In the west of Kenya, near the shores of Lake Victoria, where I come from, a tuberculosis outbreak is no different from one that takes place anywhere else in the world. A few dozen people get sick, health workers attempt to locate and test everyone with a bad cough and other symptoms. A concerted effort is made to make sure that patients take their medications for the entire duration of treatment, at least six months, to help stem the creation of drug-resistant infections.
The problem is that Western Kenya has a high burden of HIV infections, which makes the communities more vulnerable to TB infections. People living with HIV are more than 14 times more likely to fall ill with TB disease than people without HIV.
Other locations — like the communities on the Uganda shores of Lake Victoria, Copperbelt Province in Zambia, Eastern Cape Province in South Africa, or Enugu State in Nigeria — have this vulnerability. Of the 30 countries that the World Health Organization identified as having a high burden of TB and HIV co-infections, 22 are located in sub-Saharan Africa. South Africa, India, Nigeria, Mozambique, and Kenya tragically have the most co-infections globally.
HIV is not like TB. While TB treatment takes six long months, this is a curable disease. HIV, on the other hand, cannot be cured. It can, however, be kept in check through medicine that suppresses the infection. The virus attacks the immune system, allowing other diseases like TB, kept in check by the immune system, to strengthen. In fact, TB is the leading cause of death for people living with HIV infections.
This is where partnerships with foreign donors can make a difference, with resources for programs that have located people living with HIV and then provided them with proper medicines. These programs help keep infections in check, preventing HIV from spreading and preventing other infections like TB from becoming more widespread. Similar programs help locate people with TB and provide them with medicines throughout the six months of treatment.
The trend right now is to disrupt these partnerships and cut foreign aid, unraveling the safety net that addresses HIV and TB. This places regions like Western Kenya at extreme risk from two contagious diseases that do not respect national borders. If they are not contained in even one location, we run the risk of the contagion spreading.
There are so many ways that this situation can be improved, in sub-Saharan Africa and throughout the Global South. We need new medicines for TB, to shorten the treatment time and make it easier for patients to take the drugs. We need medicines that can cure HIV instead of just keeping the infections in check.
We also need vaccines to prevent both of these infections. The only available TB vaccine, BCG, dates back to 1921. It protects babies and young children against severe forms of TB, but it offers inadequate protection for adolescents and adults against the most common form of the disease. There is no vaccine to prevent HIV, although new prevention methods have been identified and are in need of development and distribution.
This is my work as a scientist, helping to develop solutions for infectious diseases that are barely held in check, if at all — even as the systems that address these diseases have just lost significant funding.
There is no disagreement that foreign aid makes a difference; more resources are needed, not less. An estimated US$22 billion is required annually for TB diagnostic, treatment and prevention services by 2027. Yet only US$5.7 billion was available in 2023. More resources are needed, from governments in both the Global South and Global North.
Global funding for neglected disease basic research and product development has declined by more than 20% since it peaked in 2018. As of 2023, high-income countries provided 59% of all funding; those numbers are now expected to drop further this year. It would be great to see low- and middle-income countries generating more research that tackles diseases like TB and HIV, and we are on the path to doing so, but we are still unfortunately at the beginning stages of this journey.
Today, progress against these diseases stands at the edge of a precipice as governments face impossible decisions on where to channel diminishing resources. The funding for all of this work does not turn on like a switch if foreign aid from high-income countries is suddenly discontinued. We have already lost so much ground during the COVID-19 pandemic. An estimated 700,00 TB deaths stemmed from the disruptions caused by the pandemic. Less than half of all people infected with drug-resistant TB received treatment in 2023. And now we risk losing the ground that we have made up since COVID.
It is important that the Global South and Global North continue to work together, finding solutions to these diseases that keep too many parts of society vulnerable. The world will always be connected. Solutions to these diseases benefit us all.
Dr. Monicah Otieno, PhD, Head of Nonclinical Development, Gates Medical Research Institute
