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While 2020 was a devastating year for global health due to Covid-19, in 2021, there was healing from the effects of the pandemic. 

Even as the recovery process continues, there are a number of issues that had been consistent throughout the year. They include:

Vaccine equity

The World Health Organisation (WHO), reports that while vaccine coverage remains highly variable across the region, only 20 African countries have vaccinated at least 10 per cent of their population, a target the health agency had set for September 2021.

Only six countries have been able to hit their end of year target of fully vaccinating 40 per cent of their citizens and 53 African countries have initiated vaccination programmes.

The successful rollout of immunisation programmes depends on the quality of the vaccine supply chain and the ability to provide a cold chain (an uninterrupted series of refrigerated production, storage and distribution activities) until the last mile.

However, with several health centres located in extremely remote, rural, hostile terrains with minimal road infrastructure, delivering an end-to-end cold chain can be challenging.

To address these gaps, various solutions have been put forward. For instance, B Medical Systems, a player in the vaccine cold chain industry partnered with Toyota Tsusho Corporation to roll out world’s first refrigerated vehicle or vaccine and cold specimen transportation in Africa.

The innovation received a Performance, Quality and Safety (PQS) prequalification from the WHO and can transport vaccines or any other specimens in a 2-8 degrees Celcius temperature range. 

 “Last-mile has always been the weakest link in the vaccine cold chain. In several regions across the world, the last mile health centres are in remote areas that are difficult to access due to the terrain and infrastructure.

We are extremely excited to bring such a solution to the market along with Toyota.

The refrigerated vaccine vehicle can easily travel through rough terrains and narrow roads delivering vaccines even to the most remote health posts, thereby ensuring an effective last-mile vaccine cold chain delivery.

The design of the solution also ensures that none of the vials are broken during the delivery process, eliminating vaccine wastage, which is otherwise common in refrigerated trucks,” said Luc Provost, CEO of B Medical Systems.

Provost believes that Africa is not lagging behind in terms of traditional vaccines the ones that were stored at four degrees temperature.

The greatest challenge is the lack of logistics and technology to carry the new vaccine to remote areas as they are of different temperatures. 

“What Africa can do is to invest in resilience structures for the health care to have robust vehicles that are not just available for the four degree vaccines, but any type of vaccines that can go into any territory where the population is located,” he says. 

While Kenya has improved in terms of access in health care, just like the other countries, it is weak in investing in bio and robustness solutions that will aid in covering the remote regions. 

“If you look at a country like Kenya, Ethiopia or Nigeria, the governments have few people in charge of the maintenance of the equipment’s. Drone delivery can also be a technological solution if done in large scale,” he says. 

Medical products production

In November last year, a Kenyan firm kept the country on the global map in a fight against Covid-19 after it became the only company in Africa licensed to produce Covid-19 vaccine syringes.

Revital Healthcare (EPZ) Limited evolved to be one of only six firms in the world approved by WHO to produce the specialized syringes.

Based in Kilifi county, the company has been operating for over 12 years now manufacturing 14 medical disposable products, including immunisation syringes, auto-disable syringes, Covid-19 testing kits, PPE kits and surgical face masks.

The local company seeks to address the lack of medical supply manufacturing capacity in Africa and is now producing over 960million syringes in a year. 

“When the pandemic hit, we were able to shift our focus and fulfill a multitude of Covid-19 specific orders in Africa by piloting our production to make viral transport medium test kits, becoming the only African manufacturer with the FDA-EVA licence approval,” says Roneek Vora, the Revital Healthcare sales director. 

“We now serve more than 20 countries producing a capacity of 80,000 test kits per day, our aim is to produce high-quality products at affordable price,” he says.

Kenya currently does not have vaccine manufacturing capacity, although the government is set to start local manufacture of Covid-19 vaccines by April this year as it seeks to cushion its citizens from future supply hitches. 

Speaking in Machakos during the inauguration of the new Kenya Biovax Institute board, health cabinet secretary Mutahi Kagwe said setting up of the vaccine production plant was meant to address the vulnerability of the country to future health emergencies as was evident during the Coronavirus pandemic that left the country as well as the continent grossly exposed from shortage of vaccines.

