Summary
Commentary by Pushpita Samina and Alice Zwerling
The word “economics” derives from the Greek oikonomia — a combination of oikos (household) and nomos (managing or law) — originally meaning the management of household affairs and resources (Leshem 2016). This etymology offers a useful lens for understanding why economics, as a social science discipline, intersects so naturally with tuberculosis (TB) research. At its core, economics is concerned with two fundamental questions: how resources are scarce, and how they can best be allocated. TB programs mirror this struggle, with highly limited resources and increasing demand. Resources devoted to TB prevention, diagnosis, and treatment are limited, and decisions about how to deploy them efficiently and equitably are unavoidable. The world since COVID-19 has made this tension more acute. The pandemic diverted health system capacity and funding away from TB programs, while TB rates increased as a result of reduced services and access to care (Arinaminpathy et al. 2023). In 2025, further cuts by bilateral donors have compounded the strain caused by the complete withdrawal or freezing of U.S. bilateral health aid across 26 high-burden countries, which is projected to result in 10.67 million additional new TB cases and 2.24 million additional deaths between 2025 and 2030 (Mandal et al. 2025). This underscores how directly financing decisions translate into health outcomes and highlights the need for health economics to ensure we are maximizing health impact while using resources wisely.
Economics does more than diagnose the problem — it also offers tools to address it. The discipline’s relevance to TB extends well beyond narrow notions of cost efficiency or technical efficiency. Cost-utility analysis, for instance, is a cornerstone of the evidence base that informs WHO recommendations, helping countries decide whether and how to adopt new diagnostics, drugs, or treatment regimens (“WHO Handbook for Guideline Development, 2nd Edition,” n.d.). These analyses are critical for guiding implementation decisions, helping countries understand how best to implement and scale up new programs, tools, and approaches to achieve the greatest impact and utilization of resources. Economics also shapes the broader conversation on health financing. As donor funding contracts, there is growing interest in innovative financing mechanisms for TB — an area explored in depth— alongside a wider push to shift TB programs away from donor dependency and toward sustainable domestic public and private financing (Wells et al. 2026). Finally, economics contributes a critical equity lens. Concepts such as horizontal equity (treating individuals in similar circumstances similarly) and vertical equity (allocating more resources to those with greater need) help ensure that the distribution of scarce TB resources doesn’t simply follow efficiency logic, but also accounts for fairness across populations disproportionately affected by the disease.
References
Arinaminpathy, Nimalan, Ya Diul Mukadi, Amy Bloom, Cheri Vincent, and Sevim Ahmedov. 2023. “Meeting the 2030 END TB Goals in the Wake of COVID-19: A Modelling Study of Countries in the USAID TB Portfolio.” PLOS Global Public Health 3 (10): e0001271. https://doi.org/10.1371/journal.pgph.0001271.
Leshem, Dotan. 2016. “Retrospectives: What Did the Ancient Greeks Mean by Oikonomia?” Journal of Economic Perspectives 30 (1): 225–38. https://doi.org/10.1257/jep.30.1.225.
Mandal, Sandip, Sreenivas Nair, Suvanand Sahu, Lucica Ditiu, and Carel Pretorius. 2025. “A Deadly Equation: The Global Toll of US TB Funding Cuts.” PLOS Global Public Health 5 (9): e0004899. https://doi.org/10.1371/journal.pgph.0004899.
Wells, William A., Sarah Scheening, Saba Waseem, Amanda Schulhofer, Yemelaknesh Wolde, and Guy Stallworthy. 2026. “Converting Donor Dependence to Domestic Ownership: The Realignment of Tuberculosis Financing for Sustainability.” PLOS Global Public Health 6 (5): e0006523. https://doi.org/10.1371/journal.pgph.0006523.
“WHO Handbook for Guideline Development, 2nd Edition.” n.d. Accessed August 17, 2026. https://www.who.int/publications/i/item/9789241548960.
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Pushipita Samina is a CIHR Health Systems Postdoctoral Fellow at the University of Ottawa. Alice Zwerling is an Associate Professor at the School of Epidemiology and Public Health, also at the University of Ottawa. Pushpita and Alice specialize in health economics.
