Potential paediatric TB incidence and deaths resulting from interruption in programmes supported by international health aid, 2025–34

Who

• Population: Infants, children, and young adolescents aged 0–14 years living in 130 low-income and middle-income countries (LMICs).

• This group represents 99.5% of global paediatric TB incidence.

• Subgroups in 63 countries were further stratified by HIV status (no HIV, on ART, or not on ART).
  

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What

• Focus of the Study: Estimate how cuts to US bilateral health aid and Global Fund contributions could affect paediatric tuberculosis (TB) incidence and mortality between 2025 and 2034.

• Key Findings:

  • If US bilateral funding stops (Scenario 2):
    +2.5 million paediatric TB cases and +340,000 TB deaths.

  • If the US also withdraws from the Global Fund (Scenario 3):
    +5.9 million cases and +0.9 million deaths.

  • If non-US donors also reduce contributions by 50% (Scenario 4):
    +8.9 million cases and +1.5 million deaths—134% increase in deaths vs continued funding.

• Interpretation: Cuts could reverse decades of gains, especially in Africa and South-East Asia.

• Implication: Rapid restoration of funding (even within one year) could reduce excess deaths by ≥90%.
  

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When

• Study projection period: 2025–2034.

• Historical model base: Paediatric cohorts simulated from 2010 to allow full 0–14-year population by 2025.
  

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Where

• Geographic scope:

  • 130 LMICs across all WHO regions (largest impacts in African Region and South-East Asia Region).

  • Minimal projected impact in Europe and the Americas.
    

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Why

• Rationale:

  • Children have higher susceptibility to TB infection and mortality than adults.

  • US government cuts in early 2025 affected USAID, PEPFAR, and potentially The Global Fund.

  • Many high-burden countries rely heavily on external TB/HIV funding; disruptions risk surging transmission, reduced treatment access, and increased deaths.
    

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How

• Study Design: Mathematical modelling study.

• Methods:

  • Transmission-dynamic TB and HIV models calibrated for 130 countries.

  • Used country-specific data on funding shares, TB/HIV epidemiology, malnutrition, and BCG vaccination.

  • Created four funding scenarios, from no cuts to severe cuts involving both US and non-US donors.

  • Modelled:

    • Changes in force of infection (TB transmission risk),

    • Declines in treatment coverage (TB treatment & ART),

    • Resulting TB incidence and mortality among children.

  • Incorporated parameter uncertainty using 1000 Monte Carlo simulations.

• Validation: Compared model outputs to WHO and Global Burden of Disease estimates for recent years.
  

Source: Menzies, N.A., Brown, T.S., Imai-Eaton, J.W., Dodd, P.J., Cohen, T. and Martinez, L., 2025. Potential paediatric tuberculosis incidence and deaths resulting from interruption in programmes supported by international health aid, 2025–34: a mathematical modelling study. The Lancet Child & Adolescent Health, 9(11), pp.787-795.