“As you already know, we currently import over 70 per cent of the country’s medical products.

This sometimes means we are unable to access these essential supplies due to logistical issues not forgetting that importation consumes a significant chunk of our health budget.

The Covid-19 pandemic has only exacerbated the challenges associated with lack of local capacity in this area,” Kagwe said.

Research investment

Prof Benson Edagwa,  associate professor, Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center (UNMC), Omaha., says preparing for pandemics requires investment in scientific research and development. 

“This is what developed countries have done and the reason we had the vaccine produced in record time.

We need to be able to study the evolution of viruses since most of them are a spill over from our environment. Understanding them ahead of time allows us to neutralise them before they cause harm. Africa is slowly getting there,” he says.

Together with a group of 500 Kenyans living in the diaspora, he plans to have a multi-billion project in Voi, Taita Taveta county as a vehicle to make Africa prepared for pandemics.

Under the ambitious project dubbed Diaspora University Town (DUT), the group seeks to build a university, a hospital, and schools on a parcel of land donated by the ancestral community of Voi. 

Cancer response

When it comes to cancer, more efforts has been placed in prevention and over 10,000 health volunteers have been trained to educate people on the early stages of cancer. 

“When it comes to screening, HPV testing has been rolled out in 25 counties. An eLearning platform was also launched last year dubbed Msaratani for basic modules of cancer prevention at primary health care level,” says Dr Andrew Odhiambo, a medical oncologist Nairobi Radiotherapy and Cancer centre.

There was also the launch of Molecular Imaging Center at Kenyatta University though the centre is yet to work with the machines. So far the only countries which have it in public institutions are Egypt and South Africa. 

“When it comes to offering chemotherapy, ten counties so far are equipped with the machines including Garissa, Nyeri, Machakos, Bomet, Mombasa and others.

Five years ago, the only counties where one could get chemotherapy in government facilities was in Eldoret and Nairobi,” he adds.

There are plans next year to have three regional radiotherapy centres in Nakuru, Garissa and Mombasa. This means patients from those regions don’t have to come all the way to Nairobi to access radiotherapy.

“There are also plans to have a national cancer registry and have all the centralised data for cancer patients. 

In the past, there lacked the palliative cancer care policy, but it was launched in October last year,” he says.

Malaria vaccine rollout

After a successful pilot immunization with the RTS,S malaria vaccine in Kenya, Ghana and Malawi, the WHO gave a historic go-ahead for its rollout in sub-Saharan Africa and other areas with moderate to high malaria infections.

WHO director general termed the progress as a historic moment.

“The long-awaited malaria vaccine for children is a breakthrough for science, child health and malaria control,” he said. “[It] could save tens of thousands of young lives each year,” he said in October.

The vaccine rollout received a boost last month following the decision by the Gavi Alliance Board to invest in the programme.

“The significance of these two announcements – first, the WHO recommendation, and second, Gavi’s decision to open a funding window for the vaccine – is truly historic. We need new tools to reach our global malaria targets. And now, for the first time, we have a malaria vaccine that we estimate can save an additional 40,000 to 80,000 lives of African children each year. This represents a scientific and public health breakthrough,” said Dr Pedro Alonso, Director of the Global Malaria Programme.

Pig kidney transplant in humans

Another exciting thing that happened in the renal populace last year was the successful test transplant of a pig’s kidney into a human being. 

“The pig was genetically modified and the test subject was unfortunately brain dead, so survived only 56 hours, but the kidney worked during this time and was not rejected. This scientific breakthrough is still many years away from medical use but gives us great hope for the availability of organs to be used in ill patients with organ failure,” says Dr Khalida B Soki, Consultant Internist and Nephrologist.

A major setback, however, was the National Hospital Insurance Fund (NHIF), announced the reduction of the average pay-out for a renal dialysis session from the Sh9,500 to Sh6,000. 

In a detailed circular, the national health insurer has decided to proceed with the proposals it issued in October, despite protests from the Kenya Renal Association and kidney patients.

Doctors are now warning that reducing the reimbursement would force many patients to drop out of treatment.

Already, the Kenya Association of Private Hospitals has threatened to stop rendering dialysis services to patients under NHIF cover due to the cost implications, should the proposal be effected.