A Country That Walks Away
The Loud, Cruel End of America’s Fight Against Tuberculosis
On March 24, the world will mark World Tuberculosis Day — though in much of the world, the alarm bells are already ringing.
In Harare, Zimbabwe, Nurse Chiedza Makura starts her day with the same dread that’s haunted her since January. Her TB clinic, once a hub of steady treatment and prevention funded by the U.S. Agency for International Development (USAID), is now on life support. Dozens of her colleagues have been laid off. The latest shipment of pediatric TB drugs never arrived. She’s stopped giving time estimates to parents asking when the medicine will come. She doesn’t know anymore.
This was not an accident. It was a decision.
For 25 years, USAID stood at the forefront of the global fight against tuberculosis — training lab technicians, funding mobile diagnostic units, and partnering with governments from Bangladesh to Nigeria to build public health systems strong enough to fight the world’s deadliest infectious disease. Programs like Challenge TB, TB CARE, and TB Platforms helped treat or cure tens of millions of people. In 2023 alone, USAID-supported programs helped avert 3.65 million deaths from TB, according to the World Health Organization.
But in January 2025, the Trump administration — returned to power — didn’t just quietly shift priorities. It loudly and ignorantly shut the door on global health, declaring USAID a “bureaucratic dumpster fire,” in the words of Secretary of State Marco Rubio, and eliminating the agency’s health functions outright. “It’s time we stop funding globalist projects that don’t serve America,” Rubio told reporters at a January press conference. The applause came not from doctors or diplomats, but from political allies who had never seen what those “globalist projects” actually did.
The consequences were swift. In Zimbabwe, the clinic where Nurse Makura works laid off most of its TB outreach staff in February. In Cambodia, USAID-funded pediatric TB drugs began running out by early March. In Kenya, Nyumbani Children’s Home — which relies on USAID for HIV and TB medications — scrambled to ration its dwindling stock of life-saving drugs. Health workers across these countries were left with no answers. Their American partners — the same ones who had trained them, funded them, stood beside them — had vanished.
On March 5, the World Health Organization issued a rare rebuke: “Millions of lives could be at risk,” the statement read. Tuberculosis, which kills over a million people every year, is resurging in areas that had previously made hard-won progress. Without testing, drugs, or surveillance, undetected cases will multiply. Drug-resistant strains will thrive. Treatment interruptions will become the norm.
The most infuriating part is how little it would have cost to keep going. Global TB programs made up a sliver of USAID’s global health work — which itself received less than one-tenth of one percent of the entire federal budget. Over five years, the Challenge TB program operated in 24 countries with just $230 million, roughly what the Pentagon spends every four hours. And yet, that modest investment helped save millions of lives.
USAID wasn’t just helping other countries. It was protecting us, too. Under the U.S. National Action Plan for Combating MDR-TB, launched in 2015, USAID played a lead role in containing drug-resistant TB before it could cross borders. In Ukraine, it helped fund digital adherence technology that kept patients with multidrug-resistant TB from falling through the cracks. In India, USAID partnered with the National TB Elimination Program to reach over a million patients annually and engage the massive private sector in screening and treatment. These weren’t acts of charity — they were smarty, strategic investments in global stability and American health security.
And now? The experts have been fired. The funding has been frozen. The systems are unraveling.
Some in the administration say other countries should “step up.” But TB isn’t a disease you can pass the baton on mid-race. The global health infrastructure took decades to build — and weeks to sabotage.
In moments like this, I return to people like Nurse Makura. Or to health officers in the Philippines who told me how USAID’s TB Platforms project helped them keep clinics running through the chaos of COVID. Or to the young woman I met in South Africa whose life was saved by a short-course MDR-TB treatment piloted by USAID and WHO.
They remind me that policy is not abstract. It’s life and death. It’s whether a mother gets to keep her child, or buries them because a foreign government changed its mind.
The United States has not simply walked away from tuberculosis. It has chosen, loudly and with indifference, to torch the scaffolding of global health leadership it spent a generation building.
The question now is whether we will be remembered as a country that left — or a country that came back.
Congress can restore USAID’s programs. The President can reverse course. The public can demand it.
The fight against TB isn’t over — unless we decide to let it be.
Originally published on Medium.