USAID funding freeze disrupts global tuberculosis control efforts | Hacker News Reader

USAID funding freeze disrupts global tuberculosis control efforts

cidrap.umn.edu

91 pointsRed_Tarsius119 comments

For context: Tuberculosis treatment requires strict, months-long medication adherence. Even a brief disruption means patients may not complete their courses, allowing drug-resistant TB to emerge. These strains are far harder and more expensive to treat, spreading across borders and undoing decades of progress.

The brief (?) interruption to PEPFAR (Bush's HIV/AIDS aid program) has major impacts too. One of the plainest ones is that infants with HIV can, if anti-retrovirals are paused, die more or less right away.

- "In children who acquired H.I.V. at birth, the infection can progress very quickly to illness, with death occurring as early as eight to 12 weeks after birth — shorter than the 90-day pause on foreign aid."

https://www.nytimes.com/2025/02/05/health/trump-usaid-pepfar... ("Foreign Aid Freeze Leaves Millions Without H.I.V. Treatment")

This article by Scott Alexander (Money Saved By Canceling Programs Does Not Immediately Flow To The Best Possible Alternative) talks a fair bit about how effective this program is: https://www.astralcodexten.com/p/money-saved-by-canceling-pr...

It also makes the point that, under some reasonable assumptions, you could assume that any domestic program you could theoretically redirect the funding to would likely be ~100x less effective than PEPFAR, which is an abnormally effective aid program.

Reasonable assumptions would not assume you to assuming the US' top medical bureaucrat being a conspiracy theorist who denies the existence of HIV (and asserts AIDS is environmental and that anti-retroviral drugs are dangerous toxins).

https://en.wikipedia.org/wiki/Robert_F._Kennedy_Jr.#HIV/AIDS... ("Robert F. Kennedy Jr.#HIV/AIDS denialism")

https://en.wikipedia.org/wiki/The_Real_Anthony_Fauci

https://www.motherjones.com/politics/2024/11/rfk-aids-hiv-hh...

https://www.nytimes.com/2025/02/13/opinion/kennedys-views-on...

Yes, given the new health secretary, it's likely to be much more than 100x worse, if the money is redirected to any sort of positive end at all.

Why is the US contribution so critical to anything outside the US when there so many other rich countries that could pick up the slack? Does this mean that besides US no one else cares? I can't believe that's true.

It's been interesting seeing Western European NGO's struggle to find funding without USAID as well. I don't like Trump, I don't like much of what he's doing, but this at least has been a bit of a wake-up call for me. While the US is rich and should provide what it can, the degree to which the rest of the world (and the rest of the West) has clearly just shrugged and let us carry them is... interesting.

Wait until you hear about NATO (and I say this as a Brit).

I see that as different, it is first and foremost an American project, born from a conflict between superpowers. I don't think the same is true about global charity.

It's not charity, it's a need that will be fulfilled by someone anyway. China is already offering their funds for everyone affected by USAID shutdown.

It was a conflict between Communism/Socialism and Capitalism on the world stage and the proxy wars were fought over those ideologies. Now that communism is mostly recognized as a dead end, I wonder if the world order will slowly re-align. Socialism is taking off with Gen Z(see Reddit) so maybe the next administration will be socialist with AOC, Warren and Bernie.

Next admin a socialist? Hold my beer sez Oligarchs.

It was born from a conflict between the West and Warsaw Pact.

Western Europe had even more skin in the game than the US.

Estonia and Poland both spend more as % of GDP than the US.

The US also spends less than the amount designated by the UN on foreign aid.

America also spent less than Germany in % of GDP in the World Health Organization funding.

As a percentage of GDP alright. Now how about absolute numbers, because pretending that doesn't matter isn't particularly helpful, and feels like playing with numbers rather than dealing with reality.

Well it shows who is pulling their own weight and the US isn't on a lot of subjects.

Although I am not a Christian, the parable of the poor widows offering always resonated with me.

