- Amna Nawaz:Earlier this year, the Trump administration’s defunding of USAID brought an abrupt halt to hundreds of global health programs, including those targeting tuberculosis. The disease kills more people than any other infectious agent, more than a million worldwide in 2023.In partnership with the Pulitzer Center, Fred de Sam Lazaro reports from Bangladesh on efforts to contain the fallout.
- Fred de Sam Lazaro:The USAID signs are still all over this 250-bed hospital in Bangladesh’s capital city. Inaugurated four years ago with state-of-the-art-lab equipment, specialized doctors, and wards for the more dangerous MDR, multidrug-resistant cases, this was considered a model facility in the global effort to eradicate tuberculosis.Dr. Ayesha Akther, Deputy Director, 250-Bed T.B. Hospital: It’s more and more challenge for us.
- Fred de Sam Lazaro:After the closure of USAID, hospital deputy director Dr. Ayesha Akther says they have had to pull in resources from other sectors of an already stressed public health system.
- Dr. Ayesha Akther:T.B. is curable disease, and we can prevent it easily. We can take drugs, antibiotics. USAID funded our T.B. drugs everywhere, not only in this hospital, but all over Bangladesh.
- Fred de Sam Lazaro:Over the past decade, USAID spent more than $100 million to support Bangladesh’s T.B. program. And it’s paid off. T.B. deaths dropped nearly 35 percent, from 73,000 in 2015 to 44,000 in 2023.Bangladesh has made significant strides in containing tuberculosis, but getting to the finish line is a daunting task in the conditions that are ideal for the infection to spread. Many people suffer from malnutrition, making them vulnerable to infections, and there is a sheer lack of space in one of the world’s most densely populated countries.
- Asif Saleh, Executive Director, BRAC Bangladesh:Early detection is extremely important.
- Fred de Sam Lazaro:Asif Saleh heads the nongovernment organization BRAC, which leads a consortium of 13 groups still fighting T.B. with remaining support from the government and other international donors, trying to build on earlier successes, particularly in increased early detection, which is critical
- Asif Saleh:In 2001, we had about 27 percent detection rate, and that has gone up dramatically to 82 percent.Bangladesh’s success in T.B. detection has been because of that, on one hand, there has been community mobilization and community awareness, and, on the other hand, a lot of the new innovations that has come in, like mobile clinics, mobile detection facilities.
- Fred de Sam Lazaro:Mobile testing vans have been deployed in slums and many garment factories, the country’s largest industry, densely crowded environments that are ripe for infection.Tuberculosis spreads through the air, attacks the lungs, and can be fatal if left untreated. Portable X-ray machines make the rounds of harder-to-reach rural areas. Radiographer Sultana Amin (ph) screens 50 to 100 people on any given day, X-raying lungs and using artificial intelligence to assign scores for each scan for the likelihood of T.B.How many patients come positive for T.B. in a month?
- Sultana Amin, Radiographer:July month, 120.
- Fred de Sam Lazaro:A hundred and twenty.
- Sultana Amin:A hundred and twenty T.B.-suspected.
- Fred de Sam Lazaro:So-T.B. suspected means its likely T.B.?
- Sultana Amin:Right.
- Fred de Sam Lazaro:In this case, she determined a 90-year-old patient had a high likelihood of infection.
- Man (through interpreter):I have coughing. I have an uncomfortable feeling in my chest, and I have fever also. Now only Allah knows actually what will happen.
- Fred de Sam Lazaro:For patients whose X-rays find lesions that might be tuberculosis, this is the start of a journey that will take them next for more accurate testing and, accordingly, for treatment.The goal is to catch infections early and start patients on a strict six-month course of daily medication before the disease can spread further. And it’s here’s that many fear progress will stall, or worse. After the Trump administration issued a stop-work order in January, detection, treatment, and research efforts like these were scaled back or shut down. Thousands of health workers lost their jobs.Many were employed by the USAID-funded International Centre for Diarrhoeal Disease Research. Center officials declined to participate in this report. Like many defunded USAID grantees, they cited fear of jeopardizing potential future funding.
