Education level a major influence on jab uptake in Kenya

An analysis of Covid-19 vaccination rates in the country suggests one socio-economic factor, more than others, is correlated to vaccine uptake. And it is not income, language or cultural barriers.

It is education.

An individual’s level of education, the Ministry of Health data shows, has the strongest effect on willingness to get the vaccine.

A review of the data by Nation Newsplex in partnership with Healthy Nation indicates that a high level of willingness to get the Covid-19 jab among people who have more than a high school certificate.

In the 47 counties, which reported vaccination data by age and profession, almost without exception, those who have had little to no education accounted for the smallest share of vaccinations compared to their share of Covid-19 cases and their proportions of the total population.

Dying from Covid

Likewise, people with lower levels of educational attainment are more likely to experience financial insecurity, live in overcrowded housing, work in frontline jobs, and lack access to adequate health care –all factors that increase their likelihood of contracting or dying from Covid-19.

This presents a particularly tricky challenge for those trying to combat vaccine hesitancy, especially as demand for first doses in the country appears to be waning.

The uptake of the second dose among those who received their first dose is at 50.7 per cent, while the proportion of adults fully vaccinated is 8 per cent, despite the government’s ambitious target of having 10 million people fully vaccinated by Christmas.

Educational level has proven to be a significant factor in people’s views about vaccine safety and efficacy. On average, Kenyan adults with at least a bachelor’s degree view the vaccine as safe and effective than those with less education.

So far, Nairobi, which leads in the share of number of people fully vaccinated in the country, with one in every five of the target population fully vaccinated, also leads as the county with the highest share of its population having attained university education.

Among the top five counties with the largest share of their targeted population vaccinated are Nairobi 22.4 per cent, Nyeri (19.2 per cent), Kiambu (12.7 per cent), Taita Taveta (10.5 per cent) and Nyandarua (10.3 per cent).

Kajiado (7.1 per cent), Uasin Gishu (9.6 per cent) and Kisumu (8.8 per cent) are among the top 15 counties with the highest share of their targeted population fully vaccinated.

At the same time, the top five counties with the highest share of their population having attained university education are Nairobi (8.8 per cent), Kiambu (6.9 per cent), Kajiado (5.1 per cent), Uasin Gishu (5 per cent) and Kisumu (3.9 per cent).

Overall, at the time of the analysis, adults with at least a bachelor’s degree had been vaccinated or planned to get vaccinated, compared to just a fraction of those with less education.

In other words, a college degree is associated with an increase in the likelihood that someone will get the vaccine. This is evident in the bottom five counties that have the least share of their population fully vaccinated – Garissa (1.5 per cent), (Mandera, 1.4 per cent), West Pokot (1.3 per cent), Wajir (1.2 per cent) and Marsabit (1 per cent), also have the lowest share of the population having attained university education.

The bottom five counties with the least number of their population having attained university education are Turkana (0.6 per cent), Tana River (0.5) per cent, Garissa (0.5 per cent), Wajir (0.4 per cent) and Mandera (0.3 per cent).

According to a knowledge attitude and practice survey conducted by the Health ministry to understand vaccine hesitancy in the communities, nine in 10 Kenyans are keeping off the vaccine due to fear of side effects, indicating a knowledge gap in the vaccination drive.

Experts say that it is not a surprise that people with higher levels of formal education tend to express more willingness –even eagerness – to get vaccinated against Covid-19. They say that as vaccine supplies increase, ensuring that higher-risk people get vaccinated as quickly as possible is a public health priority.

Academic achievement

Dr Willis Akhwale, the head of the National Covid-19 Vaccine Deployment Task Force explained that a person’s highest level of academic achievement should not be confused with their intelligence, and that there is misinformation among those who do not have access to information about the Covid-19 vaccine.

“There is a lot of misinformation on Covid-19 vaccine and that is why education campaigns are important and need to be sustained for acceptability and use to ensure the vulnerable are vaccinated,” he said.

This is especially true among the elderly who he says despite falling under the vulnerable category and being prioritised to receive vaccines, tend to shy away from taking it. He added that it was puzzling that a number of people who fall under this vulnerable group are not willing Covid-19 jab given that out of the 5,314 deaths so far, they form the largest proportion.

