As the world marks World TB Day, a stark reality unfolds in Kenya, where a confluence of factors, including a recent US aid freeze, threatens to unravel years of hard-won progress against tuberculosis (TB) and other diseases.
The timing could not be more critical, as the highly contagious nature of TB demands unwavering global attention.
The ripple effects of the Donald Trump administration’s policy shifts, marked by a withdrawal from the World Health Organization (WHO) and a halt to USAID donations, are already being felt acutely in Kenya’s healthcare sector, which relies heavily on international support.
With over 70% of the nation’s HIV, TB, and malaria treatment programs dependent on foreign aid, particularly from the United States, the directive has triggered a healthcare crisis.
Here are 10 crucial points to understand about TB, especially in this precarious context:
1. Leading cause of death
Tuberculosis is one of Kenya’s most persistent public health threats.
The disease is airborne and highly contagious, with approximately 120,000 new cases reported annually, according to the Copenhagen Consensus Center, which states: “About 120,000 people a year develop TB (48,000 of them being HIV-positive) and 18,600 people die from it.”
2. TB causes
TB is caused by the bacterium Mycobacterium tuberculosis, which spreads through airborne droplets when an infected person coughs, sneezes or speaks.
It primarily affects the lungs but can also impact other organs like the kidneys, spine, and brain.
Diagnosis involves several methods:
Tuberculin Skin Test (TST): A small amount of TB protein is injected under the skin to check for a reaction.
Interferon-Gamma Release Assays (IGRAs): Blood tests that detect TB infection.
Chest X-ray: Used to identify lung damage caused by TB.
Sputum Test: Microscopic examination and culture of mucus from the lungs to detect TB bacteria.
3. Essential TB programs
USAID has historically funded the provision of TB medication, diagnostics, and community outreach.
The aid freeze jeopardizes these programs, threatening to undo years of progress in reducing TB-related deaths and transmission.
4. Life-saving medicines
Kenya is already facing a national stockout of antiretrovirals (ARVs) and TB vaccines.
Aid money significantly improved access to life-saving medicines, making them more affordable and readily available for vulnerable populations who would otherwise struggle to obtain essential treatments.
However, the USAID funding freeze is creating challenges in accessing the Bacillus Calmette-Guérin (BCG) vaccine, which protects infants against tuberculosis (TB).
5. Drug resistance
Incomplete or interrupted TB treatment increases the risk of developing drug-resistant strains, a more complex and costly challenge.
The emergence of multi-drug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) looms large.
With second-line TB drugs already in short supply, the aid freeze could result in higher mortality rates and the emergence of harder-to-treat TB cases.
6. HIV and TB
People living with HIV are significantly more vulnerable to TB.
Kenya has 1.37 million people living with HIV, with women disproportionately affected.
Without continuous treatment, patients may develop drug resistance, leading to an increase in new infections.
7. Legal action
Civil society organizations, including the Kenya Legal and Ethical Issues Network on HIV & AIDS (KELIN), have taken legal action against the Ministry of Health and the Kenya Medical Supplies Authority (KEMSA).
A court case pending judgment seeks to hold the government accountable for failing to ensure the uninterrupted supply of essential medicines.
8. Healthcare
The county’s healthcare system is heavily reliant on foreign aid, particularly from the US.
Despite discussions in the Senate and National Treasury, there has been little domestic investment in ARVs and TB medication.
Without an alternative financing strategy, future stockouts may become more frequent.
9. Community health programs
The aid freeze threatens the operations of community-based organizations that provide TB screening, support treatment adherence, and combat stigma.
These programs are vital in remote areas where public health infrastructure is limited.
10. What next after USAID freeze?
Experts warn that without urgent policy changes, Kenya will struggle to sustain TB and HIV programs.
The unpredictable nature of the Trump administration makes it difficult to rely on USAID for funding critical health programs in Kenya.
Relying on donor funding risks the lives of vulnerable populations in the country.
Possible solutions include increasing the national health budget, promoting local production of essential drugs, and expanding the Social Health Insurance Fund (SHIF) to cover TB and HIV treatments.
Martin Oduor
The alchemist of literary works – a master wordsmith with a proven record of transforming the raw materials of language into a rich tapestry of emotion, thought, and imagination.
