State of Kenya’s vaccine uptake, obstacles and the way forward

When Dr Kate O’Brien, director of the Department of Vaccines, and Immunisation, World Health Organization (WHO)visited the country last month, Angela Oketch had a sit-down with her. Dr O'brien shared her understanding of Kenya’s position on various vaccine uptakes as well as the challenges unique to African countries and areas we can improve on. 

What was the reason behind your visit to Kenya?

I looked at the vaccine and immunisation programme of every country around the world and Kenya got my attention. It is one of the countries globally that has a good vaccination programme.  I wanted to know and witness how they do it. Coming to Kenya was a great way for me to know the support that the country needed from WHO in order to seamlessly deliver vaccines to its people.

I am here to also witness the rollout of the malaria vaccine that took 30 years to develop. It is the first time that it is available in immunisation programmes.

Kenya is one of few countries that has been deploying the malaria vaccine in its immunisation programme. It is an opportunity for other countries to learn from Kenya.

I interacted with healthcare workers to understand their experience with administering the malaria vaccine and to learn of any benefits the malaria immunisation programme had to the children through their mothers. I also had an opportunity to go to the community from house to house administering the cholera vaccine to children. That helped me have a personal interaction with them, probing them to find out if they were aware why they were taking the vaccine.

While in the field giving the vaccines and interacting with the mothers and children, what was the experience like?

This was one of the most fulfilling experiences for me. Seeing children and mothers getting vaccines that could save their lives. I was happy that the mothers had a great understanding of the importance of taking the vaccine. The greatest satisfaction I have is seeing the gorgeous smiles on the children's faces.

How is Kenya’s routine immunisation compared to other countries?

 I have had the opportunity to visit many countries and Kenya is one of the countries that has really stood out for me. It has one of the best practices with a strong immunisation programme at community level. Most Kenyans, if not all, value vaccination and understand it charts the best path forward for children in their early years and onwards to a healthy life.

The vaccine given to young girls to protect them from cervical cancer is an incredibly resilient immunisation programme in the country. What I have seen also is that during the pandemic, many countries' immunisation programmes were not well adhered to because the shift moved to Covid-19.

Somehow, Kenya managed to have a strong programme which delivered vaccines the same way it did before, during and after the pandemic.

I wanted to learn how the country did it, what challenges existed and how they overcame them. The Health ministry and the government’s commitment to prioritise and set aside resources for vaccines helped the programme as it is key in addressing primary health care services and preventing diseases.

Your assessment of Kenya is flattering. However, the country has in the past recorded a shortage of some important vaccines including the Rotavirus vaccine, why so and what can be done to ensure that this is not witnessed again?

Vaccines supply, like many commodities, is a global enterprise and producing vaccines is complex and not the same as producing medicines. Vaccines are biologicals with different complexity. Manufacturers around the world have had challenges such as quality control measures. No vaccine can be released unless it passes all the quality control measures.

This then makes countries to sometimes experience periodic shortages.

Also, the reason for the shortage is that there is a market for vaccines and different suppliers are providing vaccines at different times, they need to know how many vaccines they need to produce and how many doses of vaccines will be on a year-to-year basis. Part of the supply problem is that at times there is no clarity from countries on how many doses of vaccines they need.

My job is to work with manufacturers and partners, especially with the Global Vaccine Alliance (Gavi) for countries that need assistance with supporting vaccine procurement. I help Gavi understand how many doses are needed and to assure that the supply procured by many entities is all lining up together.

Most African countries are not in the space of vaccine production, is there a time that the continent will produce its own vaccine?

I am a supporter of Africa becoming more independent in its vaccine production. During the pandemic, we saw that regional manufacturing was one of the determinants for where the vaccine was going and its availability.

It is a great investment especially when countries come together and ensure that there is vaccine production in the continent. Production is a business that needs to be planned carefully and ensure that there is a healthy market where manufacturers can thrive. We are training manufacturers on mRNA (messenger RNA) vaccines to find a way of producing one in the continent.

Currently, do we have enough vaccines on the continent?

Yes, we do but at the moment there is a supply constraint for the malaria vaccine. We are working carefully with countries who wish to have it. For countries that have introduced it like Kenya, we have to plan on the timing of the scale-up for the programme so that it is done in a way that will ensure the doses are enough.

We are also working with other manufacturers to bring the second and third malaria vaccines.

For Covid-19, we have enough vaccines around the world and supply is not an issue anymore, my biggest worry is whether those at risk are vaccinated. There has been an ongoing effort in Kenya to ensure that those at risk are fully vaccinated. The virus is not done with us and we need to all get vaccinated to fully protect ourselves.

You are seated at the helm of a global department that ensures that lives are saved using these special commodities, what is the one thing that bothers you the most?

What keeps me awake and bothers me the most is the fact that we have other populations that are in need of vaccines yet they cannot access them.

I will only be at peace if every country around the world has access to vaccines and the vaccines are delivered to every person in need.

Africa is a continent with low uptake of vaccines, what assistance can be given to ensure that the disease burden is reduced?

African countries have incredible experience and expertise in deploying vaccines. But we should be concerned about the children who do not get even a single dose of vaccine through the routine immunisation programme.

These children are special because they live in communities with no access to services. I am working with governments to figure out where the children are living so that they come up with a package of what the children need. This is one of my priorities. I want to ensure that every country reduces by half the number of children who are still not getting even a single dose of vaccine in the immunisation programme. 

What challenges and successes have you had in your docket so far?

I have had the privilege of being in this position for the past four years, and for the first time, I have seen the world coming up with a vaccine within a short period of time. Precisely, in less than a year.

I have to acknowledge how the world came together to deliver the Covid-19 doses to the people who seriously needed them. When the world comes together, they can objectively deliver.

There were stumbling blocks along the way, which came with a bag of lessons. There was substantial inequity, we spoke out from the very first day and we ensured that vaccines are distributed to everyone.

I am glad that we have had new vaccines for diseases that had no vaccine or treatment. We had credible people, the science community coming together for one goal.

What assistance will the WHO offer to Kenya's current outbreaks?

In partnership with the Ministry of Health, we are designing a cholera outbreak vaccine response. We will provide resources to ensure that the vaccines are here. We will ensure that there is enough workforce to facilitate the process.

Parting shot?

Vaccines are safe, and effective and only work if people receive them. Vaccines alone do not save lives and do not protect the future of people, it is getting vaccinated that results in the impact.

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