Public transport: the missing link in tuberculosis control in Somalia

Abstract

Tuberculosis (TB) remains a major public health challenge in Somalia, where conflict, displacement, delayed diagnosis, and fragile healthcare systems sustain ongoing transmission. While existing TB control efforts largely emphasize household and healthcare-associated exposure, the role of overcrowded public transport systems has received limited attention. In rapidly urbanizing Somali cities, particularly Mogadishu, minibuses and shared taxis represent enclosed, poorly ventilated, high-turnover environments that may facilitate airborne transmission of Mycobacterium tuberculosis . Evidence from high-burden settings demonstrates that public transport can function as a significant transmission setting because of prolonged close contact and inadequate airflow. Somalia's low case detection rates and frequent delays in treatment initiation further increase the likelihood that infectious individuals continue using crowded transport networks during active disease. This letter argues that public transport should be recognized as a neglected but modifiable determinant of TB transmission in Somalia. Integrating transport-focused interventions into national TB strategies, including awareness campaigns, community-based active case finding, improved ventilation practices, and mobility-informed surveillance, could provide a practical and context-appropriate opportunity to reduce transmission. Addressing public transport as a mobile transmission environment may strengthen TB control efforts and contribute to reducing the burden of disease in Somalia's fragile urban settings.