LISTEN: It would take a lot more people getting sick from TB for the U.S. to reach the crisis other countries face. But federal budget cuts could lead to a spike in cases, and cases have already gone up. GPB's Sofi Gratas has the story.
Tuberculosis sounds like a relic of the past. Emory University professor and epidemiologist Kenneth Castro says he hears that a lot.
“Whenever I say to anyone that I work on TB, I usually get, 'Do we still have that disease in our country?'”
Castro was the director of TB elimination at the Centers for Disease Control and Prevention in the 1990s and 2000s, and has also worked on HIV and AIDS. He says the millions of dollars spent by the U.S. on TB every year has paid off — worldwide, the number of new tuberculosis cases reached a record low by 2020.
Then came the COVID-19 pandemic. A majority of resources were refocused from other infectious disease work, including tuberculosis.
“Four years later, we should have been going back to the downward trend that we had seen earlier, and we're not seeing that,” Castro said.
Instead, infection trends have gone up.
There were 254 tuberculosis cases in Georgia last year, up 3% from 2023, according to a statewide surveillance report from the Georgia Department of Public Health. Globally, the rate of tuberculosis infections per 100,000 people went up around 4% from 2020 to 2023.
Emergency room visits and deaths from TB in Georgia have also gone up a bit, according to data collected by the Georgia Department of Public Health.
Tuberculosis, also known as TB, is the deadliest infectious disease in the world, although it was bumped below COVID-19 for three years. Over a million people died from tuberculosis in 2023, and many more fell ill.
And yet, in the United States, most people don’t think about tuberculosis. That’s because of major investments in prevention and treatment.
It would take a lot more people getting sick from TB for the U.S. to reach the crisis other countries face. But Castro says federal budget cuts are laying the groundwork for a TB resurgence.
“Tuberculosis has been a very classic disease that responds to the money and the people that you put in to work to bring the rates down,” he said. “The moment you stop doing that, then it comes right back and bites you. We are at a very dangerous inflection point with tuberculosis.”
This year, the Trump administration left in limbo the millions of dollars approved by Congress for TB prevention and treatment done by U.S. agencies overseas. The dismantling of the U.S. Agency for International Development (USAID) operations have left high-burden countries struggling to even diagnose tuberculosis, a crucial first step to get people care.
Federal officials recently released their plan for how the U.S. will participate in global health efforts moving forward.
Then there are proposed cuts to the CDC, that does TB prevention and treatment work here.
Castro says most at risk of these cuts to funding are foreign-born people, who account for most of TB cases in the U.S. Incarcerated people, those in jails or detention centers, are also vulnerable, because TB can spread quickly.
“Those are going to be your canaries in the coal mines, and then after that, you'll see it elsewhere,” Castro said.
Anyone can get TB. Over half of tuberculosis cases in the U.S. are among people born elsewhere, often in countries where it’s more common.
DeKalb County has the highest incidence rate of tuberculosis in the state. Along with Gwinnett and Cobb counties, the three reported the highest number of TB cases in 2024.
Supervising physician in the Department of Infectious Diseases and Refugee Health, Dr. Alawode Oladele said he’s seeing more patients at the DeKalb County tuberculosis clinic. Most come from the refugee health clinic next door.
“But we also have immigrants,” he said during a tour of the clinic in August. “And you also have undocumented individuals.”
Both clinics at the Richardson Health Center in Decatur are run by the DeKalb County Department of Public Health. Providers here treat adults and kids, and can complete the mandatory health screenings people need to get a Permanent Resident Card.
From May to July, case managers and providers at the DeKalb TB clinic treated and managed about 55 active TB cases a month. A vital part of that job is contact tracing.
“When we find who you've been around, we test them. If they're infected, we treat them,” he said.
Patients can be tested and treated at the clinic.
Oladele said the new surge in immigration enforcement, which is making people scared to go to church, work or school, has made contact tracing more challenging. He has seen patients fall off the grid, seemingly too scared to get health care.
“And so the question becomes, how do we do more with less?” he said. “And how do you get creative, especially with the increasing complexity of the dynamics that we are faced with?”
For instance, a key aspect of those dynamics is making sure people complete their course of care. Even with modern medicine, treatment for active TB can still take months. For it to be effective, providers can require that people come in person to take their medicine, Oladele said.
And a lot of patients are sick in other ways, since TB suppresses their immune systems, and the comprehensive screenings that include TB can reveal other chronic health issues.
Oladele says prevention is less expensive than treatment.
“It's one of those scenarios where pay now or pay later,” Oladele said.
And then, of course, there is the human cost, which many public health experts fear if the U.S. chooses the latter.
The tuberculosis clinic in DeKalb County was recently relocated and upgraded with a negative pressure system, which contains air that could be contaminated with droplets of infectious pathogens.
There’s also a new X-ray machine, so that staff can run chest X-rays, and a machine called a sputum booth. Inside the enclosed booth, tuberculosis patients can cough into a device that collects samples staff can send out for testing.
All this equipment costs money. Future investments into this clinic could be on the line because of cuts to federal health agencies that support local public health departments.
The CDC could lose up to $220 million set aside for HIV/AIDS, viral hepatitis, STD and TB prevention work if Congress passes the 2026 budget as is, according to an analysis from the CDC Data Project. The DeKalb County tuberculosis clinic has already lost staff as a result of a cancellation of COVID-era grants that supported a variety of public health work.
The clinic still has volunteer providers come in from the CDC — they’ve helped address a backlog of refugee patients that went back to the start of the year, and was only recently caught up on.
Back inside a lab where staff test blood samples for TB, Dr. Alawode Oladele points to a big machine.
“Because of the cuts, we had to settle for this one. But this is not the one that we wanted,” he said.
This machine costs over $50,000. A newer, more automated version would cut out a day’s work of manual testing that lab techs have to do, Oladele said. They’re not counting on getting that new machine any time soon.
