BCG vaccine shortage puts infants at risk of severe TB, experts warn

Stakeholders in a procession along Uhuru highway during the launch of 'Mulika TB-Maliza TB' awareness campaign during the commemoration of World TB Day at Uhuru Park on Friday, March 24, 2016.[JONAH ONYANGO/STANDARD.] A nationwide shortage of Bacillus Calmette-Guerin (BCG) vaccines in the country leaves Kenyan newborns vulnerable to Tuberculosis (TB), a disease with a high prevalence in the country, health experts warn. The vaccine has been out of stock for over a month, with some counties facing limited supply while others have complete stock out. Prof. Ruth Nduati, a Paediatrician and Researcher, emphasises the critical role of BCG vaccine in protecting newborns. BCG, she explains acts as an antigen, teaching the body's immune system to recognise and combat TB bacteria without causing infection. "BCG vaccine is a very important vaccine. An infant who is vaccinated develops immunity after three weeks, therefore preventing severe forms of Tuberculosis (TB)," says Prof. Nduati. She emphasises that while BCG does not entirely prevent TB infection, it significantly reduces the risk of severe manifestations such as miliary TB, which can affect multiple organs, including the lungs. TB in babies also leads to TB meningitis, a life-threatening condition that impacts the brain and central nervous system. TB meningitis, Prof Nduati notes, has a high fatality rate, and even survivors often face severe consequences - including brain damage, cerebral palsy, stunted growth, and lifelong disabilities. "Pulmonary TB damages the lungs permanently, even if successfully treated, and this is particularly concerning for children whose lungs are still developing," she states. TB is a respiratory disease with symptoms including a persistent cough, high body temperatures, fatigue, lethargy and night sweats. Symptoms of TB in infants include persistent cough, weight loss, enlarged lymph nodes, altered mentation when the brain is affected, weakness and reduced alertness and activity levels. "BCG prevents babies from developing severe forms of the disease. Although it doesn't guarantee full immunity, immunised children are far less likely to experience these critical complications," Prof. Nduati adds. The researcher highlights the increased risk of TB transmission from adults to children, especially in households with individuals living with HIV. Stephen Anguva, the National Coordinator of the Network of TB Champions Kenya, adds that if nothing is done, the country shall record increased cases of TB in infants, with some dying. "Infants are so vulnerable, and their first immune defense is BCG vaccine. If mothers expose their babies, they are likely to get TB," says Anguva, adding, "TB is highly infectious. We have many people being exposed to TB, this worsens safety of babies." Data by Ministry of health reveal that proportion of TB in children below the age of 15 years was 13 per cent in 2024, a slight increase from 12 per cent in 2023. In 2023, at least 139,000 people developed TB in Kenya, among them 17,000 were children. "While most adults with TB do not have HIV, the disease is often more severe in HIV-positive individuals. National TB programmes must prioritise screening among people living with HIV and those with advanced disease, and implement standard TB prevention programmes including prophylaxis, advises Nduati. She further warns that undiagnosed TB cases in communities pose a significant threat. "Someone with undiagnosed TB could be a mother, father, babysitter, or relative, unknowingly transmitting the bacteria to infants. TB bacteria can linger in the air for up to 18 hours after being expelled through a cough," she says. "The risk of TB transmission is heightened in crowded places" To protect newborns, Prof. Nduati advises limiting their exposure to large groups of people and suggests that mothers and caregivers wear masks especially if there is a respiratory infection. She also cautions against infections brought home by school-going children. "For babies born during this period of BCG shortage, we should not be surprised to see a rise in TB cases, including severe forms of the disease. Infants have low immunity, making them particularly vulnerable. "After contracting TB, it typically takes 10 to 14 days for severe symptoms to develop," explains Nduati. Despite impact of the disease, Anguva notes that its diagnosis in babies is a major problem. StopTB Partnership's Coordinator in Kenya, Evaline Kibuchi, explains that diagnosis in infants requires removal of sputum for testing. Extraction of sputum can be uncomfortable in babies because it involves inserting pipes in the respiratory system. In babies, TB presents with loss of weight, lack of appetite and fever- symptoms which can easily be mistaken for other diseases leading to misdiagnosis. Kibuchi however faults the government for inconsistency in the supply of BCG vaccines that prevent TB in children. Last year, the country reported stock out of the vaccine. Prof. Nduati is calling for urgent measures to address the vaccine shortage and prevent further harm to the most vulnerable populations. "Whenever crises like this arise, we must quickly identify the root cause and implement systems to prevent recurrence. Learning from our mistakes is essential for better future outcomes," she concludes. "The current shortage of BCG vaccines is alarming. This is a shame for our Nation as immunising children is a predictable annual need that must be adequately planned and budgeted for." Notwithstanding the shortage, the expert applauds quick measure by the government to ensure supply of the crucial jab by next week, as promised by the PS for Medical Services, Harry Kimtai.Kimtai said The National Treasury has allocated Kshs 500 million for procurement of the vaccine, noting that logistics has already been worked on together with UNICEF. Meanwhile, civil society organisations have lamented low budgetary allocation in immunisation which they link to disruptions. James Kamau, a health economist and the chief Executive Officer for Kenya Treatment Access Movement, attributed the shortagee of the vaccines to failure by the government to allocate budget. "The government has to pay upfront for BCG, and other childhood vaccines. It does not have the money. It has to be put on budget," Kamau told 'The Standard'. SIDEBAR In 2024/25 financial budget, Kshs 4.6 billion was allocated for vaccines and immunisation programme, a decrease from Kshs 9.8 billion under the 2023/24 budget. Between 2016/17 and 2018/19, vaccine procurement budget remained constant at Kshs 703 million (USD 6.9 million).In 2019/20 financial year, vaccine budget was increased to Kshs 748 million (USD 7.3 million) followed by the 87 percent increase to Kshs 1400 million (USD 13.4 million) in 2020/21 after Health Committee engagements with NVIP and non-state actors. Under the 2022/23, the budget was increased to Kshs 1559.2 million (USD 15 million) in 2021/22, an allocation which remained constant in 2022/23.

BCG vaccine shortage puts infants at risk of severe TB, experts warn

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