Slow uptake of Covid-19 vaccine hampers Kenya's vaccination programme

Covid-19 jab

Ann Boraya, a nurse, administers Covid-19 vaccine to the Covid Taskforce Chairman Willis Akhwale at Mutuini Hospital in Dagoretti South, Nairobi, on March 9, 2021.

Photo credit: Kanyiri Wahito | Nation Media Group

A little over 50,000 people have received their first dose of the coronavirus vaccine, two weeks since Kenya launched its vaccination programme.

More than a dozen of these are politicians who have jumped the Covid-19 vaccination priority queue to receive this first dose. This is despite President Uhuru Kenyatta and Health Cabinet Secretary Mutahi Kagwe insisting that medical professionals would be prioritised to receive the first doses of the vaccine, which arrived in the country two weeks ago.

'Leading by example'

In the last week, some politicians and governors have gone ahead of the health care workers targeted with the initial doses, claiming that they are leading by example.

“The vaccine will be first given to our health workers to protect them. Even I will wait for my turn and will not jump the queue,” said Mr Kenyatta, 59, recently.

Machakos, Makueni, Kiambu, Nyeri, Kakamega, Meru, and Vihiga county governors were the first people to be vaccinated in their respective counties as soon as the vaccine arrived, taking up doses meant for health care workers.

Some non-health care government officials in Kenya, however, have had to shelve their vaccination plan and await their turn after their announcements to be inoculated were met with public criticism.

Among them is government spokesman Cyrus Oguna, whose invite to the press to witness his vaccination irked a number of social media users, forcing his office to call it off.

“When we met with the Council of Governors, they [governors] said that they will be vaccinated as a way of boosting confidence among their constituencies. Once the vaccine leaves the national depots to counties, we have no control of how they are deployed,” said Dr Willis Akhwale, chair of the Covid-19 Vaccine Advisory and Deployment Task Force.

Now, the Ministry of Health has resolved to ‘punish’ hospitals found to offer Covid-19 vaccines to people who are not on the priority list after it emerged that the country was offering the vaccines to all diplomats living in Nairobi, despite not completing inoculating health workers, other front-line workers and the elderly.

Priority list

According to the national Covid-19 vaccines deployment and vaccination plan, the country was to initiate Phase 1 of inoculation between February and June 2021, targeting 1.25 million people, key among them frontline health workers and other cadres in priority sectors.

This means that the country ought to be vaccinating about 300,000 people in this priority group monthly if it is to meet its target.

Due to the global vaccine supply shortage, the World Health Organisation (WHO) advised countries to vaccinate all health workers in the first 100 days. The aim was to protect the health care workers, who are at the highest risk of infection and death from Covid-19 due to increased exposure to the virus.

Dr Githinji Gitahi, CEO at Amref Health Africa explained: “The vaccine priority list is a way of ensuring the following principles are met in the face of limited access - target individuals at the highest risk of death, at the highest risk of hospitalisation, and those in most frequent contact with cases.”

The country anticipated that initial vaccine supply would be limited, so when the first shipment of 1.02 million doses delivered by Unicef through the Covax initiative landed, there was a unanimous agreement that health care workers in all cadres would be offered the vaccine as a priority. The next group would be teachers, non-teaching staff and uniformed officers. The country received an additional donation of 100,000 doses of the Oxford/AstraZeneca vaccine, supplied by the Serum Institute of India.

Slow execution

On paper, said Dr Githinji -- a member of the vaccine deployment task force -- the plan was great, but the execution has been slow. Then, pictures of politicians receiving their first doses and people who were not on the priority list standing in long queues at some vaccination sites, including at Afya House, began to pop up on social media.

“By people who don’t fall in this [priority] category taking vaccines, they deny someone in this category a vaccine, which is similar to a country horsing its vaccines for the low risk while other countries have no vaccines for their high-risk populations,” noted Dr Githinji.

If everything went according to plan, Dr Akhwale said, the 622 vaccination sites across the country ought to be vaccinating at least 15,000 people daily.

However, two weeks into the vaccination campaign, only about 2,000 people are vaccinated daily, culminating in about 40,359 people categorised by the Health Ministry as frontline workers. Further, almost half (590,000) of the vaccine doses are still lying idle at the national vaccine depot.

Dr Were Onyino, president of the Kenya Medical Association (KMA), agrees that “we should have seen an increase in the number of health workers vaccinated so far.” This, however, is not the case, because “the ministry didn’t involve the people who were to be the first recipients of the vaccine from the start. This affected the uptake,” he insisted, even as Dr Akhwale said that the professional associations representing health workers have been engaged.

Rising Covid cases

In the meantime, the country’s Covid-19 infections continue to rise, pushing up the number of cases to 122,040 with 2,023 recorded deaths.

Globally, the Covid-19 vaccine programme is designed to ‘tame’ the virus by reducing its ability to cause severe symptoms and death.

“I am seriously concerned about the speed, while the pandemic is killing people. Vaccines deserve to be in peoples arms not stored and that’s our sole purpose,” said Dr Githinji.

One of the reasons cited for the low and slow uptake of the shots is growing reluctance amongst some health workers who have expressed doubt about the safety of the vaccines. According to various health professionals’ representatives, a lack of sensitisation and training by the government is contributing to a reluctance to embrace the injections that have been scientifically proven to be safe and effective.

However, the recent peak in cases of infections and deaths, coupled with increased access to information about the safety of the vaccine, has seen more health workers embrace the vaccine, noted Dr Onyino.

“More doctors have come out to take the vaccine and seeing that most of them haven’t reported any serious side effect, other health professionals have also come out to get the shot,” he said.

Controversy 

The AstraZeneca vaccine being used in the country has faced some challenges internationally that have eroded confidence in the shot, following news of possible rare, serious side effects. Last week, at least a dozen European countries paused on administering the vaccine following reports of rare strokes called cerebral venous sinus thromboses (CVST) and blood clotting in people who had received it.

But on Thursday, the European Medicines Agency (EMA) said that while it could not rule out that the symptoms were connected to the vaccine, the benefits strongly outweighed the risks, and as a result, the countries resumed using the Covid-19 vaccine. On Monday, the company released the latest trial data that showed the jab is 79 per cent effective in preventing someone from developing symptomatic Covid-19. The vaccine was also found to be “100 per cent” effective at preventing people from falling seriously ill and getting hospitalised and had no safety issues reported.

For Dr Akhwale, hesitancy to get the vaccine has not been as big an issue compared to the fact that the shot, given in two doses four weeks apart, is being offered on a voluntary basis, making it a personal choice for people to take it or leave it.

“Health workers are the people who should have access to information but if a health worker decides not to get the jab, what can we do?” he asked.

The sluggish uptake of the vaccine -- which has a short expiry date of June -- amongst the frontline cadre it was preserved for has seen the deployment task force opt to move to the next group of people targeted for vaccination -- those above the age of 50 and those with underlying health conditions.

“The problem is that the priority plan became a bottleneck -- that’s what needs to be cleared so we open up beyond the current priority group,” said Dr Githinji.

Kenya plans to vaccinate 30 per cent (or 15.8 million) of a total population of 49,070,876 by the end of June 2023 in three phases.

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