Around 2018, Diango Tounkara began losing her night vision. In Mali, doctors diagnosed trachoma, a bacterial infection that scars eyelids and can cause eyelashes to turn inward and blind people. In 2022, a USAID-funded program paid for antibiotics and corrective surgery that saved her sight. For about two decades Tounkara had worked distributing NTD (neglected tropical disease) drugs in local communities — a job paid for by USAID — and in 2023 Mali officially eliminated trachoma. The country was also close to eliminating lymphatic filariasis and was fighting other NTDs.
That progress is now at risk. In January 2025, the Trump administration cut funding to USAID’s NTD program. The freeze forced planned community campaigns to stop and left workers like Tounkara out of work. Mamadou Coulibaly, who coordinates several NTD programs for Mali’s health ministry, said the cuts “were like a thunderbolt.” The lack of financing halted activities including post-treatment monitoring. Diagnostic test kits USAID bought are sitting unused in warehouses and are due to expire in February. Without staff to run tests, countries can’t confirm whether diseases are truly gone, increasing the risk of resurgence in Mali and more than a dozen other countries that depended on U.S. support.
Neglected tropical diseases are a group of 21 conditions that primarily affect the world’s poorest and most marginalized communities. They include onchocerciasis (river blindness), schistosomiasis (a snail-borne illness that causes fever and diarrhea), and cysticercosis (tapeworm infection that can affect the brain). NTDs typically cause chronic disability rather than immediate death, so they have historically received less attention and funding than high-profile killers like HIV or malaria.
The USAID NTD program began in 2006 with bipartisan backing and a small budget of $15 million. It relied on partnerships with pharmaceutical companies that donated medicines on the condition they would be distributed. USAID’s role was to help countries deliver those donated drugs and to support monitoring. Since the program began, pharmaceutical companies have donated more than $31 billion in medicines. With roughly $1 billion in U.S. taxpayer funds over nearly two decades, the program treated about 1.7 billion people and helped eliminate at least one NTD in 14 countries.
Proponents say the approach has been highly cost-effective. Researchers have estimated that treating NTDs through mass drug administration can cost less than 50 cents per person. Emily Wainwright, who led USAID’s NTD strategy until she was fired in January, said the program’s tactic — treating communities once a year for a set number of years — made elimination feasible rather than merely aspirational. Lisa Rotondo, a global health consultant who worked on USAID-funded NTD programs, noted the program’s foundation in public–private partnerships that ensured donated drugs didn’t go to waste.
Last year the program’s budget was $114 million — a small fraction of larger global health spending but, advocates say, crucial and consistent support. Angela Weaver, vice president of NTDs at Helen Keller International, called it “one of the most effective and cost-efficient programs that USAID has ever had.” Nonprofits that partnered with USAID helped fill gaps and scale campaigns, but the sudden federal funding cut forced many to scale back.
Countries that relied on USAID are scrambling. Coulibaly said Mali had been receiving roughly 90% of its NTD funding from the U.S.; domestic resources can’t replace that quickly. Nonprofits are trying to raise money, and some short-term help may be possible, but the loss of stable federal funding threatens long-term planning and sustainability. “We might be able to fill some of the gaps this year, but what about next year? That’s where I’m really concerned,” Weaver said.
There was some hope after USAID’s dismantling that funding could be shifted or resumed through the State Department, given past bipartisan support for NTDs. But in September 2025 the administration released its 40-page America First Global Health Strategy with no mention of neglected tropical diseases. When NPR requested comment about the rationale for cutting NTD funds and whether any programs were still supported, a USAID spokesperson replied with a screenshot of an NPR piece reflecting on the agency’s dismantling and the statement, “What do you think farewell meant?”
Local impacts are immediate. In Mali, community health workers who once mobilized drug distribution and conducted follow-up surveys are unemployed. Test kits risk expiration. Leaders worry that without consistent treatment and monitoring, eliminated diseases could return, undermining years of progress that improved people’s ability to work and participate in community life. The NTD program’s supporters argue the modest U.S. investment leveraged donated medicines, local labor, and measurable public health gains — and that cutting it threatens to reverse those gains just as elimination was within reach for many countries.
