What you need to know:
- Vaccine development is in five phases:
- Phase 1: Discovery research. Takes 2 to 5 years. Up to 100 potential vaccines are developed.
- Phase 2: Preclinical trials. Takes about 2 years. Vaccines are narrowed down to about 20 potential vaccines
- Phase 3: Clinical development. This stage has 3 phases.
- Phase 4: Regulatory review and approval. Takes 1 to 2 years.
- Phase 5: Mass manufacturing and delivery.
When Kenya rolled out a mass vaccination campaign to protect women against cervical cancer in October 2019, Zipporah Amisi was determined to prevent her 10-year-old daughter from getting the jab.
She was convinced the vaccine would make her daughter infertile. “I had heard in my chama that the vaccine caused infertility even though it was disguised as a cancer prevention campaign. I could not allow my daughter to take it,” says Zipporah, a 40-year-old primary school teacher in Nakuru town.
The Human Papillomavirus (HPV) vaccine was to be administered to about 800,0000 girls aged 10 years across the country.
This was not the first time that Zipporah was rejecting a vaccine. In 2014, she had refused to take a tetanus vaccine aimed at women in their childbearing years. “I was 34 years old at the time. I shunned the injection because my church said it was a stealth population control ploy,” she says.
The tetanus vaccination campaign targeted women in the reproductive ages of 14 to 49 years. It excluded boys and men and was sponsored by the World Health Organization (WHO) and Unicef.
Not much has changed since then and Zipporah says she is not sure she will get the Covid-19 vaccine. “I have my doubts about the vaccine. It was rushed. We do not know if there are any future side effects. What if it will cause recurrent pneumonia? I have read stories of people who fainted or died days after taking it. I am not sure it is safe,” she says.
Tomorrow Kenya is expecting its first batch of the Covid-19 vaccine. Kenya will receive over four million doses of the Oxford–AstraZeneca vaccine manufactured by the Serum Institute of India.
Misinformation and rumours
Zipporah is one among millions of people who are doubtful about the vaccines developed to combat the deadly Covid-19 disease. Experts worldwide have advised on the need to tackle vaccine apathy to ensure immunisation plans succeed.
Like previous vaccines such as polio, tetanus and HPV, the Covid-19 vaccine roll-out could also face vaccination apathy in Kenya.
Prof Salome Bukachi, a medical anthropologist at the Institute of Anthropology, Gender and African Studies at the University of Nairobi, explains vaccine apathy.
She says theories, disinformation, misinformation and rumours about the Covid-19 vaccine and disease will inevitably have an impact on vaccination rate.
“Various beliefs about the disease and how it can be cured have been propagated for months. There are people who think Africans are immune to the disease. Some think it can be cured through traditional methods such as herbs,” she says.
Prof Bukachi adds that perception of risk will also play a role in how people receive and perceive the vaccine. “People hardly mask up in rural areas. They perceive the disease as a ‘disease of Nairobi’. Such people will hardly go for vaccination,” she says.
Influence from political leaders will also play a major role in vaccine apathy. “Vaccination is one branch in the prevention tree. There are other branches such as masks, social distance and washing of hands in the same tree. If a leader does not mask up or advocate social distancing in his activities, the followers are less likely to do it, and even less likely to get vaccinated,” says Prof Bukachi, adding that the most probable reasoning among these followers will be ‘Why do I need to do it, when they can’t do it.’
According to the 2020 Year End Survey by Tifa Research, Kenyans differ on their willingness to take Covid-19 vaccines, but generally consider UK (Oxford-Astrazeneca) and US (Pfizer) vaccines more favourably.
The study shows nearly half of all Kenyans could accept the vaccine. The lowest level of vaccine confidence is in North Eastern region at 40 per cent. The highest acceptability was recorded in Eastern at 55 per cent, Western (55), Rift valley (55), Nyanza (54), Central (54), Coast (52) and Nairobi (52). “Eleven per cent of Kenyans said they would not get the vaccine even if offered for free, while another 47 per cent said they would not rush to get it and would instead assess the side effects first,” showed the survey.
And Covid-19 vaccine hesitancy is not only likely to be faced in Kenya. According to the 2019 Gallup World Poll, globally, France has the lowest levels of trust in vaccines. It is followed by Gabon, Togo, Russia, Switzerland, Armenia, Austria, Belgium, Iceland, Burkina Faso and Haiti.
This poll identified the reasons people shun vaccines as lack of confidence, complacency and inconvenience in accessing vaccines.
Additionally, another report shows nearly one-third of people from 19 countries that have been hit hardest by Covid-19 will have difficulties accepting to be vaccinated. "The problem of vaccine hesitancy is strongly related to a lack of trust in governments. Vaccine confidence will invariably go higher in countries where trust in governments and their handling of the pandemic is higher," said Dr Jeffrey Lazarus, the ISGlobal researcher who authored the report.
Dr Mercy Mwangangi, the chief administrative secretary at the Health ministry, has said older citizens, aged 58 years and above, are among those to be vaccinated early.
Perhaps the strategy to start with the elderly will not only protect them, but also help with vaccine hesitancy. The same report shows that it will be easier to administer the vaccine among elderly people and tougher to give it to younger people.
