Obituary: In Memory of SMART4TB and Project ACCELERATE

This photo illustration displays the Johns Hopkins University logo on a tablet.

(Adobe Stock 575797316 by Игорь Головнёв)

It is with a heavy heart and a profound grief that I announce the untimely passing of 2 vital global health initiatives—SMART4TB and Project ACCELERATE—whose lives were abruptly cut short by the devastating blow of federal funding cuts.¹ They leave behind a world that is now better equipped to fight tuberculosis (TB) and HIV/AIDS—2 of the deadliest infectious diseases known to humankind—due to their efforts.² Their absence will be felt by the millions they served, the research they left unfinished, and the progress they were forced to abandon.

The official announcement of their deaths came to this writer in a shocking Thursday afternoon email from Johns Hopkins University, home to these 2 programs. Born of the relentless pursuit of scientific advancement and humanitarian service, SMART4TB and Project ACCELERATE were beacons of hope in the realm of global health and infectious disease prevention and control. Their purpose was noble, their impact undeniable, and their legacy one of lives saved, knowledge gained, and a hope for the future.

The tragic decision to end these programs is not merely a casualty of the current US administration; it is a catastrophe with repercussions that will ripple through communities, hospitals, and research institutions across the globe.

SMART4TB (2022 – 2025): A Life Devoted to Ending Tuberculosis

SMART4TB (Supporting, Mobilizing, and Accelerating Research for Tuberculosis Elimination) was conceived in 2022 with the ambitious goal of transforming the landscape of tuberculosis research, treatment, and prevention.³ With up to $200 million in United States Agency for International Development (USAID) funding,^4,5 the program mobilized an international coalition of researchers, clinicians, and advocates determined to change the trajectory of TB. Under an esteemed group of scientists, SMART4TB was a lifeline to those in TB-affected regions, driving research into better diagnostics, shorter treatment regimens, and groundbreaking vaccine studies.³

In its short but impactful life, SMART4TB pioneered trials to develop faster and more effective treatments for drug-resistant tuberculosis, led community-based initiatives to improve TB detection, and engaged in critical research to understand TB transmission in high-burden areas. It sought to amplify local research capacity, empowering scientists in affected countries to lead the charge against TB. Through SMART4TB’s work, diagnostic tools were being refined, drug regimens improved, and lives saved.

Then, without warning, SMART4TB was slain by a political decision. Its funding, essential to the survival of its research and the communities it served, was revoked.¹ Clinical trials were halted midcourse, international collaborations severed, and a program brimming with promise was silenced before it could reach its full potential.

The loss of SMART4TB is not just a bureaucratic shift—it is a human tragedy. The very research that could have saved countless lives has now been left unfinished, abandoned in a world where tuberculosis still kills more than 1.5 million people each year.² The global health community mourns its loss, knowing that every delayed discovery and missed opportunity could cost lives that could have been saved.

Project ACCELERATE (2019 – 2025): A Champion in the Fight Against HIV

Project ACCELERATE was an unwavering force in India’s battle against HIV/AIDS, dedicated to closing service gaps for marginalized communities.⁶ Launched in 2019 under the President’s Emergency Plan for AIDS Relief, it sought to revolutionize HIV care through innovative, community-centered solutions. In its years of service, Project ACCELERATE transformed care models, established the first comprehensive transgender health clinic in India, expanded HIV prevention for vulnerable youth, and provided treatment access for thousands living with the virus.

Project ACCELERATE worked alongside India’s National AIDS Control Organization (NACO) to implement sustainable, integrated healthcare services. It pioneered digital health interventions, like the TAAL+ e-pharmacy for people living with HIV⁷ and the Safe Zindagi online outreach platform.⁸ These initiatives reached communities that traditional health care systems had failed, ensuring that HIV care was accessible, compassionate, and effective. Project ACCELERATE was more than a program—it was a movement toward equity, innovation, and dignity in HIV care.

However, Project ACCELERATE was abruptly paused on February 27, 2025, and eventually terminated in March.¹ With its USAID funding lost, services were halted, community clinics shuttered, and countless patients left without the support they had come to rely on. Among its many casualties was the Mitr Clinic in Hyderabad, India’s first dedicated health care center for transgender individuals.⁹ Without funding, it was forced to close its doors, leaving a vulnerable population, who are stigmatized in mainstream health care communities, without access to specialized care.

The loss of Project ACCELERATE is not just a statistic—it is the erasure of lifelines for thousands of individuals who depended on its support.^10,11 Without the outreach workers, counselors, and health advocates it funded, the progress made in India’s fight against HIV is now at risk of reversal. The promise of an AIDS-free generation has been thrown into uncertainty, all for the sake of political maneuvering and budgetary cuts.

Final Words

May this obituary to these programs, SMART4TB and Project ACCELERATE, be more than a somber reflection of the progress lost due to federal funding cuts. May it be more than only a tribute to their vast achievements. May their untimely demise be a call to action that reverberates around the globe. A call to preserve programs such as these is a lifeline to millions around the world who rely upon this access to health care and the future of global health innovation through research. If we do not protect the funding for critical research and lifesaving interventions available in programs such as these, we are not only abandoning projects, we are digging a grave for the people who relied on these services delivered by these programs.

