March 28, 2025 l Manila Times
Since 1961, the United States Agency for International Development (USAid) has played a pivotal role in global development, addressing challenges in health, education, and economic growth across numerous countries.
In 2023, the US government allocated nearly $65 billion to foreign aid, with USAid managing approximately two-thirds of these funds.
The President’s Emergency Plan for AIDS Relief (Pepfar), for example, has saved millions of lives and significantly reduced new HIV transmissions globally.
In Uganda, the USAid Defeat TB Activity increased the TB case detection rate from 61 to 102.6 percent in targeted districts between 2017 and 2022.
Recent policy shifts in the Trump administration on the restructuring of USAid have raised serious concerns. This is aimed to enhance transparency and efficiency, partly by leveraging blockchain technology to secure and trace aid distribution.
However, critics argue that such technological solutions may not be necessary or cost-effective in humanitarian contexts.
The Trump administration has imposed a 90-day freeze on foreign aid, leading to immediate and severe impacts on global humanitarian efforts. This abrupt halt disrupted food programs, medical clinics, and disease surveillance systems worldwide.
The cuts, totaling at least $54 billion, resulted in job losses for approximately 60,000 aid workers and the cancellation of 83 percent of USAid programs.
As a board member of the Philippine Tuberculosis Society Inc. (PTSI), I find the actions of USAid on its Global Tuberculosis Strategy for 2023-2030 of special interest. The plan was to accelerate detection and treatment for all patients, scale up prevention and treatment of multidrug-resistant TB, expand coverage of interventions for TB-HIV co-infection and improve TB service delivery platforms.
Cessation of funding
In the Philippines, USAid’s local partners have been instrumental in introducing new TB technologies at the primary health care level, including Truenat diagnostic instruments. These tools have enhanced TB testing capabilities, especially in remote locations, leading to more timely diagnoses and treatments.
USAid has allocated funds for accelerated detection in the countryside. But the cessation of funding has disrupted essential services, such as testing, drug supply chains, and the employment of health workers.
The World Health Organization (WHO) has expressed concern that these funding cuts could jeopardize recent progress in combating TB in low- and middle-income countries heavily reliant on US support.
TB remains one of the deadliest infectious diseases, killing over 1.6 million people annually. USAid has been instrumental in scaling up diagnostic tools, treatment programs, and drug-resistant TB surveillance. The sudden halt in funding has negated progress made so far.
A major concern is the spread of multidrug-resistant TB and extensively drug-resistant TB, which require more expensive and prolonged treatment. When TB programs are cut, patients may not complete their treatment, leading to increased resistance. The spread of drug-resistant TB poses a direct threat to global health security, as the US remains vulnerable to imported cases through international travel.
USAid-supported health initiatives have also strengthened health systems in recipient countries. This included training health care workers, improving supply chains for medications, and ensuring rural clinics had diagnostic capabilities. Without USAid’s support, national governments and NGOs must fill the gap, but many lack the financial or logistical capacity to do so effectively.
Cuts to TB funding mean other health priorities (like combating HIV/AIDS, malaria and child health concerns) may also suffer, as national health budgets are stretched too thin. Countries with high TB burdens often see economic losses due to decreased labor participation, prolonged illness, and the financial strain of treatment.
As developing nations struggle with TB and other preventable diseases, their ability to engage in trade and economic partnerships with the US diminishes. Many of these countries are emerging markets for US exports, and a downturn in their economies can lead to reduced trade opportunities, impacting American businesses.
A lack of investment in global health and development can lead to increased political instability. Health crises often trigger wider societal issues, including unrest and forced migration. If TB cases rise dramatically in low-income regions, the economic burden and loss of life could contribute to instability.
The US leadership needs to realize that it must play a vital role in global health while safeguarding its own interests. It cannot afford to take a myopic perspective on the interconnectedness of global and domestic health security.
***The views expressed herein are his own and do not necessarily reflect the opinion of his office as well as FINEX. For comments, email benel_dba@yahoo.com. Photo is from Pinterest.