Is Trump Making the World Safe for Tuberculosis?

MERRILL SINGER

In his book, Everything is Tuberculosis: The History and Persistence of Our Deadliest Infection, best-selling American novelist John Green writes that “tuberculosis is both a form and expression of injustice.” In Green’s view, tuberculosis is not primarily caused by the bacteria Mycobacterium tuberculosis but by human choices. Green came to understand the social causation of tuberculosis through his relationship with Partners in Health and its physician/anthropologist founders, Paul Farmer and Jim Yong Kim.

The accuracy of Green’s view is now subject to a morbid test. In his slice and dice approach to government programs, including the semi-independent U.S. Agency for International Development (USAID), will Donald Trump make the world safe for tuberculosis to wreak havoc on the public’s health?

Since he assumed the presidency for the second time, Trump has made it clear he intends to eviscerate the USAID, dismiss thousands of its employees, and cancel foreign aid programs for the world’s poorest people. Trump claimed on Fox News that USAID “has been unaccountable to taxpayers as it funnels massive sums of money to the ridiculous—and, in many cases, malicious—pet projects of entrenched bureaucrats, with next-to-no oversight.” While the New York Times has debunked such claims, Trump nevertheless moved swiftly to cut aid to most of the 130 countries receiving assistance through USAID for a variety of pressing needs, including tuberculosis prevention and treatment.

As Green pointed out on PBS’s Amanpour and Company, the U.S. “has long been the most generous supporter of the fight against tuberculosis” all around the world. Thus the consequences of the U.S. withdrawing from that fight, he warned, will be profound. And, indeed, without USAID money, thousands of people have already seen their treatment interrupted, meaning further spread of, and more deaths from, tuberculosis.

What is Tuberculosis?

Over time, TB has been characterized in contradictory ways. During the colonial era, TB was seen as a disease of “civilized” white people, particularly European administrators, soldiers, and settlers in Asia and Africa, rather than colonized people of color, who were viewed as being more resilient to tropical diseases. By the end of the 19^th century, the disease was linked to alcoholism and moral weakness in the publications of a number of physicians as well as by the U.S. Temperance Movement. That blame-the-victim attitude provided many with a false sense of protection.

Tuberculosis has had many names over the centuries, including "the white death" and “the white plague” because of the extreme anemic complexion of sufferers caused by a pronounced loss of red blood cells. “Consumption” was another name for TB because in its late stages sufferers exhibited significant weight loss, suggesting that the disease was “consuming” them. Paul Farmer used this trope in the title of his article “The Consumption of the Poor: Tuberculosis in the 21st Century,” when he called attention to “the larger social contexts in which they [people] become infected, fall ill, and meet with a series of therapeutic misadventures leading to complications, ongoing transmission to others and, often enough, death.”

The cause of tuberculosis was not well understood until the last quarter of the 19^th century when German physician and microbiologist Robert Koch isolated the tubercle bacillus, cultivated it in animal serum, and reproduced the disease by inoculating the bacteria into laboratory animals. He presented his discovery to the Society of Physiology in Berlin in 1882 and received the Nobel prize in Medicine for his efforts in 1905. Koch’s work laid the foundation for the global fight against TB.

Tuberculosis is the deadliest infectious disease in human history, more deadly than small pox, more deadly than bubonic plague. Most commonly, it affects the lungs but the bacteria that causes TB can invade many other parts of the body including the bones, kidneys, brain, and skin. It is spread through the air when infected individuals cough, sneeze, or spit. While most people who develop active TB become sick within a few years of infection, others can remain symptom-free even decades after the bacteria enters the body. About 5 to 10% of people infected with TB eventually develop symptoms.

The bacterium that causes TB has an unusually fatty and thick outer cell wall that makes it difficult for white blood cells released by the body’s immune system to penetrate, hence the delayed onset of active TB in some individuals. The body adapts to this challenge by surrounding the bacteria with multiple white blood cells, calcifying into a structure known as a tubercle (hence the name of the disease). As long as this structure holds, active disease will not develop. Shocks to the immune system like hunger, chronic stress, or infection by another disease can allow the bacteria to make a prison break and enter into an active state of symptom onset and disease spread. That’s why TB cases tend to cluster among disadvantaged groups such as the poor, the malnourished, ethnic minorities, those facing cultural barriers to accessing health care, and people who are HIV positive. A person with HIV is about 13 times more likely to develop active TB than a person who is not HIV-positive. According to the World Health Organization, TB contributed to 1.25 million deaths in 2023 (including 161,000 people with HIV).