"Jesus sat down opposite the place where the offerings were put and watched the crowd putting their money into the temple treasury. Many rich people threw in large amounts. But a poor widow came and put in two very small copper coins, worth only a few cents.

Calling his disciples to him, Jesus said, “Truly I tell you, this poor widow has put more into the treasury than all the others. They all gave out of their wealth; but she, out of her poverty, put in everything—all she had to live on.”

I think the WHO proved during COVID it is an ineffective, corrupt organisation. I hope more countries leave it.

while it makes perfect sense in a democracy to argue about funding levels or even if the program should exist and make your voice hear through your representatives.

Turning it off without any planning like its the back up server for a social media company is irresponsible and will cause people to die.

Of course, what we're seeing is careless and foolish, I'm not endorsing any of it. I am however somewhat enlightened by the consequences of that foolish endeavor.

Because the US is the de-facto leader of the Free World, the wealthiest country in the Western hemisphere and the winner of the Cold War. Heavy Lies the Crown. Especially when it's about fighting the deadliest infectious disease known to man.

True point, but I question how many people remember the Cold War. It’s arguably no longer relevant.

> the deadliest infectious disease known to man

where did you get that?

it seems like Ebola Zaire, Marburg, and sundry other diseases are saying "hold my beer".

TB is vastly underestimated here in the US where we have largely eliminated it, but it is indeed the deadliest infectious disease known to man. It killed 1.25 million people in 2023.

https://www.pih.org/article/tb-deadliest-infectious-disease-...

https://www.who.int/news/item/29-10-2024-tuberculosis-resurg...

This is nitpicking, but I guess which disease bears the title depends on how you define it. I remember seeing some estimate that malaria has killed ~40% of all humans that have ever lived.

Rabies has a nearly 100% kill rate. It's just rare that someone does get infected.

good data; thanks.

i realize "deadliest" could be evaluated both as "least curable" and "most killed", which are definitely different things.

Country yes but govt no.

Just the interest on the US debt is almost a trillion dollars a year now which is 3% of GDP and the debt is ~35 trillion. Deficit spending is higher than federal taxes on the paycheck, which means you're basically paying double of what your paycheck shows.

Meanwhile Norway's sovereign wealth fund has $1.75 trillion dollars.

Norway and Singapore are petro-states. Alaska and Texas (to a much smaller degree) have wealth funds off of resources. Whether they're fiscally responsible with that is up to the state.

Labelling Singapore as a petro-state is a stretch. Collecting taxes from refining is a very different thing than reaping the benefits of royalties from oil production.

The goodwill the US gets from soft and hard power projection is precisely what allows us to have the world reserve currency. This allows the government to print large amounts of new money with much smaller consequences. The US is basically the center of an economic empire, which the neofascists are intent on destroying - either out of mistaken adherence to the political tropes of analyzing a country like a household (eg the harping on "government debt"), or it's likely they are just overtly selling us out to the rising empire of China.

The USA is the wealthiest and most powerful nation in the world. Why would ceding this soft power to other countries benefit the USA? These cuts will be meaningless in cutting the deficit while harming the USA's global influence.

Because we get a lot of travelers through our country who may otherwise spread TB here if we made no effort to control it outside of the country, and it would be a huge public health problem for us despite the fact that treatment for it is readily available in our country.

If we're going to do this we should probably institute some kind of health screening during the immigration process at entry points.

It's the same rationale we used for the Iraq War - fight the terrorists there so we don't have to fight them here. People understand that intuitively. But when it's framed as helping people, there's a big question mark as to the utility.

> Because we get a lot of travelers through our country who may otherwise spread TB here if we made no effort to control it outside of the country

A dozen of vaccines and a proof (from the doctors certified by the US officials) that you have no contagious diseases (including TB) is a prerequisite to get any US visa. The only way to bring TB to the US, I presume, is to jump over the fence at the border.

Or to contract it on your way to the US through one of the many stops you will make along the way.

