USAID Cuts Threaten Efforts to Tackle TB in Ukraine

Experts have raised concerns about Ukraine’s ability to tackle its tuberculosis (TB) epidemic following the collapse of the United States Agency for International Development (USAID).

In January, the Trump administration issued a stop-work order for all global funding. What was initially billed as a 90-day freeze to undertake a review has led to the termination of 83% of the United States’ foreign aid contracts and the dismantling of USAID, the agency responsible for coordinating most of them.

Before the war, Ukraine had the fourth highest TB incidence rate, the third highest TB mortality rate, and the highest mortality due to HIV-associated TB among the 53 countries of the World Health Organization (WHO) European Region. Ukraine is also on the WHO’s current high-burden country list for multidrug-resistant (MDR) TB for 2021-2025.

USAID previously funded approximately one quarter of the total international donor funding for TB. It was also the third largest funder for TB research but has stopped all its funded trials, severely affecting progress in TB research and development. It is unclear how much USAID directly contributed to Ukraine’s TB response, but the effects of the cuts are already being felt.

Drug Shortages Expected

Lucica Ditiu, MD, MPH, executive director of the Stop TB Partnership, the largest global provider of TB products to the public sector, told Medscape Medical News that Ukraine is yet to experience drug stockouts, but she expects them later in the year.

“For now, Ukraine has drugs, but they only have them in Kiev, and it’s not that easy to reach patients across the country,” she said. “The more dramatic thing is that, toward the end of the year, Ukraine will not have the funds to procure the drugs it needs.”

“We were already worried about Ukraine before the war because of its MDR-TB burden; it’s one of the highest in the world. Ukraine was directly receiving money from the US to procure drugs and commodities and also from the Global Fund [to Fight AIDS, Tuberculosis and Malaria], but its funding future is now uncertain. It breaks my heart.”

In a 12-page report, the Stop TB Partnership has detailed the disruptions caused by the dismantling of USAID in high-burden TB countries. In Ukraine, laboratory support, including reagents, equipment, and training, has stopped. TB treatment is affected due to drug supply issues. Adherence support has been disrupted. The training of teachers for TB education programs has been put on hold. And pilot interventions for mobilizing local governance and communities for TB elimination have stopped.

The report also stressed that there was “no clarity on TB commodity procurement funding for 2026, as USAID was a major contributor to domestic funding substitution for DS-TB [drug-susceptible TB] and DR-TB [drug-resistant TB] medicine procurement.”

Yana Terleeva, MD, head of the Department of TB Program Coordination at Ukraine’s Ministry of Health, told Medscape Medical News, “For years, USAID-supported projects have played an important role in strengthening national efforts to combat TB. These initiatives have provided high-quality medical services, comprehensive social support, education programs, and campaigns aimed at addressing stigma…Recognizing the gravity of the situation, concerted efforts are being made to ensure the continuation of these essential services.”

She said that Ukraine ordered a shipment of 3 months’ worth of first-line TB medications in October 2024 that will no longer be delivered due to the cessation of USAID operations.

Despite this setback, there is no immediate risk for treatment disruptions, she said. Ukraine currently has enough first-line treatment supplies to last until August and second-line treatment until November this year.

Terleeva is especially concerned about the growing risks associated with an increase in drug-resistant TB. “Treating these forms of the disease is extremely costly, raising the question: Will we be able to guarantee full access to life-saving medications in the future, particularly against the backdrop of a prolonged war?”

She added, “The ongoing war and its accompanying challenges underscore the need for coordinated international efforts to sustain Ukraine’s TB treatment programs.”

Impact on Patients

Meanwhile, the Alliance for Public Health (APH), one of Ukraine’s largest non-state organizations involved in the TB and HIV response, has had to take on patients in 12 different regions that were receiving medical and psychosocial support for DR-TB as part of a USAID-funded program that was implemented by the international nonprofit PATH.

“This places additional financial load…on the budget since we didn’t expect additional patients. Now there’s a risk of lack of money for patient support. All our savings are now being used to cover needs in procurement for TB and HIV programs that were previously covered by PEPFAR [the United States President’s Emergency Plan for AIDS Relief] or PATH,” Evgenia Geliukh, MD, APH program manager for TB and HIV, told Medscape Medical News.

Geliukh added that APH has also put on hold its advocacy project for decreasing stigma — a major barrier to TB control.

“This topic is very sensitive to the community. If the situation lasts too long, we expect a rollback on progress in tackling stigma. We’re afraid all our prior efforts will become useless. We need other donors to cover the finance gap, and we are looking for them.”

The Fear of Drug Resistance

One of the biggest fears is that interruptions to people’s treatment will allow TB to mutate into a new and untreatable form, affecting decades of progress on combating the world’s biggest infectious killer. Cuts in diagnostic services could also lead to the unfiltered spread of disease.

“Currently, we have a good drug to treat [MDR-TB]: Bedaquiline. But improper handling of this drug [by not taking it regularly or at the wrong dose due to shortages] will be a disaster. If we lose this drug, we’re really, really in big trouble. This is my greatest fear,” Ditiu said.

Professor of infectious diseases and international health at University College London, London, England, Sir Ali Zumla, MD, PhD, told Medscape Medical News that USAID funding cuts were a “significant blow” to the global TB response and will exacerbate an already fragile situation, with an existing US$11 billion shortfall in TB funding. He shared Ditiu’s concern about the possible emergence of new resistant TB strains.

“Without sustained investment in diagnostics, treatment access, and adherence support, we risk creating a cycle where drug resistance spreads unchecked, which could lead to increased MDR-TB transmission within communities; longer, more toxic, and costlier treatments for patients; and greater strain on health systems due to rising caseloads of difficult-to-treat TB,” he said.

He added that the ongoing war in Ukraine and USAID cuts could lead to drug supply issues, healthcare access issues, and cross-border transmission.

For example, new research found that the displacement of Ukrainians into Poland has led to an increased number of drug-resistant cases there.

“While TB does not spread as quickly as some other infectious diseases, the movement of people from Ukraine into neighboring countries raises concerns about undiagnosed or untreated MDR-TB cases,” he said. “It is important to frame this issue carefully — while there is a theoretical risk of increased transmission, host countries with robust TB surveillance can mitigate it. However, ensuring displaced populations have uninterrupted TB care is crucial to preventing a surge in MDR-TB.”

Terleeva agreed. “With mass population displacement, both within the country and across its borders, uncontrolled TB spread becomes an even greater threat. This situation is not solely Ukraine’s problem — it’s a global challenge that requires coordinated efforts from all stakeholders.”

In 2023, there were 10.8 million new TB cases and 1.25 million deaths from the disease globally. Earlier this month, the WHO warned that “abrupt funding cuts” would “cripple TB prevention and treatment efforts, reverse decades of progress, and endanger millions of lives.”

Ditiu, Terleeva, and Geliukh, reported no relevant financial relationships.

Zumla reported receiving grant funding from the European and Developing Countries Clinical Trials Partnership (EDCTP2) program. He is also in receipt of a UK NIHR Senior Investigator Award, the Mahathir Science Award (Tropical Sciences), and the EU-EDCTP Pascoal Mocumbi Prize.

Sophie Cousins is a global health journalist currently based in Southeast Asia.