AMNA NAWAZ: Earlier this year, the# Trump administration's defunding## of USAID brought an abrupt halt to# hundreds of global health programs,## including those targeting tuberculosis.# The disease kills more people than## any other infectious agent, more# than a million worldwide in 2023.

In partnership with the Pulitzer Center, Fred de## Sam Lazaro reports from Bangladesh# on efforts to contain the fallout.

FRED DE SAM LAZARO: The USAID signs are# still all over this 250-bed hospital in## Bangladesh's capital city.

Inaugurated four# years ago with state-of-the-art-... specialized doctors, and wards for the more# dangerous MDR, multidrug-resistant cases,## this was considered a model facility in the# global effort to eradicate tuberculosis.

DR. AYESHA AKTHER, Deputy Director, 250-Bed T.B.# Hospital: It's more and more challenge for us.

FRED DE SAM LAZARO: After the closure of USAID,## hospital deputy director Dr. Ayesha# Akther says they have had to pull## in resources from other sectors of an# already stressed public health system.

DR. AYESHA AKTHER: T.B.

is curable disease, and# we can prevent it easily.

We can take drugs,## antibiotics.

USAID funded# our T.B.

drugs everywhere,## not only in this hospital,# but all over Bangladesh.

FRED DE SAM LAZARO: Over the past decade,## USAID spent more than $100 million to support# Bangladesh.. T.B.

deaths dropped nearly 35 percent,# from 73,000 in 2015 to 44,000 in 2023.

Bangladesh has made significant strides in# containing tuberculosis, but getting to the## finish line is a daunting task in the conditions# that are ideal for the infection to spread.## Many people suffer from malnutrition,# making them vulnerable to infections,## and there is a sheer lack of space in one of# the world's most densely populated countries.

ASIF SALEH, Executive Director, BRAC Bangladesh:# Early detection is extremely important.

FRED DE SAM LAZARO: Asif Saleh heads# the nongovernment organization BRAC,## which leads a consortium of 13 groups# still fighting T.B.

with remaining support## from the government and other international# donors, trying to build on earlier successes,## particularly in increased early# detection, which is critical ASIF SALEH: In 2001, we had# about 27 percent detection rate,## and that has gone up dramatically to 82 percent.

Bangladesh's success in T.B.

detection# has been because of that, on one hand,## there has been community mobilization and# community awareness, and, on the other hand,## a lot of the new innovations that has come in,# like mobile clinics, mobile detection facilities.

FRED DE SAM LAZARO: Mobile testing vans have been# deployed in slums and many garment factories,## the country's largest industry, densely crowded# environments that are ripe for infection.

Tuberculosis spreads through the air, attacks# the lungs, and can be fatal if left untreated.## Portable X-ray machines make the rounds of# harder-to-reach rural areas.

Radiographer## Sultana Amin (ph) screens 50 to 100 people# on any given day, X-raying lungs and using## artificial intelligence to assign scores# for each scan for the likelihood of T.B.

How many patients come# positive for T.B.

in a month?

SULTANA AMIN, Radiographer: July month, 120.

FRED DE SAM LAZARO: A hundred and twenty.

SULTANA AMIN: A hundred and twenty T.B.-suspected.

FRED DE SAM LAZARO: So-T.B.# suspected means its likely T.B.?

SULTANA AMIN: Right.

FRED DE SAM LAZARO: .. she determined a 90-ye.. MAN (through translator): I have coughing.# I have an uncomfortable feeling in my chest,## and I have fever also.

Now only Allah# knows actually what will happen.

FRED DE SAM LAZARO: For patients whose X-rays# find lesions that might be tuberculosis,## this is the start of a journey that will take them## next for more accurate testing# and, accordingly, for treatment.

The goal is to catch infections early and# start patients on a strict six-month course## of daily medication before the disease can# spread further.

And it's here's that many## fear progress will stall, or worse.

After# the Trump administration issued a stop-work## order in January, detection, treatment,# and research efforts like these were## scaled back or shut down.

Thousands# of health workers lost their jobs.

Many were employed by the USAID-funded# International Centre for Diarrhoeal## Disease Research.

Center officials declined# to participate in this report.

Like many## defunded USAID grantees, they cited fear# of jeopardizing potential future funding.

ASIF SALEH: Oftentimes, whether the foreign# grants come or not, it's very whimsical.

These## are political decisions.

So, for that, you need to# diversify.

You need to have your own independence.

FRED DE SAM LAZARO: That's the big lesson# from USAID's demise, says Asif Saleh of BRAC,## which is considered one model, now the world's# largest NGO, operating in 12 developing countries.## It relies on foreign aid, but also# various businesses that generate## revenue for its charitable work,# medical clinics for paying patients,## a commercial bank, retail store for# rural craftwork, even a university.

ASIF SALEH: Every country# needs a thriving social sector.## I think the Bangladeshi government as well# need to think that how some of their own## development budget can be used to -- for --# where implementation can be done by local NGOs.

DR. NAZMUL HUDA, Former Country Project Director,# Health Systems for Tuberculosis: My project## was about to prepare the government## to take the responsibility of managing# and financing the tuberculosis program.

FRED DE SAM LAZARO: Dr. Nazmul Huda led# a now-shuttered USAID-funded project,## ironically one intended to wean this country's# T.B.

program off foreign funding.

Economic## progress in recent years has moved Bangladesh from# a less developed to a lower-middle-income nation,## something that will automatically# mean a drop in foreign assistance.

DR. NAZMUL HUDA: It has stopped at a# very crucial time for the country.

There## is a process for technology transfer.

So,# whatever we achieved in the last few years,## we could not transfer that# result to the government.

FRED DE SAM LAZARO: He says the setback not only# stalls Bangladesh's path toward self-reliance,## but also threatens to reverse# progress made, as fewer cases## are detected and many that are diagnosed# do not complete their treatment regimen.

DR. NAZMUL HUDA: It requires long# treatment.

And if there is interruption,## more complexities might happen, for example, in# the form of multidrug resistance tuberculosis.

FRED DE SAM LAZARO: How many patients# will have interrupted therapy?

DR. NAZMUL HUDA: You know, the data, recent data,# there is also interruption.

Data is not coming.

FRED DE SAM LAZARO: We don't even know# because the data has been interrupted as well?

DR. NAZMUL HUDA: Yes.

FRED DE SAM LAZARO: Some estimates are that tens of thousands of patients have# seen their treatment stopped.

ASIF SALEH: So the full impact of it is not# visible as yet, because it's early days.

FRED DE SAM LAZARO: Saleh says it's# not just Bangladesh that should be## concerned about infections that could# emerge in the months and years ahead.

ASIF SALEH: If it is not controlled# within the borders, then it's just## going to spread across all over the# world, so we are going to go back to## a situation where no country will be# immune to these kinds of challenges.

FRED DE SAM LAZARO: Back in Washington,# the Trump administration and congressional## leaders have moved to restore some global health# programs, including tuberculosis.

But experts## say many projects already dismantled will be# difficult, if not impossible to quickly restore.

For the "PBS News Hour," this is Fred de Sam# Lazaro in the village of Raipur in Bangladesh.

AMNA NAWAZ: And Fred's reporting is a# partnership with the Under-Told Stories## Project at the University# of St. Thomas in Minnesota.