Many other rich countries give more on a per capita basis.[1] Indeed the U.S. has been kinda cheap, on a percent of gross national income basis.[2] It could be countered, of course, that the U.S. has paid substantially more for defense, and for the defense of many donor countries.

[1] https://ourworldindata.org/grapher/foreign-aid-given-per-cap...

[2] https://en.wikipedia.org/wiki/List_of_development_aid_sovere...

This data only includes government spending, which leaves out private and NGO spending. Many Americans prefer that their charity funds be spent outside of the control of the government.

Because we already volunteered to do this specific thing, so it's incredibly disruptive for us to back out at (or well after) the last minute. Other countries do other things, and it would be similarly disruptive if they pulled or froze funding and operational support with 0 notice.

It'd be like if Microsoft donated free copies of Windows to a hospital and then one day was like "Actually we've been donating too much stuff, your licenses are invalid as of today, your computers will now not work." It would be similarly strange to ask why Microsoft's contribution is so critical to anything outside their own company, when it's because they made it that way on purpose, partially for PR purposes, partially from genuine altruism, and partially to tie Microsoft's well-being to the hospital's.

It's always a shame when people get used to free things because they lose the ability to provide for themselves.

I say we stop so other countries can spin up their own programs and pay for it. I have zero interest in using TAX dollars to fund medical programs outside the US.

For people down-voting, it's no different than being told "Don't feed the bears" and Yellowstone Park. It's worse off for the animals because they become dependent.

Link to Eric Olszewski's blog on the topic: https://medium.com/@eolszewski/dont-feed-the-humans-they-wil...

Stopping HIV & drug-resistant TB outside of the US borders directly benefits Americans.

That is indirect at best.

I assume, perhaps incorrectly, that you realize that diseases don't honor national borders?

It's always a shame when people make major commitments and then flake on them at the last minute.

Leadership. You are not a leader if you ask why should we when they can.

I don’t understand what bubble Elon Musk is living in where the ruthless slashing of USAID spending won’t have huge negative repercussions for the US.

I think the rest of the world will withdraw from trusting the US after this and other actions. A lot of trust in the world leadership positions the US takes are being torched by these vandals right now and while I hope for an amazing US comeback in 4 years it looks a lot more like China will step in as a stable partner for a lot of countries after an almost complete betrayal of western values.

Who benefits from the world no longer trusting the USA?

putin.

And China. Don’t forget China.

What trust? Other governments trust the USA as much as people trust Facebook to deliver them non brain rot content or McDonalds to serve them a healthy nutritious meal.

Countries have a mutually beneficial relationship with the US out of need(world's biggest economy and consumer market), out of fear(world's biggest military), and out o necessity (Russia and China being worse alternatives) not out of trust. Basically, Realpolitik. Trump didn't move the needle on that front at all despite the optics in the eyes of the plebs.

If by some hypothetical scenario, tomorrow the US would disappear from the world and its status as the leading world super-power be replaced by a country like Russia or China, then the other countries on the planet would kiss their ring, just as how in a herd/pack all the males succumb to the alpha male. It's nothing to do with trust, it's all to do with power and influence.

Talk to any Canadian and tell me that trust in the US as an ally hasn't been irreparably damaged.

Global geopolitics are complicated. It's true on some level that no one trusts anyone else, but relative levels of trust still matter. There aren't many superpowers out there, if the US is seen as unreliable, China and the EU can step in and replace US influence. This has been happening in Africa for a couple decades or so, with China becoming increasingly influential.

These actions will drive US allies into partnerships with our rivals, which will make the US weaker. Everyone on both sides of the aisle understood this from 1946-2016.

>Talk to any Canadian and tell me that trust in the US as an ally hasn't been irreparably damaged.

Firstly, I have no sympathy here. If you trust any foreign government that's not accountable to you to begin with, that's on you.

The upshot is that this serves as a good lesson and wake-up call for Canadians and for us in EU as well that we need to start pulling our weight in the world and looking out for our own interests instead of letting ourselves at the mercy of foreign powers.