With every day that passes, these funding cuts leave patients untreated, communities vulnerable, and the next generation without the advancements in health care they deserve. The war against tuberculosis, HIV/AIDS, and countless other global health threats is far from over, but it is a battle we cannot afford to fight with empty hands.

May this obituary be more than mourning the jobs lost for the hundreds of dedicated public health servants who dedicated their lives to this work. Let it serve as a warning and a plea to the world: We must stand against the erosion of global health funding and scientific research before the holes that these funding gaps leave are filled not with a nation made great again but with the bodies of countless individuals left without access to health care and the innovation made possible through scientific research and efforts in global health and development.

References

1. Reuters. Johns Hopkins University slashes 2,000 jobs after Trump administration grant cut. March 13, 2025. Accessed March 14, 2025. https://www.reuters.com/world/us/johns-hopkins-university-slashes-2000-jobs-after-trump-administration-grant-cut-2025-03-13/#:~:text=The%20job%20cuts%20impact%20the,profit%20for%20international%20health%2C%20Jhpiego.
2. World Health Organization (WHO). Global Tuberculosis Report. Accessed March 14, 2025. https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2024.
3. Johns Hopkins University Center for Tuberculosis Research. SMART4TB: Program Overview. Accessed March 24, 2025. https://tbcenter.jhu.edu/smart4tb/.
4. Johns Hopkins Medicine Newsroom. Johns Hopkins Medicine-led consortium to receive up to $200 million to fight TB globally. August 4, 2022. Accessed March 14, 2025. https://www.hopkinsmedicine.org/news/newsroom/news-releases/2022/08/johns-hopkins-medicine-led-consortium-to-receive-up-to-200-million-to-fight-tb-globally#:~:text=The%20WHO%20also%20reports%20that,and%20efforts%20to%20mitigate%20it.
5. Johns Hopkins Medicine Newsroom. New funding to fight TB. October 9, 2022. Accessed March 14, 2025. https://www.hopkinsmedicine.org/news/articles/2022/10/new-funding-to-fight-tb#:~:text=By%20Michael%20Newman%20on%2010,Tuberculosis%20Research%20at%20Johns%20Hopkins.
6. US Department of State. PEPFAR latest global results factsheet. December 2024. Accessed March 14, 2025. https://www.state.gov/pepfar-latest-global-results-factsheet-dec-2024/.
7. USAID EpiC Blog. New e-pharmacy improves access to lifesaving medicines and creates an innovative business model for a community-led organization in India. March 7, 2023. Accessed March 14, 2025. https://epicproject.blog/new-e-pharmacy-improves-access-to-lifesaving-medicines-and-creates-an-innovative-business-model-for-a-community-led-organization-in-india/.
8. Indian Express. World AIDS Day: Safe Zindagi is an e-platform that provides HIV services to hard-to-reach populations and young online users. Accessed March 14, 2025. https://indianexpress.com/article/cities/pune/world-aids-day-safe-zindagi-an-e-platform-that-provides-hiv-services-to-hard-to-reach-populations-young-online-users-9049297/.
9. OpIndia News. Mitr Clinic closure due to USAID cuts. Accessed March 14, 2025. https://www.opindia.com/2025/02/indias-first-transgender-clinic-shuts-down-due-to-usaid-fund-freeze/#:~:text=Mitr%20Clinic%20was%20established%20in,PEPFAR.
10. Johns Hopkins Centers for Infectious Diseases in India. Our team. Accessed March 14, 2025. https://www.hopkinscidi.org/our-team#:~:text=Infectious%20Diseases%20in%20India,level%20technical%20assistance.
11. Johns Hopkins Centers for Infectious Diseases in India. Project Accelerate. Accessed March 14, 2025. https://www.hopkinscidi.org/about-the-project#:~:text=Since%202019%2C%20the%20project%20team,Safe%20Zindagi%20for%20online%20outreach.

Further Reading

· Dateline Health Africa. What US funding cuts mean for millions in Africa. March 12, 2025. Accessed March 14, 2025. https://www.datelinehealthafrica.org/what-us-health-funding-cuts-mean-for-millions-in-africa#:~:text=The%20cuts%20are%20a%20result,S%20government.

· Johns Hopkins. Medicine Matters. Accelerate: Progress to end HIV in India. August 15, 2019. Accessed March 14, 2025. Available at: https://medicine-matters.blogs.hopkinsmedicine.org/2019/08/accelerate-progress-to-end-hiv-in-india/.

· Spotlight. Massive $200 million TB research programme derailed by US funding cuts. March 4, 2025. Accessed March 14, 2025. https://www.spotlightnsp.co.za/2025/03/04/massive-200-million-tb-research-programme-derailed-by-us-funding-cuts/#:~:text=While%20the%20project%20has%20accomplished,by%20American%20taxpayers%2C%20is%20wasteful.

· USAID/India Health Office. Best of 2023. Accessed March 14, 2025. https://indiainstitute.jhu.edu/news/media-coverage/media-coverage-2-3/#:~:text=ACCELERATE%20Featured%20in%20Best%20of,2023%20by%20JHU.