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“We have to start winning wars again!” (Donald Trump, March 1st 2017)

Right now this rather grotesque hankering towards winning wars seems to add up to hiking U.S. military spending (probably safest not to call it ‘defence’ spending any more) by a mind-boggling $54 billion and to slashing pretty much the same amount from non-defence spending (including stopping all payments to UN programs and Climate Change). What this means is slashing the budget for the U.S. State Department by 28% (taking just over $11 billion out of its budget) - and by ‘State Department’ please potentially read 'USAID', the agency that supports global tuberculosis control because it comes under State Department governance. Oh yes, and winning wars also means cutting $650 million of support to the World Bank that also supports anti-tuberculosis programmes.

So this looks to be pretty bad news for tuberculosis control – in fact it could possibly be really bad news – although things don’t seem to be quite so bad for HIV/AIDS because support for PEPFAR is so far being ring-fenced. It’s bad news for TB for at least two reasons: one is because according to TAG (the independent think-tank Treatment Action Group) funding for TB R&D is already only totalling a third of what’s needed to see the post 2015 TB Targets met; the second it's because as long as ‘America First’ is the watchword then any resultant policy is inevitably going to result in increased global poverty, poorer health and malnutrition and geopolitical stress, all of which are unquestionably going to stoke the TB pandemic.

U.S. support (i.e. congressional appropriations ) for global TB efforts had actually already peaked back in 2012 anyway (at $256 million), reducing to $240 million and flat-lining since. This was already worrying enough, but it now looks like it's going to reduce again just at the moment everyone agrees a huge investment needs to be made.

We should at least all be grateful that the U.S. has been the largest donor to the Global Fund since its inception (providing roughly a third of all money donated – a generosity which must surely be sticking in the throat of those currently occupying the White House) and it's also been one of the largest donors to the Global Drug Facility (that provides grants to countries for TB drugs through the auspices of the Stop TB Partnership). In a nutshell, global TB control has been and still is is massively dependant on U.S. goodwill: the Global Fund provides 60% of TB international assistance for instance (so a full 20% of international assistance comes from the U.S.), with the country providing another one fifth of assistance directly.

here’s a massive amount at risk here.

Well next year, 2018, most probably in October, there is going to be a High Level Meeting (HLM) at the UN in New York devoted to tuberculosis. Doubtless this won’t be showing in the Presidential diary (that is if Trump is still in office then) since he'll know that he won’t be impressing his supporters much if he attends – but it will still be happening on American soil. Knowing the positive difference that American activism made in the war against HIV, let’s hope we’ll be witnessing that same of the same feisty humanity out there on the streets of New York City when the HLM is convened.

This meeting has been an awful long time coming, but (whether or not he attends) we have a message for the President anyway:

“You want to start winning wars again Mr President? Well so do we, Mr Trump – and the war we have to start winning is this war against TB again - NOW!”

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