In Mali, Diango Tounkara began losing her night vision around 2018 and was diagnosed with trachoma, a bacterial eye infection that can scar eyelids and cause blindness. In 2022, a USAID-funded campaign supplied antibiotics and paid for corrective surgery that restored her sight. Tounkara had spent about two decades paid by USAID distributing neglected tropical disease (NTD) medicines in local communities; by 2023 Mali had officially eliminated trachoma and was close to wiping out lymphatic filariasis.
That fragile progress has been put in jeopardy. In January 2025 the Trump administration cut funding for USAID’s NTD program. The freeze halted planned community campaigns, left many community health workers unemployed and stopped follow-up activities such as post-treatment monitoring. “It was like a thunderbolt,” said Mamadou Coulibaly, who coordinates several NTD programs for Mali’s health ministry. Diagnostic test kits purchased with USAID funds now sit unused in warehouses and are due to expire soon. Without staff to perform tests and continue surveillance, countries cannot reliably confirm whether diseases have been eliminated, increasing the risk of resurgence across Mali and more than a dozen other countries that relied on U.S. support.
Neglected tropical diseases are 21 conditions that primarily afflict the world’s poorest and most marginalized people. They include river blindness (onchocerciasis), schistosomiasis (a snail-borne disease causing fever and diarrhea), and cysticercosis (a tapeworm infection that can affect the brain). NTDs more often cause chronic disability and impairment than immediate death, and historically they have received far less attention and funding than diseases like HIV or malaria.
The USAID NTD program began in 2006 with bipartisan support and an initial budget of about $15 million. It depended on partnerships with pharmaceutical companies that donated medicines on the condition they would be distributed; USAID helped countries deliver those drugs and supported monitoring. Since the program’s start, 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 contributed to the elimination of at least one NTD in 14 countries.
Supporters argue the approach was highly cost-effective. Researchers estimated that 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 model — treating whole communities once a year for a set number of years — made elimination achievable rather than merely aspirational. Lisa Rotondo, a global health consultant who worked on USAID-funded NTD programs, pointed to public–private partnerships that ensured donated drugs reached people who needed them.
Even as the program’s annual budget remained modest compared with larger global health lines, it provided steady, predictable support. Last year the NTD budget was $114 million. 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.” Nonprofit partners scaled up campaigns and helped fill gaps, but the abrupt federal funding cut forced many organizations to scale back operations.
Countries that depended on USAID are scrambling. Mali received roughly 90% of its NTD funding from the U.S.; domestic budgets cannot replace that overnight. Nonprofits are attempting to raise short-term funds, and some emergency help may be possible, but the loss of stable federal financing 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 hope that responsibility for the program might move to the State Department or be restored, since NTD efforts had enjoyed bipartisan support. But in September 2025 the administration published its America First Global Health Strategy with no mention of neglected tropical diseases. When NPR requested comment about the cuts and whether any NTD programs remained supported, a USAID spokesperson responded with a screenshot of an article about the agency’s dismantling and the statement, “What do you think farewell meant?”
On the ground, the effects are immediate: unpaid community health workers who once mobilized drug distribution and ran follow-up surveys, expiring test kits, and mounting uncertainty about whether gains will hold. Advocates warn that the modest U.S. investment had leveraged donated medicines, local labor and measurable public-health gains — and that cutting that support now risks undoing years of work just as elimination was within reach for many countries.
