Virginie Troare said she has witnessed great strides in her country's battle against a host of neglected tropical diseases, or NTDs. But funding cuts by the Trump Administration have brought an abrupt end to these and other important global health initiatives.
"We were very close to the elimination for two diseases," Troare said, in a video interview from Abidjan, a port city in Cote d'Ivoire.
Troare is a physician and public health coordinator who worked for the Durham-based nonprofit FHI 360, overseeing a mass drug administration, treatment, and surveillance effort in Cote d'Ivoire. That effort is part of the organization's Act to End NTDs program in West Africa, or Act-West, aimed at eliminating five NTDs in 11 countries in that region.
'Some children cannot go to school'
Due to the Trump Administration's cuts to foreign aid and scientific research, FHI had to pull the plug on Act-West, which had been in place since 2015 and provided treatment to millions of people.
Troare said the program had gotten Cote d'Ivoire to the brink of eliminating two NTDs, trachoma and lymphatic filariasis, also known as elephantiasis.
Trachoma, a bacterial disease, causes blindness. Lymphatic filariasis, caused by parasitic worms and transmitted by mosquitoes, can be debilitating and disfiguring. Troare also said the illnesses caused by these NTDs contribute to a cycle of poverty in the communities plagued by them
"Some children cannot go to school because they are in charge of the people who are blind and not able to move or also to work," she said.
With bipartisan support, Congress earmarked more than $114 million in fiscal years 2024 and 2025 to combat NTDs, some of which went to FHI 360. That funding was terminated as of April.
Trump's cuts have halted work on TB
The cuts have left developing countries like Cote d'Ivoire desperately looking for alternative funding sources, perhaps from philanthropic organizations like the Gates Foundation, according to Dr. Myron Cohen, a professor of microbiology and epidemiology at UNC Chapel-Hill.
"This situation has only arisen over the last three months, right?" Cohen said. "So, as we see scrambling for backfill, the question is: How successful will backfill be? And the other question will be: Will the United States change its position in the funds it makes available?"
Cohen also runs UNC's Institute for Global Health and Infectious Disease, which works with FHI on HIV treatment and prevention, a public health effort that has benefited greatly from U.S. government funding through the PEPFAR program started under President George W. Bush.
The loss of federal funding for combating NTDs means more than just losing government dollars, according to Juliana Soares Linn, FHI 360's senior director for infectious disease.
"With every $1 of U.S. funding we attracted $26 in donated drugs," Soares Linn said.
The Trump Administration has also pulled the plug on funding that fueled FHI's global fight against drug-resistant tuberculosis. Soares Linn said that spells the end, for now at least, of FHI's work in 24 countries aimed at preventing the spread of "the world's deadliest infectious disease."
According to Soares Linn, these 24 countries account for 70% of all drug-resistant tuberculosis patients in the world.
People will look for 'better places'
Ending treatment, tracking, and prevention programs abroad certainly poses risks at home, according to Dr. Cameron Wolfe, an infectious disease specialist at Duke University.
"Boy, if there was a lesson from Ebola or if there was a lesson from COVID that we should have learned is that most infections don't stay where they originate," Wolfe said.
Wolfe added that the impacts of terminating programs like FHI's TB initiative could be substantial but might not be seen for years.
"Tuberculosis is not something where we see overnight, snap outbreaks like we did with COVID, where we go from week to week with escalating numbers," Wolfe said. "But this will be something that's much more insidious."
The farther out the effects of unchecked TB, the harder it is to trace them back to bad policy decisions that let the disease spiral out of control in the first place, according to Wolfe.
Meanwhile, in Cote d'Ivoire, Dr. Virginie Troare said the sudden funding cuts to fighting NTDs mark a wasted, decade-long investment that showed real progress.
She also warned that increased illness comes with economic impacts that spur migration, from rural to urban areas, from impoverished countries to more affluent ones.
"Because people will look for better spaces, better places," she said.