People need to learn lessons the hard way on their own skin if they're too stupid to learn from past history, like how Czechoslovakia was fucked over by its allies in WW2 and gave to Hitler on a platter. Don't rely on supposed allies to fight your battles, look out for yourself. That's why I'm a big fan of the Swiss's neutrality system and France's post-WW2 nuclear deterrent program. A strong military is better than stronger allies that can change their mind.

And secondly, nothing is ever irreparably damaged. 80 years ago Japan and US were at war and for over 50 years they've been strong allies. Canada also invaded the US in 1814 and burned down the White House and yet they've been each other closest allies after that. Similarly, in 20 years Russia could be the west's best friend. So relationships between countries change all the time based on how the wind blows. Nothing ever lasts forever, only gullible fools with no understanding of history try to hang onto such idealistic beliefs.

The Swiss trust their neighbors in most things. They have extensive trading relationships with their neighbors, many treaties and relatively open borders. There military is structured under the assumption their neighbors won't invade.

Sure, but that was only a personal opinion tangent and not the core of my argument which still stands. That's like the safari guide telling you to stay in the vehicle because the Bengali tigers outside will maul you and you go "Ackshually, those are Siberian Tigers, not Bengali." While you're technically correct, it doesn't change the point.

Trust isn't a binary. If everybody trusted all of their neighbors as much as South Korea trusts North Korea then the world economy would collapse and we'd likely have billions of deaths.

It isn't binary but clever countries with a strong defense policy like the US and Switzerland also have insurance polices and backup plans for the case their allies turn against them since it's better to be a warrior in a garden than a gardener in a war. Guess in which case Europe is a the moment?

So what should Canada do? Spend 100% of their GDP preparing for an American invasion that they'd probably still lose?

got 2 words nuclear proliferation.

Australia just gave America a down payment of $800 million to build submarines.

Submarines the US is incapable of producing.

I dunno, one thing is for sure the US has some amazing submarine technology. What makes you say they can't be made?

Because the US submarine production calender is completely full and unable to scale up.

https://www.abc.net.au/news/2024-04-18/aukus-congress-subcom...

Australia will also not have full control of their own submarines:

https://www.theguardian.com/world/article/2024/may/07/austra...

Impossible to scale up I’m not convinced by, military projects delayed? 100% certainty I’d say.

US single handedly boosting European investment in European defense companies

crypto why do you think their doing this.

He's not interested in helping anyone but himself. IDK how stopping this stuff helps him exactly, but his actions make a lot more sense if you look at them through that lens. Negative repercussions for the US aren't necessarily negative for him, or they may be outweighed by something positive for him.

1) Elon isn't a fraction as bright as he thinks he is 2) Elon suffers from extreme Dunning-Kruger 3) His boss only cares about adulation & retribution 4) Their enablers are willing to sit on the sideline as the side effects are destroying their political opposition

Oligarchs don't care about other people or even the country.

They're so rich that they're isolated from any negative fallout (and they'll try to benefit from them too).

$400m state department Cyber Truck order says cost cutting is going superbly. Definitely no conflicts of interest here!

Seems to be consistent with Musk's MO. Cut first then (maybe) measure.

Cut twice, measure once?

Or just cut, call it good and move on.

Anyone that actually does measure later and tells him his cut was off is just part of the radical left, fake media and woke mob.

Cut quickly, prevent anyone from measuring -- before or after.

There's always money to be made from things failing or instability unfortunately. There's a reason they want to cause the economy to crash.

crypto. and network states. curtis yarvin.

Haha, crypto is great while there is money for pure speculation. Only Gold will hold it's value.

