while we’ve slowly been making strides in terms of trying to find more people with undiagnosed TB this is going to have major implications of setting us back in terms of rollout of the policy [to screen and test high-risk individuals].”
The epidemiologist said this would drive up cases of tuberculosis and TB associated morbidity and mortality because there would not be enough people to administer treatment or diagnosis.
TB, a preventable infection that affects the lungs, accounts for the highest number of deaths compared with other infectious diseases in South Africa. In 2023, about 270 000 new TB cases were recorded and there were about 56 000 TB-related deaths, according to the department of health.
The department has set a target to reduce new TB cases by 29% and TB-related deaths by 41% by 2035, by scaling up testing to five million people annually.
A report published by the TB Accountability Consortium earlier this month said South Africa was the only high-TB burden country that reached the 2025 milestones of reducing TB incidence rates by 50%.
“New and repurposed TB drugs have increased the proportion of drug-resistant TB patients treated successfully, and decreased treatment regimens from nine months to six,” however, South Africa is still far from the end goal of reducing the heavy burden of TB,” it said.
Multiple programmes that were doing groundbreaking research in South Africa have been terminated and halted, and there’s great uncertainty among the programmes that have not yet been terminated, said Jennifer Furin, a US-based clinician, researcher and lecturer at Harvard Medical School who specializes in TB research.
“It’s not an exaggeration to say that any innovation that we’ve seen around tuberculosis, diagnosis, treatment and prevention has come directly from work in South Africa, and so it is absolutely devastating, not just to South Africa, but to the world, including the United States,” she said.
TB programmes worldwide had just started to recover from the set-backs of the Covid-19 pandemic, which resulted in an 18% drop in TB notifications in 2020 and a surge in deaths in 2021, but the funding cut reverses the progress made to combat the infectious disease, a report by the TB Community Coordination Hub showed.
“The abruptness of the funding cuts by the Trump administration has similarly not allowed organizations to plan for continuation of their life-saving work, thereby risking again an increase in TB transmission and drug resistance globally due to
delayed diagnosis and treatment,” it said.
In 2023, an estimated 10.8 million people fell sick with TB worldwide, and 1.25
million died — 15% of whom were children and young adolescents.
“Mathematical modeling from the TB Impact Counter estimates that 3 146 lives have already been lost to TB because of US inflicted disruptions of work, with a risk of losing more than two million lives over a five-year period if funding amounts lost are never resumed,” the report showed.
Furin said research led by South Africa was supporting the United States’ response to a surge in TB cases in Kansas, in the midwestern region of the US.
“We really need to keep funding that work. In a recent statement, a prominent leader emphasized the importance of funding at a higher level to ensure the safety, strength, and positivity of all countries. This call to action highlights the need for increased investment in various sectors to promote global well-being and progress.
The leader’s assertion underscores the interconnected nature of the world and the shared responsibility of nations to support each other. By providing adequate funding, countries can address pressing issues such as security threats, economic challenges, and social inequalities. This proactive approach not only benefits individual nations but also contributes to a more stable and harmonious global community.
One of the key arguments for higher funding is the potential impact it can have on enhancing security measures. With increased resources, countries can strengthen their defense systems, combat terrorism, and address cyber threats effectively. This proactive approach is essential in safeguarding the well-being of citizens and preventing conflicts that can escalate into larger crises.
Moreover, higher funding can also support efforts to boost economic growth and development. By investing in infrastructure, education, healthcare, and technology, countries can create more opportunities for their citizens and stimulate economic progress. This, in turn, can lead to greater prosperity, job creation, and overall well-being for communities around the world.
Additionally, increased funding can facilitate initiatives to address social issues such as poverty, inequality, and discrimination. By allocating resources to social welfare programs, countries can improve the quality of life for marginalized populations and promote inclusivity and diversity. This commitment to social justice is crucial in building a more equitable and compassionate society for all.
Overall, the call for higher funding reflects a commitment to building a safer, stronger, and more positive world for everyone. By investing in key areas such as security, economic development, and social welfare, countries can work together to address global challenges and create a better future for generations to come. It is imperative that nations prioritize funding as a means to promote peace, prosperity, and progress on a global scale.
