Tough balancing act: Inside Kenya’s Covid vaccine plan

This year began with a wide ambition; to get as many people as possible vaccinated against Covid-19.

The vaccines are new and their development has been expedited to mitigate against the pandemic. Ordinarily, vaccine development takes approximately 15 years.

In a world of 7.8 billion people, a total of 16 billion vaccines are required to get everyone vaccinated which means that given the mad rush to get the vaccine not everyone will get vaccinated this year.

Here in Kenya, the government has announced it will vaccinate as per the African Union (AU) guidelines, which state that frontline workers will have priority to receive the limited doses of vaccine ordered.

The country is so far looking at three channels of acquiring the Covid-19 vaccine, all by the end of the first quarter of the year.

The Health ministry has said it has ordered 24 million vaccines through the World Health Organization (WHO) and Gavi, the Vaccine Alliance, which is looking to securing vaccines for poor and middle-income countries such as Kenya.

Extremely cold temperature

Health Cabinet Secretary Mutahi Kagwe says Kenya has already ordered 24 million doses from AstraZeneca as the country looks to partner with Chinese organisations that develop the vaccine that is cheaper, safe and efficient.

He says compared to others, the Oxford/AstraZeneca jab is far cheaper and easier to store and get to every corner of the world.

“We are currently carrying out tests with Kemri Wellcome Trust and we are relying on the Oxford/AstraZeneca vaccine that can be stored in a normal fridge unlike Pfizer’s jab - which has to be kept at an extremely cold temperature (-70 degree Celsius). This makes it much easier to distribute,” he says.

The 24 million doses will cover 20 per cent of the population. They will be acquired through the Gavi Covax facility, which is a programme through which demand and resources are pooled to support the availability of, and equitable access to Covid-19 vaccines for all countries. Covax is co-led by WHO, the Coalition for Epidemic Preparedness Innovations and Gavi.

The programme is the main global scheme to vaccinate people in poor and middle-income countries around the world against the coronavirus. It aims to deliver at least two billion vaccine doses by the end of 2021 to cover 20 per cent of the most vulnerable people in 91 countries, mostly in Africa, Asia and Latin America.

Through this programme, Health Chief Administrative Secretary Mercy Mwangangi says people will be vaccinated with two doses each at first. A total of 1.2 million health workers will be vaccinated, 5.2 million elderly people and 1.4 million people with comorbidities will be vaccinated.

“The rationale for the priority target populations is aligned with WHO-SAGE recommendations and the roadmap for prioritising uses of Covid-19 vaccines in the context of limited supply. It has been adapted to country context through consideration of local Covid-19 epidemiology data,” says Dr Mwangangi.

The vaccination will be done according to the existing routine immunisation mechanisms. It is expected to be offered in hospitals and supplemented with targeted outreaches at the community level.

Buy tea and snacks

The Oxford/AstraZeneca vaccine is said to provoke an immune response in people of all ages, including people over 55.

Unlike Pfizer vaccine, which announced one figure, showing its vaccine was 90 per cent effective, Oxford/AstraZeneca presented three different figures.

The first figures showed that overall, the vaccine was found to be 70 per cent effective, the second one shows that for the majority of people in the trial who got two full doses the figure was 62 per cent. Lastly, for a small group who got a half dose and then a full dose, that figure was 90 per cent.

However, even the lower 62 per cent figure is a better result than the best flu jab, which is about 50 per cent effective.

The vaccine trials show that no one was hospitalised or got seriously ill due to Covid-19 after getting the vaccine.

Kenya will also buy vaccines worth Sh10 billion to cover an additional 10 per cent of the population. The government says the additional funds can be drawn from domestic resources and or multilateral development banks financing such as the World Bank to support these cost-sharing contributions.

The Gavi indicative prices for all vaccines available through the Covax facility is $7 (Sh772) per dose. This means the portion of Sh1 billion donated by the World Bank last year for emergency response, including procurement of personal protective equipment, medicine and setting up of isolation facilities but was used for leasing ambulances, buying tea and snacks as well as airtime by the Health ministry, could have gone a long way in securing extra vaccines for the country.

A breakdown of Sh1.3 billion spent in the fight against the Covid-19 pandemic includes Sh42 million for leasing ambulances, Sh4 million for tea and snacks, and Sh2 million for airtime. The Sh48 million would have secured vaccines worth $62,366.

The third source of the vaccine will come from the African Union (AU), which has secured a deal to procure 270 million doses of the same for all member states.

Through this programme, Kenya is expected to receive 11 million additional doses of the Covid-19 vaccine.

AU chairperson, South African President Cyril Ramaphosa, says the funds for the vaccine will be sought by the African Vaccine Acquisition Task Team. The team will seek the funds through financing options such as special drawing rights that different countries have which will raise between $1.5 billion to $2 billion.

There is also the Africa Export-Import Bank (Afrexim Bank), which has put aside a facility for $5 billion. The World Bank and the African Development Bank have also put aside money for countries to borrow.