“The next phase of fighting Covid-19 will be on the diminished trust in a vaccine. We cannot hope to see the last of Covid-19 with a vaccine if we do not start building vaccine literacy early and restoring public trust in science,” said Prof Heidi Larson, who was among the senior coordinators of the report.
For Kenya to return to normalcy Dr Moses Masika, a virologist at the University of Nairobi, says the government should target to vaccinate as many people as possible. "The target proportion should be 80 per cent, and, or slightly lower or higher. If a large population is vaccinated, then the risk of infection will be reduced to levels that allow for the reopening of the country," he says.
Therefore, he says Kenya must combat vaccine hesitancy and vaccine misinformation on social media as early as possible. “Vaccine apathy might be less because people may generally appreciate the urgent need to remedy the Covid-19 situation. However, not everybody will be enthusiastic about it, and the government will need to share as much information on the vaccine as possible to shore up confidence,” says Dr Masika.
One of the areas of concerns has been the speed of the Covid-19 vaccine development. Usually, it takes years for a vaccine to undergo all the crucial phases for it to be approved for use by the public. This has not been the case with the Covid-19 vaccine.
In August 2020, Russia became the first nation in the world to register a vaccine against Covid-19. The vaccine, known as Sputnik V, was registered for widespread use after less than two months of human testing and clinical trials.
In December 2020, US and German pharmaceutical companies announced the development of the Pfizer BioNTech vaccine. The UK became the first country to approve the vaccine which had been tried and tested in a large pool of clinical trials. The Pfizer BioNTech vaccine was approved on December 1, 2020 for emergency use on frontline healthcare workers. This vaccine had been tested on 43,000 people.
The Pfizer vaccine scored an efficacy rate of 95 per cent. Russia’s Sputnik V vaccine has 90 per cent in efficacy. According to the journal History of Vaccines, a vaccine takes between 10 and 15 years to be fully ready. It usually goes through five stages before approval.
However, Dr Thumbi Mwangi, a researcher and infectious disease epidemiologist at the University of Nairobi, says the speed at which the vaccines were developed should not be a concern because the best technology was used.
“The Covid-19 situation was so dire that it became a concerted global effort. Resources and modern bioinformatics technologies were deployed to get a vaccine as fast as possible. Pfizer’s vaccine made from messenger RNA, known as mRNA, used the latest development technology, and has the highest rate of efficacy,” he says.
The AstraZeneca vaccine that Kenya has approved has been in the headlines after a study by the Wits Vaccines and Infectious Diseases Analytics Research Unit cast doubts on its effectiveness against the new B.1.351 strain of Covid-19.
On February 8, South Africa stopped the roll-out of the Oxford–AstraZeneca vaccine after the study’s trial that involved 2,000 South Africans showed the jab offered minimal protection against mild and moderate cases of coronavirus. By the time the country stopped the roll-out, it had acquired over one million doses of this vaccine.
But, the WHO has affirmed its recommendation of the Oxford–AstraZeneca vaccine to be used on all adults. WHO Strategic Advisory Group of Experts (Sage) made this recommendation after the South Africa case.
According to Sage, the vaccine should be given in two doses that should be administered eight to 12 weeks apart. “The efficacy of the Oxford–AstraZeneca vaccine is higher when the second dose is administered within the stipulated schedule of eight to 12 weeks between the two doses,” said Dr Joachim Hombach, the executive secretary of Sage.
The experts further noted that the vaccine should continue to be rolled out even in countries where the South African variant has been reported. “Even if there is a reduction in this vaccine’s efficacy, it should be rolled out even in countries with the circulation of the new variants,” said Dr Alejandro Cravioto, the chairperson at Sage.
In the same vein, Dr Masika said the South Africa data on AstraZeneca was based on one strain. "This does not mean the vaccine is ineffective for all the other strains," he says.
The vaccine to be rolled out in Kenya will be used in about two million people who will get two doses each. This will cover approximately four per cent of the population.
According to the vaccination plan by the Health ministry, the first phase of the vaccination will target 1.25 million people. The second phase will target 9.76 million people. The third phase will target 4.9 million people. “When the vaccine arrives, healthcare workers, teachers and the police will be among the first beneficiaries because they are now frontline workers,” said Dr Mwangangi.
Dr Mwangi, also a researcher at the Paul G Allen School for Global Animal Health at the Washington State University, concurs that this is the best strategy for the rollout.
“We would want to vaccinate healthcare workers first in order to plug any staff deficits that could arise at the hospitals. You do not want to go to a hospital and find healthcare workers missing because they have contracted Covid-19 when they could have been vaccinated first,” he says.
Health workers who understand the pandemic better would be expected to be at the frontline in taking the vaccine and advocating its use.
However, there is risk that not all health workers will willingly accept the injection. In the US, for example, the KFF Covid-19 Vaccine Monitor had shown three in every 10 people who work in the health system would not get vaccinated in December 2020. A third of all the other people who were termed as essential workers and prioritised in the vaccine queue said they would not get vaccinated.
In February this year, the KFF monitor showed that at least 22 per cent of all Americans had adopted a wait-and-see approach towards the vaccine. “One in five people say they will get the vaccine only if it is a mandatory requirement for work, school or other activities. Fifteen per cent say they will definitely not get vaccinated,” showed the latest KFF monitor results.