Tuberculosis infects more than a quarter of the world’s population, kills more than 1 million people per year, and is still a scourge at home. It has never disappeared from the United States, and there was even a recent cluster of cases in Boston, according to Sarah Fortune, a Harvard scientist leading one of the world’s preeminent tuberculosis research programs.
Her lab, along with its collaborators at 11 other sites across the country and in Africa, has solved some of the crucial mysteries of the disease, and continues making discoveries that could prove life-saving for generations to come.
That enterprise is now at risk, caught up in the Trump administration’s antisemitism investigation at Harvard. Fortune’s $60 million contract with the National Institutes of Health was the number one project threatened in a memo the Trump administration sent to Harvard last week, apparently because it was the largest.
If that contract is canceled, “it’s over,” Fortune said Monday at her Boston laboratory.
The funding for Fortune’s program is just one of hundreds of grants and contracts now under “review” as the Trump administration investigates Harvard’s response to campus antisemitism and pro-Palestinian protests. The review encompasses $9 billion of federal grants and contracts destined for Harvard and its affiliates, according to the Trump administration’s antisemitism task force. That funding may be canceled if Harvard does not comply with a sweeping list of demands sent last Thursday covering everything from diversity programs to student disciplinary procedures. The university is now weighing how to respond.
The funding review appears to target all outstanding funding commitments to Harvard and its affiliated teaching hospitals and research institutes, such as Mass General Brigham and the Broad Institute. It includes what the Trump administration has described as $8.7 billion in grants and $255 million in contracts. The government has not publicly explained which grants and contracts are included, but a government memo sent to Harvard’s leaders on March 31 and later obtained by the Globe listed them.
To many, including academics, free speech activists, and some Jewish advocacy groups, the administration’s methods seem like a weaponization of antisemitism to prosecute a broader crackdown on elite universities. To President Trump’s supporters, the approach is innovative and necessary. Antisemitism and campus disorder, they say, were so pervasive that only a maximally aggressive strategy will work: targeting federal funding, the lifeblood of research universities.
Scientists like Fortune are caught in the middle. “It is a weird time,” she said. She and her collaborators are making breakthroughs that could help millions of people, she said, but they don’t know if they will be defunded at any moment. “So we vacillate between moments of excitement and then a lot of anxiety about the future,” she said.
Fortune is the chair of the Department of Immunology and Infectious Diseases at the Harvard T.H. Chan School of Public Health and head of the Fortune Lab.
Her group’s contract is what some call a “moonshot,” an attempt by the NIH to bring together the best minds and laboratories in the world to solve seemingly intractable problems of public health.
They are producing “unparalleled research,” said Joel Ernst, chief of the division of experimental medicine at the University of California San Francisco and a member of an external board that advises the NIH on tuberculosis research conducted under Fortune’s contract and two others. Their work has changed the field’s understanding of the immune response to tuberculosis in a way “that very quickly translates to designing vaccines to provide protection and immunity to control the global tuberculosis pandemic,” he said.
Those advances have economic and public health implications globally, including in the United States, Ernst said. Although cases of tuberculosis are concentrated in sub-Saharan Africa and India, the bacterial infection has never disappeared from the United States and has surged since the COVID pandemic.
Fortune said she is aware of a current tuberculosis cluster in Boston that public health officials are surveilling and containing. She could not say more due to her “nondisclosure agreement with the Department of Public Health,” she said.
In a statement Monday, Bisola Ojikutu, Boston’s public health commissioner, said, “Massachusetts has seen an uptick of tuberculosis cases over the past several years.”
Tuberculosis is generally spread through prolonged, close contact in spaces with poor ventilation, Ojikutu said, and, “currently there is no broad public health threat from tuberculosis.”
Fortune’s lab is the hub of a 12-site program, including other laboratories at MIT, the Ragon Institute at Mass. General, UMass Chan Medical School, Case Western University, the University of Pittsburgh, and clinical sites in Uganda and South Africa.
The researchers collect data on tuberculosis patients to study how different people’s immune systems respond to the infection.
Each lab contributes different kinds of expertise. “This is what a moonshot looks like,” Fortune said. “You assemble a best-in-class team and then you work collectively to try to move it forward.”
The Fortune Lab specializes in mapping the way an immune system responds to tuberculosis at the cellular level. Other labs isolate and analyze other features of the immune response. All of the data funnels to a lab at MIT that uses machine learning to analyze huge data sets and determine which aspects of the immune response confers protections from the disease, Fortune said.
Their methods have produced significant breakthroughs. By studying antibodies in patients’ blood, they discovered a kind of stealth form of tuberculosis infection in asymptomatic patients that had previously evaded existing diagnostic tools.
The 12-site collaboration enabled that research to advance to the point that it can aid diagnosis, treatment, and containment, Ernst said.
Fortune said none of that would be possible without federal funding. “There is no foundation or philanthropic funding that can reproduce the scale of this kind of effort,” she said.
Approximately half of the $60 million NIH contract has already been paid out, according to federal spending records.
Last week, when the Harvard funding review was announced, academics at Harvard and affiliated institutions spent days anxiously speculating about whether their projects were included.
Fortune figured her contract might be under review, but did not know for sure until she received an email from a Globe reporter Friday afternoon. She was in a meeting with collaborators at MIT discussing data analysis, she said.
She gave the email a once over, she recalled, and told her colleagues, “This looks bad.”
Mike Damiano can be reached at mike.damiano@globe.com.