Dr Akhwale explained that these deaths among the older generation occurred through all the waves, but more were recorded during the Delta variant outbreak in the third wave.

Misinformation

Halima Hussein a 50-year-old Mandera County resident, is among those who have suffered misinformation. According to her, the vaccine is not suitable for people with hypertension, which she has. This is information she got from the women’s group she attends.

“I’ve been told that if I take the vaccine, and I have an underlying condition, it will worsen that condition. That is why I have not taken the jab until now,” Ms Hussein said.

Ramadhan Wario, who takes care of his elderly mother, has also not taken the jab. He said older women have succumbed to complications from the vaccine.

“We have lost old women around here from Covid-19 vaccine complications. They become very sick after the vaccine so I am afraid of taking my mum for the vaccine,” he said.

Asked why he has not taken the vaccine himself, Mr Wario said that the vaccine gives you the virus.

“I have heard the vaccine is made of Covid-19 so that means when I get the vaccine I get Covid-19 and that is even why the old women are dying after vaccination,” he explained.

Both Ms Hussein and Mr Wario have the wrong information. The Covid-19 vaccine has been shown to be safe for those with underlying conditions as well as the elderly.

Religion

Some Catholic church doctors have also raised objections against the Covid-19 vaccines, although they insist their objections are based on science and not religion.

“As long as there is medicine available for any disease then there is no need to develop a vaccine. In Europe and Israel, where 70 per cent of the population have been vaccinated, we are still seeing them resort to lockdowns and back to getting medicated, which is what should have been done in the first place,” said Dr Wahome Ngare of the Catholic Doctors Association.

The bottom five counties with the least number of vaccinated people in the country are majority Muslim. For example, Mandera, Wajir and Garissa have the biggest share of Muslims, with nine in 10 residents being Muslim. These counties have less than 2 per cent of their populations fully vaccinated.

It is however not an Islam issue only, despite Isiolo having seven in 10 of its residents being Muslims,  1.5 percent of their population has attained university education while 2.4 per cent of the target population is fully vaccinated.  This puts the county at position  38 out of the 47 counties in terms of vaccination.

Hassan Ole Naado, the deputy secretary-general of the Supreme Council of Kenya Muslims (Supkem) agreed that it is not a religious issue when it comes to the north, but rather circumstances.

“Droughts have been a great issue for the people of the north and it would be very unfair to go to a hungry person and start talking to them about vaccines instead of offering water or even food.

“This is why we suggest that they perhaps offer food and other provisions then talk to them about the vaccines,” he said.

Accessibility

Mr Naado further explained that some county governments do not go the extra mile to get the vaccines to the people, especially if the county is vast and vaccination points are far apart, making it hard for the residents to access them.

This is evident even in the Health ministry strategy, which is limited due to the storage requirements of the vaccines.

The distribution of Pfizer/BioNTech and Moderna, which use RNA technology and therefore need to be kept at very low temperatures, is dependent on the availability of cold chain storage. This only currently available in Kitengela, Nairobi, Eldoret, Kisumu, Mombasa, Nakuru, Nyeri, Meru and Kakamega.

The two vaccines can only be distributed to areas that are within a maximum of seven hours travel from these regional depots. Garissa County is expected to receive the two vaccines when a specialised deep freezer suitable for the climatic conditions is shipped into the country.

But the number of vaccination centres seems to have little effect on vaccine uptake. Despite Nyeri being among counties with the least number of vaccination centres (three) it is the second county with the highest share of its targeted population fully vaccinated. Turkana, which is among those with the least share of its targeted population fully vaccinated, has 14 vaccination centres.

Gender

Lastly, we found that gender also influences vaccine acceptance, with adult males showing a higher willingness to get vaccinated. Out of the total number of people who are vaccinated, males were 53 per cent while females were 47 per cent.

Of the total, those attained university educations were 58 per cent male and 41 per cent female.

Reporting by Nasibo Kabale, Amina Wako and Brian Osweta