After the advent of antibiotics, TB became a curable disease, with four drugs being the most commonly used. Since 2000, global efforts to combat TB, including the efforts funded by USAID, have saved about 80 million lives. However, the bacteria that causes TB is growing drug-resistant, a major public health crisis. Drug resistance emerges when TB medicines are used inappropriately, patients receive poor quality drugs, or patients’ treatment is stopped prematurely. That’s yet another reason why the cutting off of USAID funds for TB treatment is so dangerous, not only for the people USAID was treating but for the entire world.

The Trump Effect

According to a document obtained by POLITICO, the cuts to TB funding imposed by Trump include:

• $57 million in tuberculosis research which had been awarded to Johns Hopkins University

• $6.5 million to manage TB drug resistance in countries supported by USAID

• Sweeping cuts to funds that pay public health workers targeting TB

Twenty-seven countries previously receiving funds from USAID now are facing crippling breakdowns in their TB response, with devastating consequences that include:

• Human resource shortages undermining service delivery

• Disruptions in diagnostic services, delaying detection and treatment

• Data and surveillance systems collapse, compromising disease tracking and management

• Interruption of community engagement efforts such as contact tracing and screening that identifies active cases, leading to increased transmission risks.

Trump’s efforts to control hiring and enrollment at universities like Harvard have further hampered the battle against drug-resistant tuberculosis. On April 15, Dr. Sarah Fortune, a Harvard immunologist, received an official “stop work” notice at her federally funded laboratory. Fortune carries out critical research on the molecular mechanisms used by the tuberculosis bacterium to generate diversity and how this diversity enables the bacterium to survive subsequent selective forces including antibiotics and immune selection. Her work is part of a $60 million dollar research consortium involving Harvard and other universities investigating ways to combat TB. Now, unless other funding can be secured, this research will be put on hold indefinitely, and potentially ended midstream—an unconscionable interference with work intended to save lives.

Trump’s cuts and stop work orders exacerbate an already underfunded global TB response. In 2023, global funders like the U.S. provided only 26% of the funding needed annually for TB prevention and care.

Epidemiologist Michael Osterholm, head of the University of Minnesota’s Center for Infectious Disease Research and Policy, notes that making sense of the current chaos “is more challenging than trying to understand what’s going on with the damn diseases themselves.” While the funding cuts are being challenged in court, fighting TB has ground to a halt in many places. In effect, Trump is making the world safe for the spread of TB — including drug-resistant TB.

Congresswoman Sarah Jacobs, the representative for California's 51st congressional district, has introduced H.R. 1196 to stop the dismantling of USAID. While the legislation has an uphill battle in the Republican-controlled Congress, a strong outcry from people who recognize tuberculosis does not respect national boundaries could help turn the tide.

Merrill Singer, who specializes in the critical anthropology of health, is an emeritus professor in the Department of Anthropology at the University of Connecticut. He is the author or editor of over 35 books and 225 peer reviewed articles.

For Further Reading

Barberis, I., Bragazzi, N., Galluzzo, L. and Martini, M. 2017. “The history of tuberculosis: from the first historical records to the isolation of Koch's bacillus.” Journal of Preventive Medicine and Hygiene 58(1):E9-E12.

Dormandy, Thomas. 2000. The White Death: A History of Tuberculosis.. New York: New York University Press.

Lönnroth, K., Jaramillo, E., Williams, B. Dye C. and Raviglione M. 2009. “Drivers of tuberculosis epidemics: The role of risk factors and social determinants.” Social Science and Medicine 68:2240–2246.

Nerlich, Andreas G et al. 1997. “Molecular evidence for tuberculosis in an ancient Egyptian mummy.” The Lancet 350(9088):1404.

Saul, Stephanie and Alan Blinder. April 17, 2025. “Space Travel and Tuberculosis Research Are Hit by Trump’s Harvard Cuts,” The New York Times.