> I think the rest of the world will withdraw from trusting the US after this and other actions

The USA currently has a problem where a large portion of the US population no longer trusts the USA. That population shifts depending on whichever group is in charge of the federal government

Maybe this is not the way to repair that trust, I don't know. But I think for a lot of people, "Stop sending tons of our tax money to other countries" is a step to repair some of that trust with the population

The next step would have to be "start re-investing that money back into America" but we'll see if that actually happens

> But I think for a lot of people, "Stop sending tons of our tax money to other countries" is a step to repair some of that trust with the population

Yes, bingo. On both sides, people have become extremely sick of seeing "billions of dollars sent to X" in the news knowing that we, American citizens, will never receive anything like that amount of aid

Except that foreign aid is a tiny part of the US budget.

> we, American citizens, will never receive anything like that amount of aid

21% of the federal budget goes to Social Security (aid)

16% goes to medicare (aid)

10% goes to other health spending (probably at least partially aid -- edit: further research shows that of this, around 90% is some kind of aid)

7% goes to income security (aid)

4% goes to veteran services (aid)

3% goes to education, training, employment, and social services (aid)

1.5% goes to natural resources and environment (aid)

1% goes to community and regional development (aid)

1% goes to foreign aid

We are already spending a huge portion of our budget on various kinds of domestic aid, the majority of it in fact.

Edit to add, data from 2024, source here: https://www.usaspending.gov/explorer/budget_function

It's not the spending itself that's the problem. It's the the waste in each program. The middle men and NGO's that are hovering up free money from the tax payers that is the problem.

All these programs are treated like cookie jars and everyone gets a nibble.

No, it's the spending. I'm sick of looking at our "allies" having the social programs our "leaders" tell us we can't have while we subsidize their countries

Do you have any proof of this assertion? Most government agencies outside of the military have passed financial audits. People who have worked as auditors in the public and private sectors generally report more waste and fraud in the private sector by far.

1% is small in terms of the national budget but massive in terms of the average American

If the argument is "it's not that much money and it wouldn't help Americans much" then can't people also turn that on it's head? "It's not that much money, so it's not actually doing much real good overseas either"

If you are a young person today, your chance of getting Social Security is low because it will be scrapped by the time we reach that age. Medicare also is for seniors, Medicaid is for the impoverished. Veteran services are for veterans.

Most of what you describe is not for the average American citizen. But it is the average American citizen who has more credit card debt than ever before, whose wages don't keep pace with inflation, whose ability to buy a home for his family drifts further and further away every year.

Why can't we take that 1% that we send to foreign "allies" (who themselves have better social services and spend more on their populations than we do) and give it to the average American who works hard and makes this country what it is?

I mean, they basically are. They are slashing foreign aid, slashing Medicaid $800B, slashing SNAP programs 20%, and they're giving the money back to the American people in the form of tax breaks.

But not average Americans, no, don't be silly. It's going back to the 1% and corporations, the "real Americans" who built this country.

Average Americans get nothing. Actually, it's worse than that we get less than nothing; we are losing social welfare programs that keep up alive and healthy. Instead, the plan as far as I can tell is to just let people who depend on those programs die.

slashing Medicaid $800B

Note that the full Medicaid budget is $880B. So "slashing" it by 90% is just code for abolishing it entirely.

[to] the "real Americans" who built this country

And to the African immigrant that purchased it.

Your first claim was "we, American citizens, will never receive anything like that" and after that's been thoroughly debunked, you're conveniently moving the goalposts. Now it's suddenly all about some ill-defined "average citizen", and I'm sure your next claim is that veterans, people on welfare, and people with medical problems are all somehow not average.

Do better.

People with medical problems don't receive Medicare and Medicaid, the impoverished and senior citizens do.

Say what you will, but if the only American citizens who receive aid from their country are senior citizens, veterans, and the impoverished, then the rest are gonna be mad when they see billions of their hard earned taxes flying out to other countries instead of spent on them. That just is what it is. Especially as the economic prospects for an average working man in the US gets worse and worse every year

> The USA currently has a problem where a large portion of the US population no longer trusts the USA.

Feature, not a bug.

Foreign aid is (was) 1% of the US budget

And is highly abused, cut it.

