At a tense meeting in Nigeria's capital Abuja, health workers pored over drug registers and testing records to gauge whether US aid cuts would unravel years of painstaking work against tuberculosis in one of Africa's hardest-hit countries.

For several days in May, they brainstormed ways to limit the fallout from a halt to US funding for the TB Local Network (TB LON), which delivers screening, diagnosis and treatment.

“To tackle the spread of TB, you must identify cases and that is in a coma because of the aid cuts,” said Ibrahim Umoru, co-ordinator of the African TB Coalition civil society network, who was at the Abuja meeting.

“This means more cases will be missed and disaster is looming.”

This desperate struggle to save endangered programmes is being replicated from the Philippines to South Africa as experts warn that US aid cuts risk reviving a deadly infectious disease that kills about one million people every year.

President Donald Trump's gutting of the US Agency for International Development (USAID) has put TB testing and tracing on hold in Pakistan and Nigeria, stalled vital research in South Africa and left TB survivors lacking support in India.

The World Health Organization (WHO) says “the drastic and abrupt cuts in global health funding” threaten to reverse the gains made by global efforts to fight the disease — namely 79-million lives saved since 2000 — with rising drug resistance and conflicts exacerbating the risks.

In Nigeria, TB LON is in the firing line.

The project was set up in 2020, during Trump's first term, and received $45m (R806m) worth of funding from USAID. The US development agency said at the time it was committed to a “TB-free Nigeria”.

Five years later and with the same president back in charge but now with a more radical “America first” agenda, USAID support for TB LON's community testing work was terminated in February, according to a TB LON official who did not want to be named.

TB kills 268 Nigerians every day and cases have historically been underreported, increasing the risk of transmission. If one case is missed, that person can transmit TB to 15 people over a year, according to the WHO.

The Thomson Reuters Foundation spoke to health workers who collect TB test samples for TB LON but had stopped doing so in January due to the US aid freeze.

Between 2020-2024, TB LON screened about 20-million people in southwestern states in Nigeria, and more than 100,000 patients were treated as a result.

“All that hard work is in jeopardy if we don't act quickly,” Umoru said, adding that non-profits working with TB LON had laid off more than 1,000 contract workers who used to do TB screening.

Nigeria's health ministry did not respond to request for comment on the effect of the USAID cuts on TB programmes.

In March, First Lady Oluremi Tinubu declared TB a national emergency and donated 1-billion naira (R11.3m) to efforts to eradicate the disease by 2030.

In South Africa, medical charity Médecins Sans Frontières (MSF) said TB and HIV programmes had been disrupted across the country, making patient tracking and testing more difficult, according to a statement sent to the Thomson Reuters Foundation.

South Africa had a TB incidence rate of 427 per 100,000 people in 2023, government data showed, down 57% from 2015. TB-related deaths in South Africa dropped 16% over that period, the data showed.

Minister of health Aaron Motsoaledi said in May that the government would launch an End TB campaign to screen and test 5-million people, and was also seeking new donor funding.

“Under no circumstances will we allow this massive work performed over a period of more than a decade-and-a-half to collapse and go up in smoke,” he said at the time, referring to efforts to tackle TB and HIV.

South Africa is also a hub for research into both TB and HIV and the health experts say funding cuts risk derailing this vital work.

The Treatment Action Group (TAG), a community-based research and policy think-tank, says about 39 clinical research sites and at least 20 TB trials and 24 HIV trials are at risk.

“Every major TB treatment and vaccine advance in the past two decades has relied on research carried out in South Africa,” said TAG TB project co-director Lindsay McKenna in a March statement.

People struggling with poor nutrition and those living with HIV — the latter affects 8-million people in South Africa — were also more at risk of contracting TB, as aid cuts made them more vulnerable by derailing nutrition programmes, community outreach and testing, said Cathy Hewison, head of MSF's TB working group.

“It's the No 1 killer of people with HIV,” she said.

In the Philippines, US cuts have disrupted TB testing in four USAID-funded projects, and affected the supply of drugs, Stop TB Partnership, a UN-funded agency said.

“The country has a nationwide problem with recurrent drug shortages, which is leading to a direct impact on efforts to eliminate TB,” said Ghazali Babiker, head of mission for MSF Philippines.

In Pakistan, which has 510,000 TB infections each year, MSF said US cuts had disrupted TB screening in communities and other services in the hard-hit southeastern province of Sindh.

“We are worried that the US funding cuts that have impacted the community-based services will have a disproportionate effect on children, leading to more children with TB and more avoidable deaths,” said Ei Hnin Hnin Phyu, medical co-ordinator for MSF in Pakistan.

“We cannot afford to let funding decisions cost children's lives.”

The Thomson Reuters Foundation is the charitable arm of Thomson Reuters.