- Asif Saleh:Oftentimes, whether the foreign grants come or not, it’s very whimsical. These are political decisions. So, for that, you need to diversify. You need to have your own independence.
- Fred de Sam Lazaro:That’s the big lesson from USAID’s demise, says Asif Saleh of BRAC, which is considered one model, now the world’s largest NGO, operating in 12 developing countries. It relies on foreign aid, but also various businesses that generate revenue for its charitable work, medical clinics for paying patients, a commercial bank, retail store for rural craftwork, even a university.
- Asif Saleh:Every country needs a thriving social sector. I think the Bangladeshi government as well need to think that how some of their own development budget can be used to — for — where implementation can be done by local NGOs.Dr. Nazmul Huda, Former Country Project Director, Health Systems for Tuberculosis: My project was about to prepare the government to take the responsibility of managing and financing the tuberculosis program.
- Fred de Sam Lazaro:Dr. Nazmul Huda led a now-shuttered USAID-funded project, ironically one intended to wean this country’s T.B. program off foreign funding. Economic progress in recent years has moved Bangladesh from a less developed to a lower-middle-income nation, something that will automatically mean a drop in foreign assistance.
- Dr. Nazmul Huda:It has stopped at a very crucial time for the country. There is a process for technology transfer. So, whatever we achieved in the last few years, we could not transfer that result to the government.
- Fred de Sam Lazaro:He says the setback not only stalls Bangladesh’s path toward self-reliance, but also threatens to reverse progress made, as fewer cases are detected and many that are diagnosed do not complete their treatment regimen.
- Dr. Nazmul Huda:It requires long treatment. And if there is interruption, more complexities might happen, for example, in the form of multidrug resistance tuberculosis.
- Fred de Sam Lazaro:How many patients will have interrupted therapy?
- Dr. Nazmul Huda:You know, the data, recent data, there is also interruption. Data is not coming.
- Fred de Sam Lazaro:We don’t even know because the data has been interrupted as well?
- Dr. Nazmul Huda:Yes.
- Fred de Sam Lazaro:Some estimates are that tens of thousands of patients have seen their treatment stopped.
- Asif Saleh:So the full impact of it is not visible as yet, because it’s early days.
- Fred de Sam Lazaro:Saleh says it’s not just Bangladesh that should be concerned about infections that could emerge in the months and years ahead.
- Asif Saleh:If it is not controlled within the borders, then it’s just going to spread across all over the world, so we are going to go back to a situation where no country will be immune to these kinds of challenges.
- Fred de Sam Lazaro:Back in Washington, the Trump administration and congressional leaders have moved to restore some global health programs, including tuberculosis. But experts say many projects already dismantled will be difficult, if not impossible to quickly restore.For the “PBS News Hour,” this is Fred de Sam Lazaro in the village of Raipur in Bangladesh.
- Amna Nawaz:And Fred’s reporting is a partnership with the Under-Told Stories Project at the University of St. Thomas in Minnesota.
USAID IS GONE
TUBERCULOSIS IS NOT
Early in 2025,, the Trump administration shuttered USAID abruptly cutting off the single largest source of funding that kept hundreds of global health programs alive in developing countries. In this report, we visit with health workers and NGOs carrying on the work with what funding remains, who are especially worried about setbacks in early detection and the spread of multi-drug resistant tuberculosis caused by interrupted therapies.
An investment in global health
Over the past decade, USAID spent more than $100 million to support Bangladesh’s T.B. program.
35%
fewer people died from TB in Bangladesh from 2015 to 2023
82%
of TB cases in Bangladesh were detected in 2023
A Global Threat
“If it is not controlled within the borders, then it’s just going to spread across all over the world, so we are going to go back to a situation where no country will be immune to these kinds of challenges.”
-Asif Saleh, Director of BRAC Bangladesh
