Kenya COVID-19 vaccination challenges

by Enock Bett · Published June 18, 2021 · Updated June 24, 2021

Since the COVID-19 vaccines were approved, their continuous development and distribution have garnered immense global interest with many countries now in different stages of vaccination. There are now several vaccines that are in use. The first mass vaccination program started in early December 2020 and millions of vaccination doses have so far been administered. The Pfizer/BioNtech Comirnaty vaccine was listed for WHO Emergency Use Listing (EUL) on 31 December 2020. The SII/Covishield and AstraZeneca/AZD1222 vaccines (developed by AstraZeneca/Oxford and manufactured by the State Institute of India and SK Bio respectively) were given EUL on 16 February 2021. The Janssen/Ad26.COV 2.S developed by Johnson & Johnson was listed for EUL on 12 March 2021 while the Moderna COVID-19 vaccine (mRNA 1273) was listed for EUL on 30 April 2021 among others that have been listed.

As governments target to vaccinate all their populations against the ever-changing virus, there are numerous challenges along the way that have blocked the effective carrying out of this exercise aimed at achieving global herd immunity against the COVID-19. Kenya received the first batch of Astra Zeneca vaccines on March 3, 2021. The 1.02 million doses of the Astra Zeneca-Oxford COVID-19 vaccine landed at Jomo Kenyatta International Airport amid jubilations and hopes to heal following a difficult year that had ravaged the country threatening to paralyze all its sectors of economies and health. The vaccines were transported by UNICEF as part of the COVAX facility, which aims to provide equitable access to vaccines for all countries around the world. A mass vaccination exercise would later be launched but some challenges continue to affect the successful countrywide vaccination exercise.

Supply crunch

Like many African countries, Kenya is depending on doses from COVID-19 Vaccine Global Access (COVAX and the Serum Institute of India and WHO says only 1% of the 1.3 billion COVID-19 vaccines given globally have been administered in Africa so far, recommending that African countries should prioritize getting the first dose to as many high-risk people as possible, given the short expiry date of some vaccines. The Cabinet Secretary for Health, Mutahi Kagwe said that the government was exploring diverse options to plug a huge shortfall of vaccine doses and ensure high-risk groups including the elderly and essential workers are fully immunized against the coronavirus. He further added that Kenya was leveraging the acquisition of vaccine doses from neighboring countries alongside donations and purchases from different manufacturers to ensure inoculation against the virus does not stall amid the global supply crunch. But that hasn’t turn out well considering the COVID crisis in India has scuttled the plans to procure enough doses as most of them were diverted for domestic use.

Rollout challenges

Kenya adopted a phased approach to the vaccine roll-out with Phase I covering the period February 2021-June 2021. The target was to vaccinate frontline health workers and other cadres in priority sectors to cover 1.25 million people as per the availability of the vaccine. Phase II, according to the plan was to cover the period July 2021-June 2022, targeting about 9.7 million populations with the most risks of getting severe diseases. Phase III would then cover the period July 2022 to June 2023 focusing on populations in congregate settings while ensuring equitable vaccination of other vulnerable groups.

This plan has not been achieved as the target group was expanded to include all Kenyans older than 58 years shooting the original possibility of vaccinating 1.25 million people to about 3.2 million in the same time. Given the unavailability of enough doses, which wasn’t possible as of June 9, Kenya has only administered slightly over 1.03 million doses of coronavirus.

The challenge of access to sufficient doses versus hesitancy

You know there is a big challenge in balancing between very little doses and hesitancy by the citizens to get the vaccines. In trying to address both challenges simultaneously, the government is struggling to prioritize the high-risk groups while at the same time encouraging the general public to be very free to uptake the limited doses. That suggests why some people that you would assume were not vulnerable have been vaccinated while the ones at high risk haven’t. There is also the challenge of accessing the vulnerable groups especially in the rural sides of the country. Finding the correct documentation of people’s locations, ages, and up-to-date information on which people had existing conditions can be considered a major challenge in rolling out the vaccines. That still suggests why there is a random vaccination against the set phases.

Vaccine safety concerns

Like many other countries, concerns regarding the safety and efficacy of COVID-19 vaccines, as well as myths and misinformation, have been spreading fast on social media in Kenya. The many cases of adverse side effects that were reported in Europe and the United States of America including the wide suspension of the use of the AstraZeneca vaccine for reports that it caused blood clots posed a major challenge in the trust of this vaccine by the general public. AstraZeneca is currently the only available vaccine in Kenya. Pharmacy and Poisons Board (PPB) announced in April that 279 people had suffered adverse effects after taking the Oxford-AstraZeneca coronavirus vaccine. After some hours, the board later recanted and said that “there was a misreporting of an adverse event following immunization (AEFI) as fatal. These kinds of doublespeak by the authorities are obviously not taken lightly by Kenyans.

COVID-19 vaccine regulatory unpreparedness

In Kenya, the Pharmacy and Poisons Board (PPB) is charged with the responsibility of regulating the practice of pharmacy and trade in health products and technologies. The core mandate is to ensure the provision of quality, safe, and efficacious medical products, and health technologies. The law requires that all drugs and vaccines must receive prior approval before use in Kenya including the COVID-19 vaccines. The government said that COVID-19 vaccines that have already received approval from stringent regulatory authorities (SRAs) or WHO would be expedited for approval within seven (7) days, upon application by the manufacturing company or their agent.

Now that Kenya heavily relies on the World Health Organisation (WHO) for approvals, it is hesitant to allow other private vaccines such as Sputnik, Sinopharm, and Sinovac that have been rolled out in other countries despite lack of WHO approval. The barring of private companies from shipping and administering the COVID-19 vaccines by the Kenyan government is a big challenge to citizens getting access to more vaccines. There is a need for the Ministry of Health to work closely with the private sector to develop a comprehensive framework that ensures other safer vaccines are purchased, approved, and supplied to Kenyans that can afford them at reasonable prices. This can only be done through strengthening the Pharmacy and Poisons Board so that Kenya doesn’t have to wait for the WHO or other European regulatory authorities.