And that's 1% (of the whole budget) too much.

When the diseases of the third world metastasise and cause a far worse pandemic than the one that just happened you will think the 1% is cheap.

Repercussions? That's for people who expect to be held accountable for their actions.

- "torched by these vandals"

That's such an apt phrase. It goes back to the time Rome was a great and prosperous civilization, and there was a barbarian tribe–"Vandals" is a proper name–who were incompatible with kind of high civilization, who rode into a weakened Rome and looted various treasures they liked. And torched the rest.

It's an apt language to talk about people who seemingly don't comprehend the value of the institutions America built up over a century, the deep soft power behind them; who see only fistfuls of cash that can be grabbed.

https://en.wikipedia.org/wiki/Sack_of_Rome_(455)

I find it particularly ironic that adherents to Ayn Rand elected a bunch of political looters who don't apparently care about the rule of law.

Elon lives in a far-right conspiracy bubble.

USAID is a bogeyman for that "community"

I think the goal is to destroy US soft power on the way to undermining the rule of law and destroying what passes for a rules-based international order. Once that's done they can really get busy stamping out democracy.

I don't think USAID is the core of US soft power, Hollywood is. Our tech industry is. Our food and our language and the way our culture seeps into everything is.

If USAID and aid to places in much of Africa was our soft power, I'd expect to see a lot less pivoting to China and Russia in those places. On that note, perhaps the countries that decided to invite Wagner or enter the Chinese BRI can ask their new friends for some TB meds?

maybe they can house some nuke bases there too.

USAID is the vehicle to paying news/entertainment industry.

We're on track for TB to become a problem again, even in the west. Global eradication efforts were put on massive pause during covid. Some governments are downplaying the issue to appear on track to meet arbitrary eradication deadlines. It's been cropping up around North America. Just as a reminder, there isn't an effective vaccine (BCG is not what we would consider a modern vaccine). Current treatment regimen is 6 months daily antibiotics. Throw in any complications (paradoxical reactions, resistance) and get ready for that to become much longer.

I had watched a loved one suffer from this disease. The pills were huge. Waiting too long to start treatment causes a lot of complications. These aren't well understood, given the massive TB funding deficits. Even when the disease is cleared from your lungs, it leaves plenty of things behind.

If you or somebody you know is coughing persistently for weeks, losing weight, has evening fevers, just get the quantiferon gold test. Be persistent with your doctor, just mention past TB exposure. Your insurance should cover it. Don't wait around months trying to look at every other avenue. It'll look very similar to aspergillosis on x-rays.

The TB that does exist out there in the world is increasingly multi-drug resistant, which means most antibiotics won't work on it. Once it starts spreading abroad and later in the US, a lot like Covid did, it's game over.

That USAID was Trump and Musk's first target after taking office is peculiar. They made no mention of it during the campaign and most people were unaware of it's existence until a couple weeks ago. The only group with any strong negative opinion of USAID is foreign adversaries.

My SO suggested that USAID was a target because during the elimination of Apartheid in South Africa it was a critical component of empowering the black population there. Elon Musk's family apparently lost a lot of their political power as a result of that, and this might be payback.

It's similar to why a lot of people thought George W. Bush rolled invading Iraq into his plan to take down Al-Qaeda despite Iraq not apparently harboring them.

I know farmers hate it with all those billions of $ in extra cash from selling food that was going to waste anyway. I'm sure the rural communities will hate it too when all that money isn't going to the love communities either.

They're already whining about it [1]. All that'll wind up happening is some sort of shell game and we'll still be subsidizing the midwest red voters.

[1]https://www.cjonline.com/story/news/politics/government/2025...

But this time only the red voters.

> The only group with any strong negative opinion of USAID is foreign adversaries.

What about American taxpayers of the "maga" persuasion?

USAID was a target of Project 2025, which Trump is following quite closely - yes, he absolutely lied about not knowing about this during the campaign.

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