Research Cuts Threaten Global Fight Against Tuberculosis

When most people think of tuberculosis (TB), they imagine a rare or outdated disease of the past, nearly eradicated by modern medicine. Yet, as of March 2025, the US is experiencing one of its worst-ever outbreaks. 147 individuals have been diagnosed with tuberculosis in Kansas City and two neighboring counties in Kansas. Alarmingly, 67 of them are exhibiting signs of active illness.

Lungs affected by TB. Source

At the same time, the past few months have seen public health funding slashed across the US, prompting the halting of research and shutdown of essential infectious disease databases managed by the CDC. In addition to the widely covered funding cuts of universities such as Columbia and Harvard, over 94 public universities and flagship state schools have lost grants necessary to continue research projects. With all this in mind, the Kansas outbreak is an ominous sign of the trouble that awaits if research is cut. 

The History of Tuberculosis Outbreaks

To understand why this outbreak is so concerning, it is important to explore the history of tuberculosis. TB as we know it has its origins in ancient times. The first written document on TB was traced back over 3,000 years to India. However, its true origins go back even further.

It is estimated that TB was initially in hominids in Africa around three million years ago.  Throughout history, TB has gone by many different names and plagued countries around the globe. The Greeks called it “Phthisis” or “to decay." In ancient Latin, it was termed “Tabes” or “wasting away." Strains of TB were found in human remains dating back 9,000 years in a city long submerged by the Mediterranean. In 1834, physician Johann Lukas Schönlein termed the modern term of tuberculosis.

As a rising health epidemic and a fearsome disease with a high mortality rate amongst poor living and working conditions in the 18th and 19th centuries, large proportions of people died, earning TB the nickname of the“white plague.” 

Eventually, the 1940s invention of streptomycin, an antibiotic, led to a decline in TB casualties, followed quickly by isoniazid, pyrazinamide, and rifampicin. Yet, the rise of drug-resistant TB has sparked ongoing research on more effective and foolproof methods of treating TB. As such, TB remains one of the largest health issues of the modern-day despite its long history.

Why Research Matters

Tuberculosis often resides in the body as a latent infection, simply waiting for the immune system to become vulnerable, whether by illness, HIV/AIDs, or exhaustion/malnutrition. This phase typically lasts for two years before the infection ensues and progresses into active infection. However, the bacterium can lie dormant for a lifetime. This latency means that roughly a quarter of the world’s population has M. tuberculosis residing in their bodies.

This issue is the target of many research projects, which have yielded much progress in recent decades. A notable example is the Quantiferon TB drug test, which tests for TB infection in twelve hours. Considering funding cuts in research, potential innovations for diagnosis will suffer, affecting not only the diagnosis of tuberculosis but many more diseases. One such case is that of hypoxic-ischemic encephalopathy—a type of brain injury that occurs in the brain of an infant due to a lack of oxygen and blood supply, which is difficult to diagnose quickly and is an active area of research. 

Aside from diagnosis, TB research is also vital for treatment. A key feature of the bacterium that causes TB, Mycobacterium tuberculosis, is its complex, thick cell wall. The buildup of the cell wall requires time; thus, binary fission, or division of the bacterium, takes much longer relative to other species. However, this also means that they are much more resistant to antibiotics and drugs, making it incredibly arduous to treat—standard practice involves six months of about five to seven pills a day, utilizing four drugs with known side effects. 

M. tuberculosis. Source

The strenuous and long process often discourages patients from taking a consistent stream of drugs, which can result in incomplete treatment and an increase in the likelihood of tuberculosis strains developing stronger and more widely encompassing resistance to antibiotics. This has already led to the development of extensively drug-resistant TB (XDR TB), rendering typical antibacterial treatment plans ineffective. 

Current researchers are working on finding new drugs and treatments to deal with highly resistant strains—a very important area of research that is also being slowed down due to recent funding cuts. In a recent outreach effort by the Johns Hopkins School of Public Health, Dr. David Dowdy, a tuberculosis researcher and public health expert, emphasized the importance of research in combating the deadly reach of TB. Research operations need to occur to address the growing issue of antibiotic-resistant strains of TB, which would pose a massive global public health threat in a world where TB cannot be treated. 

Neglect Kills

At first, tuberculosis and Ebola may seem worlds apart. One is a slow-burn, ancient infection, and the other is a fast-moving and headline-grabbing killer virus. However, both diseases tell a similar story of how neglect can be lethal.

In 2014, West Africa was hit by the largest Ebola outbreak in history, killing over 10,000 people and sparking global panic. Paul Farmer, the former chair of the Department of Global Health and Social Medicine of Harvard Medical School, emphasizes in Fever, Feuds, and Diamonds that Ebola is not difficult to treat. Mid-20th-century technology was enough to ensure survival in most patients. In the US, almost no local deaths occurred despite several cases having made it onshore. So, what was the cause of such a disastrous epidemic? The neglect of public health vulnerable countries and a lack of funding. 

A similar situation is now unfolding with TB, albeit on a far larger scale. Compared to Ebola in 2014, the consequences of letting TB grow unchecked may be even grimmer. TB is already the world’s deadliest infectious disease, causing almost 1.5 million deaths annually worldwide, not only due to the difficulty of treatment but primarily because of gaps in public health. According to Dr. Tedros Adhanom Ghebreyesus of the World Health Organization, “the fact that TB still kills and sickens so many people is an outrage, when we have the tools to prevent it, detect it and treat it.” The implications are clear—TB deaths are preventable, often resulting from funding and bureaucratic dysfunction. 

Low and middle-income countries (LMICs) bear the harshest burden of TB while also facing funding shortages. Of the current $22 billion annual funding target, only $5.7 billion has actually materialized. Additionally, only $1 billion of the $5 billion global target for TB research is currently funded, slowing the vaccine/treatment development rate. 

TB's health burden is concentrated in LMICs. Source

To combat the devastating effects of TB, multiple issues also seen with Ebola must be addressed: massive funding deficits, the harsh financial burden on TB-affected individuals, and poverty in the form of malnutrition. Coordinated bureaucratic action is necessary for improved outcomes. 

Without sufficient attention and funding, the death toll of TB may only increase over time as its evolution eventually outpaces advancements in technology. Scientific research has the potential to eliminate TB and lock it away in history books; however, the march has been impeded by cuts in funding and finances.

Although Kansas and the wider US remain mostly safe and have very little risk of an escalation in the outbreak, it is essential for global collaboration in fighting against the disease. TB can affect anyone, and a lack of attention can result in a drastic surge in TB cases and more drug-resistant strains. TB outbreaks, especially those on scale with that of Kansas, are an indicator of public health error. According to the Johns Hopkins School of Public Health, the issue with the outbreak was that it was not contained when the initial cases were discovered, but rather it was only until contact tracing was performed to identify a more widespread and numerous number of cases that the significance of the threat was recognized—a very tardy response which likely would’ve resulted in a more explosive epidemic given a more infectious strain of TB was spread. 

Ultimately, public health efforts and systems must be able to detect such outbreaks to prevent further outbreaks; meanwhile, research must continue, and action must be taken to fund the care and treatment of TB worldwide. It is not a matter of if but when—how many more will die from TB if funding targets are not reached?