US aid freeze leaves TB survivors in India ‘high and dry'

TimesLIVE

14-05-2025

By
Sudeshwar Singh, a tuberculosis survivor and health activist, used to co-ordinate and mentor about 800 advocates in India's eastern state of Bihar, part of a grassroots network that plays a pivotal part in global efforts to end the epidemic by 2030.
However, since the US suspended foreign assistance earlier this year, Singh had to drop his work ensuring patients get treatment and instead search for a new job as the sole breadwinner in his family of four.
'Most of us ourselves are affected by TB and committed to the TB community, but when our own income is affected, how do we support others?' he said.
Singh, 48, is the founder of TB Mukt Vahini (TMV), which roughly translates as the Army for a TB-Free Community, one of two dozen community-led health organisations in India whose funding has dried up since US President Donald Trump dismantled the US Agency for International Development, or USAID, under his 'America first' foreign policy.
Singh and other survivors of tuberculosis who were trained as 'TB champions' are on the front line of India's response to the disease, working in their communities to raise awareness, reduce stigma and support patients in a country with the highest number of infections in the world.
USAID has spent more than $140m (R2.5bn) since 1998 to fight TB in India, where an estimated 2.8-million people have the disease, more than a quarter of cases worldwide.
Without groups like TMV, public health experts in India are warning of a spike in infections and deaths from tuberculosis, an infectious disease caused by a bacteria that can kill half of patients who do not receive treatment.
'It is with great difficulty that we found TB survivors who were trained to be TB champions. How can they work without support?' asked Blessina Kumar, who is based in New Delhi and is CEO of the Global Coalition of TB Advocates, an organisation with 540 members in 76 countries.
'The TB community is left high and dry due to the USAID funding problems, and their work (is) left incomplete.'
Bihar, where TMV worked with TB patients, is one of the country's most impoverished and populous states, with an annual per capita income of less than $500 (R9,115).
'With the recent freeze we are unable to sustain our operations,' said Singh.
The TB champions working with Singh co-ordinate with government health centres and guide patients through treatment to make sure they receive medication.
The survivor-led networks also provide patients with emotional support amid the challenges of treatment while facing potential discrimination in the community.
India's National Tuberculosis Elimination Programme (NTEP), which has an annual budget of $492m (R8.9bn), is almost entirely funded by the government to procure drugs and provide diagnostics.
USAID awarded grants and contracts to government agencies, non-governmental organisations and the private sector, whose work on controlling TB has helped shape the Indian government's policies on fighting the disease.
However, the agency's annual investment of $100,000 (R1.8m) in community-based organisations ensured that vulnerable populations, including the urban poor, miners and migrants, were reached.
Across the world, foreign funding accounts for about a fifth of the money spent fighting TB, and the US previously contributed more than 55% of the funds, according to the Geneva-based Stop TB Partnership administered by the UN.
Subrat Mohanty, a board member with Stop TB Partnership, said shelters for destitute patients in India and other small organisations were specially hard hit by the collapse in US aid.
'They are not getting any money, neither are any activities happening, including healthcare screening, taking TB patients to the diagnostic facilities or follow-up for further treatment,' he said.
Mohanty fears India's goal of ending TB this year is in jeopardy.
'At the end of the day, it is the community that has to use the diagnostic tools and has to come for screening. If they are not going to be sensitised or empowered, how will the (national) programme see results?'
A Stop TB Partnership study showed USAID's funding cuts could lead to as much as a 36% rise in cases and a 68% jump in deaths to 2.24-million by 2030 in 26 high burden countries.
'The withdrawal of US support threatens essential TB services, including diagnostics, treatment, TB-HIV co-infection interventions and research initiatives critical to achieving TB eradication,' the study said.
Mohanty said India must devote more of its own money to curbing tuberculosis and seek assistance from non-traditional TB donors such as Denmark, Sweden, South Korea and Japan.
India is the world's third-biggest producer of pharmaceuticals, putting it in a better position than other countries, specially in Africa, that have relied on USAID to purchase life-saving medication to treat tuberculosis. However, experts said the Indian government has not publicly acknowledged the impact of the loss in USAID assistance.
Urvashi Singh, deputy director-general of the NTEP, did not respond to questions sent by text message and e-mail.
Kumar said: 'India has enough resources to meet the gap through government and private funding, but it needs to act now.'