In this interview, Jackline Kiarie, Programme Manager, Amref Health Africa who is coordinating the Covid-19 vaccine rollout efforts within Amref Kenya Country Office, highlights lessons we can learn from other successful immuunisation programmes.

Milliam Murigi @millymur1

Last week, the world observed Immunisation Week, set aside to promote the use of vaccines to protect everyone against disease.

With the theme, Vaccines Bring Us Closer, the celebrations came at a time when discussions about Covid-19 vaccine, its manufacture, distribution, use and effects have geared up. 

With a few countries on the way to vaccinate almost all of their population, concern has been raised over inadequate or lack of vaccines for countries in Africa, Asia and Latin America. 

Many stakeholders under the banner of People’s Vaccine are calling for provision of the vaccines to everyone as a global common good, with distribution guided by open source patents that would allow manufacture of the vaccine across the world. 

In Kenya, the Covid-19 vaccination drive has been met with confusion, hesitancy and lack of coordinated information as ineligible people were able to get the vaccines meant for first phase that included healthcare workers and security and immigration officials, citizens over age 58 and adults with certain medical conditions. Now concerns over shortage of the vaccines have also surfaced.

Against this background, we talk to experts in the field to highlight issues surrounding vaccination in Kenya and around the world.

As the country continues to roll out Covid-19 vaccination, what can we learn from other successful vaccination programmes such as polio?

First, we can learn that for any programme to be a successful, political will must be there.Political will ensures the coordination structures are in place, resources are committed and policies are enforced.

There is also a need for stakeholder and community engagement because involvement of all stakeholders from national to decentralised county levels will keep them in the know in a timely manner for smooth planning and coordination.

The community needs to be engaged to ensure people understand the importance of vaccination for good uptake.

There’s been euphoria the pandemic is almost over. Yet at the same time, we keep hearing about new variants of the virus. How does that change planning for this?

We can only learn from global experiences. We are seeing reduced numbers in countries that have managed to vaccinate a good percentage of their population and vice versa.

We should, therefore, be keen to increase the vaccination coverage, observe public health measures on Covid-19 prevention and prepare our health system for the worst. Prevention and preparation is key.

So, should the arrival of new variants be a concern to Kenyans?  And does this mean we’re going to need a new vaccine? 

Viruses constantly change through mutation, so these variants are quite as expected.

So far, there’s no scientific data indicating vaccines we have out there cannot handle the current variants circulating. However, research is ongoing and including continued vaccine developments to ensure they are responsive to emerging needs.

We have seen reports of emerging variants in other regions across the world, such as the UK, South Africa, Brazil and India variants, we are not safe since we live in a global village.

There’s a need for continued collaboration on research, especially on genomic sequencing to identify the variants before they become a threat to humanity.

Having said that, it is an important and urgent reminder that nobody is safe until everybody is safe. And that means we need to vaccinate everyone.

The ministry has done a lot of work in the past around public trust. How are we doing on that front in terms of people trusting the efficacy of the vaccine? 

Unfortunately, we are living in a period of easy access to information, what is being referred to as an infodemic.

We can’t control what kind of information people access, but we can ensure they know where to go for correct information.

The government has ensured that daily briefs in regards to the pandemic are availed, in addition to the government website.

Health officials at the community level are also actively involved in engaging communities through local radio stations, a channel that has been identified as critical in access to health information.

Community members have also been advised to reach out to the nearest health facility, reach out to the Pharmacy and Poisons Board through hotline numbers such as *719# to report any concerns on the vaccine.

Is Covid-19 vaccine going to be an annual vaccine like the flu or a “one-time” or “every 12 years” kind of schedule? 

There’s an indication that immunity induced through natural exposure wanes off after 90 days hence the need for the vaccine.

Unfortunately, we are still not sure of the durability of the immunity induced by the vaccine, we just know it prevents hospitalisation and death for the majority of the people taking the vaccine.

 Some countries such as the US are already making going for the third booster dose, so let’s wait and get the official position from the World Health Organisation.  

What lessons have we learnt over the past few months since the vaccination exercise started?

We could have done better in community engagement to ensure that our communities understand why the Covid-19 vaccine is important, training health care workers in good time before the vaccine rollout could also have added another layer of ‘vaccine ambassadors’, which would have helped a lot in improving vaccine confidence and ultimately the uptake amongst priority populations.

It’s possible that in a couple of months we’ll not just be talking about managing a supply chain of one vaccine, but actually two or three different vaccines. What is the government strategy, and logistically, how will it keep track? 

Due to the special storage requirements of some vaccines, Pfizer, for example, the government is already making plans to ensure minimal wastage once such vaccine become available.

Unfortunately, all these services rely on the same national immunisation programme infrastructure, the government is, therefore, closely monitoring the roll-out of Covid-19 vaccination programme as well as service provision for other programmes such as childhood immunisation to ensure minimal interruption and hence prevent another catastrophe in the near future.

Do influencers have a role to play in Covid-19 vaccine acceptance campaign considering that previously they had played an important role?

Yes, different audiences are being targeted in this vaccination campaign and, therefore, very useful to use different channels such as radios and TV, opinion leaders, community engagement structures as well as influencers in making correct information available in a timely manner.

We have rolled these vaccines to market/patients faster than any other public-health intervention we have ever seen before. What insights have we gotten from this?

I think the underpinning insight is that it took collaboration between different stakeholders to get to where we are today. Timely planning and coordination across all levels are critical.

However, planning should include microplanning to ensure all necessary functions are covered for smooth roll-out, community engagement is also critical to ensure good uptake and overall reduce wastage.

What challenges we are facing with regard to the vaccine supply? 

Externally, we are facing the supply challenge and unfortunately, we cannot control this.

Resource allocation to enable us purchase from different manufacturers would be crucial even as work towards improving our vaccine manufacturing capacity as country and continent.

Internally, we are facing a challenge of data management, which is critical in any vaccine roll-out programme because it ensures that we can account for the vaccines supplied and distributed, number of people immunised, and overall coverage of the programme. 

Currently, some counties are struggling to account for vaccines acquired from the central storage facilities making it difficult to account for the number of people immunised, vaccines in their custody, and therefore ability to order more stock.

Strengthening this will ensure that we resolve emerging bottlenecks, monitor vaccine uptake, and determine how successful the vaccination programme will be in the end.