Four Decades Forward: CDC Kenya Celebrates 40th Anniversary

Kevin DeCock

Colleagues and Friends,
It was in 1979, 40 years ago, that CDC initiated work in Kenya. As always, chance played an important role in choices made and developments that ensued. The big CDC was established in 1946 as an infectious disease control agency succeeding the Malaria Control in War Areas unit that was set up in Atlanta early during World War II. Tropical medicine and infectious challenges in faraway places have been integral to CDC’s character from its earliest days. In the mid-1960s CDC took on a leadership role in malaria eradication efforts, with the late Robert Kaiser, a former EIS officer, heading the effort. Kaiser later became head of CDC’s parasitic diseases program and in 1979 assigned one of his staff, Harrison Spencer, to initiate malaria research in Kenya. Chloroquine resistance had just been described in East Africa and a technique to culture Plasmodium falciparum outside of the human body had been recently introduced. “Why Kenya?” one may ask. Certainly, there was enough malaria to study, and the country’s research and educational infrastructure was strong. Undoubtedly, however, other issues were relevant; Kaiser had met his wife in Nairobi, and felt a lifelong affinity with the country.

A small but vibrant Kenyan and international tropical medicine community existed in Nairobi in 1979, working on malaria, leishmaniasis, schistosomiasis, filariasis, hydatid disease and other conditions. Harrison divided his time between Nairobi and western Kenya where he conducted his fieldwork. The Kenya Medical Research Institute (KEMRI) was established at the same time, explaining the strong links between the Kenya Ministry of Health, KEMRI and CDC that have endured over time. The malaria work increased in complexity and scope, giving insight not only into basic science but also burden of disease and epidemiology. Interventional work was emphasized such as the large evaluation of insecticide-impregnated bed nets, prevention and management of malaria in pregnancy, and vaccine trials. CDC staff came and went, but over time, a full-time CDC presence was established in Kisumu, working out of the KEMRI campus in Kisian.

By the time the first case of AIDS was described in Kenya in 1984, silent spread of HIV was already extensive and the region around Lake Victoria was the most heavily affected. CDC decided in the early 2000s to expand its research to include HIV, and the advent of the Global Fund to Fight AIDS, Tuberculosis and Malaria and the President’s Emergency Plan for AIDS Relief (PEPFAR) shortly thereafter fundamentally changed the landscape. Increased funding for other areas such as emerging infectious diseases and a broader vision of the requirements of global health—recognition that U.S. domestic health was related to health everywhere—led to substantial CDC expansion. Evolution led to CDC Kenya becoming the agency’s most diverse overseas office, working programmatically as well as on research for HIV/AIDS, malaria, tuberculosis, influenza and other infectious diseases and public health issues, and conducting regulatory functions for immigrants and refugees traveling to the United States.

One of CDC’s contributions apart from conducting research and program work has been to support the development of scientific and public health leadership in Kenya. Through the Kenya Field Epidemiology and Laboratory Training Program (FELTP) and the related Improving Public Health Management for Action (IMPACT) program, CDC has offered hands-on, in-the-field training to the next generation of epidemiologists and public health leaders. These programs have produced over 300 graduates, many of whom have gone on to hold leadership positions in the Ministry of Health and other organizations in Kenya and internationally.

I am pleased to share this report with you, one that tells the story of CDC in Kenya over the last year. We sincerely thank all partners and the Government of Kenya for their work that does so much to make Kenya a safer and healthier country. CDC Kenya would not be where it is today without the contributions and commitment of all our staff over the past 40 years, emphasizing that the greatest asset of any successful organization is its people. I salute them all. We dedicate this report to the memory of Dr. Harrison Spencer who started it all.

Kevin M. De Cock, MD, FRCP (UK), DTM&H
CDC Kenya Country Director