Ahmed Ogwell, the deputy director, Africa Centres for Disease Control (CDC), says they have completed negotiations with Pfizer, AstraZeneca and Johnson & Johnson. He adds that by the end of the first quarter of the year the continent may end up with 10 vaccines that will have received emergency approval.

Remove barriers

He says vaccines from China are also an option as long as they pass the safety and efficacy test. “We want to see who will give us the best deal and we will be talking to all manufacturers, including China. We want to ensure the safety and efficacy of the vaccine,” he adds.

Africa has a population of slightly over 1.2 billion and the continent needs at the very least to have 60 per cent of the population vaccinated, which is about 800 million individuals. If it is a double dose as most vaccines are, then the continent will need to acquire 1.5 billion doses of the vaccine.

Dr Ogwell says this means the continent will need upwards of $15 billion just to buy the vaccines. “With the $15 billion, we have not factored in the transport cost, which syringes, needles and swabs are needed, how to dispose of them, how we are going to document who has gotten which vaccine, how we are going to monitor whether they are going to have adverse reactions or not.

We estimate that we will need another $10 billion to do the other things that are required for vaccination to happen,” he says.

Their main focus is to ensure access to the vaccine to be equitable and not tied to where a country or an individual is around the world.

This, Dr Ogwell says, will be made possible through the Africa vaccine development and access strategy. Its main objective is to accelerate African involvement in vaccine development, ensure Africa’s access to sufficient supply and remove barriers to vaccine delivery and uptake.

This means that Africa has positioned itself to participate in any clinical trials and research towards identifying a vaccine that works.

To this end, the continent has set up different sites for trials for various vaccines and therapies for Covid-19. Dr Ogwell says the Africa CDC has insisted that any manufacturer who would like to engage with Africa must have a trial site in the continent to be able to see how the vaccine interacts with the population.

So far, there are 14 sites for trials in Africa and Kenya is among the countries that have one located at the Kenya Medical Research Institute (Kemri) Wellcome Trust in Kilifi. Kemri Wellcome Trust is leading the study for the Oxford/AstraZeneca vaccine that has enrolled 24,000 participants from across the world, including in the UK, South Africa and Brazil.

In ensuring Africa has access to sufficient supply of the vaccine, the AU has estimated that at least 60 percent of the population needs to be vaccinated to reach levels of immunity that would allow people to go on with their lives in the new normal.

Risky strategy

Dr Ogwell says the AU is also going to remove all barriers to vaccine delivery such as money, uptake and acceptance by the public and ensure the supply chain is secured.

The rush to get the vaccine is intense and countries such as the UK, which hopes to get their entire population vaccinated by the end of the year, have approved the measure to increase the period between the prime and booster jabs from the recommended three-to-four week interval to 12 weeks.

The UK is planning to postpone giving the second dose of both the Pfizer/BioNTech and the Oxford/AstraZeneca vaccines by up to 12 weeks – twice the length of time for which there is data, according to the WHO.

WHO, however, has joined Pfizer and BioNTech in warning against delaying the second dose of their Covid-19 vaccine.

Pfizer’s phase three final trial showed people began to be protected from 12 days after one vaccination – but nearly all were given two shots within three weeks. “There are no data to demonstrate that protection after the first dose is sustained after 21 days,” says the company.

Dr Moses Masika, a virologist in Kenya, says although he is certain that not everybody in the country will have access to the vaccine by end of this year, this is not a strategy the country should employ.

“The initial one gives you a 70 to 80 per cent response and the booster takes you to 90 per cent. It is for this very reason that we give the measles vaccine twice. However, this method has not been proven to work yet… they are banking on the fact that the initial dose will give some level of efficacy,” he says.

No evidence

The other option countries are exploring is combining vaccines to boost efficacy. In December, AstraZeneca said it would soon start work with Russia’s Gamaleya Institute to investigate whether their two coronavirus vaccine candidates could be successfully combined.

The announcement came shortly after the developers of the Sputnik V Covid-19 vaccine approached AstraZeneca via Twitter late last month to ask whether they should try combining the two common cold virus-based vaccines to boost efficacy.

Data published in The Lancet medical journal this week showed AstraZeneca’s vaccine has an average efficacy of 70.4 per cent, based on the pooling of interim data from late-stage clinical trials.  The vaccine was also found to be safe and effective.

Russia has claimed Sputnik V is over 90 per cent effective in preventing people from contracting the virus, citing preliminary results from ongoing trials.

But, Dr Masika says there is no evidence combining will help in terms of boosting efficacy.

Given the different options and the desperation surrounding the need to have all Kenyans vaccinated, Dr Masika says the country needs to be aggressive and look to the east to countries such as China without compromising the safety.

He adds that the country is likely to have more than one vaccine in circulation and this means that protection will be largely similar for all emergency Covid-19 vaccines.

However, he says there has to be well thought out logistics laid out to make sure that data is collected to find out how the vaccine is working and ensuring that there is no confusion in terms of who gets which vaccine.

He recommends ensuring that a hospital offers one type of vaccine to avoid any confusion with the different jabs that are expected in the country.