By Samwel Doe Ouma@samweldoe
Delays and shortages of vaccine supplies are driving African countries to slip further behind the rest of the world in the COVID-19 vaccine rollout, and the continent now accounts for only 1 per cent of the vaccines administered worldwide,” the WHO warned
Less than two per cent of Kenya’s population of more than 50 million have had their first shot, according to Our World in Data.
According to data from the Ministry of Health, in its first round of vaccination, only 991,184 doses from the approximated 1.2 million total doses of AstraZeneca jabs were administered as well as 527 sputnik shots. Fewer than half a million people in Kenya have received the second dose.
Kenya received just over 1.2 million of the 3.6 million AstraZeneca doses promised by the global vaccine-sharing alliance COVAX by May.
Kenya’s low rollout is, despite a steady parade of ‘variants of concern’, brandishing mutations that might boost the virus’s spread, or undermine the effectiveness of already developed COVID-19 vaccines.
Variants like, the Indian delta variant (B.1.617), the (501Y.V2) variant, which first emerged in South Africa, (P.1) variant first detected in brazil and the (B.1.1.7) United Kingdom have been detected in the country.
Christian Happi, Director of the African Center of Excellence for Genomics of Infectious Diseases (ACEGID) in southern Nigeria, said African countries should strive to immunize as many people as possible before dangerous variants able to elude shots emerge.
“My big concern is that if vaccine nationalism continues, and if people [in Africa] are not vaccinated early enough, the virus will keep mutating and as the virus keeps mutating, we may end up having a virus that is completely resistant to all of the vaccines out there,” he said.
According to Dr John Masasabi, Kenya’s low vaccination uptake is partly attributed to vaccine hoarding by wealthier nations, delivery delays, inability to self-procure and or locally manufacture its vaccines thus depending on donations, low vaccination capacity and lack of clear-targeted communication.
The country seems to rely on getting its vaccines through the global COVAX scheme-the idea behind it being pooling resources to support the development of vaccines to ensure that all countries received a fair supply of effective vaccines.
However, wealthier nations have seemingly stymied its effectiveness by doing deals with manufacturers guaranteeing themselves a supply meaning COVAX has struggled to obtain enough doses.
This leaves Kenya with two daunting problems—getting enough vaccines and quickly distributing them to the counties.
According to Medicines San Frontiers (MSF), ‘The current expiry dates add real pressure to vaccination campaigns.’
For example, Denmark recently donated 358,700 unused vaccine doses to Kenya, saying the batch of AstraZeneca vaccines it shared on June 21 expires July 31 and should be delivered as soon as possible.
Most non-COVID-19 vaccines have an expiry date of about three years, according to GAVI, while according to WHO, the main issue with vaccine expiry dates is potency, just like for small-molecule drugs, rather than safety.
All the 47 counties health management has in the past faced challenges of industrial actions due to inadequate budgetary allocations causing frequently disruption of essential health care service delivery.
When vaccines arrive in the country, they are received into a central vaccine store and then distributed to nine regional vaccine stores, from where the counties collect and distribute the vaccines to local hospitals at county and sub-county levels.
“There is unclear and robust acquisition and deployment plan for vaccines by counties and the fact that most of the vaccine manufacturing companies are also not providing sufficient rapid supply of vaccines leading to shortages of jabs, rescheduling and inconsistencies of information on when to receive the jab(s) is affecting its uptake and likely to fuel hesitancy,” Dr Masasabi said.
The creation of many vaccination centres is a way to address this challenge of matching supply with demand, therefore, enabling larger batches of people to be vaccinated, using up open vials more efficiently minimizing wastages.
The undersupply has also forced clinics to turn away people seeking the vaccine as pressure is mounting for these vaccines to be distributed and administered quickly.
The World Health Organization (WHO) says a large number of poorer countries relying on the global vaccine sharing scheme COVAX do not have enough doses to continue vaccinating.
Dr Masasabi, says inconsistencies in communications like unclear scheduling of who is eligible, where do you get the vaccine, its adverse effects- has hindered vaccine uptake in Kenya coupled with delivery delays and tight dose expiry dates.
He adds that “some of the members of the public targeted for the jab are the elderly and the communication channel used to relay some critical vaccination information especially through the online platforms of Twitter and Facebook may not reach for example my 80 years old mother who has cataract and cannot see properly.”
Another source of the slow pace of vaccinations seems to stem from the priority in which vaccines were to be given.
Ministry of Health had identified frontline health workers, teachers, police, military and those aged 58 years and above in this priority category which would be targeted during round one of the inoculations.
However, journalists, diplomats and top government officials are also receiving the jab.
Many health care workers in public facilities say many of them risk being infected even as they wait on their second vaccine doses and lament a lack of protective gear and health insurance.
Kenya has received 358,000 AstraZeneca doses from Denmark and 182,000 from COVAX in June 2021. It is expecting another 10 million single dose, Johnson and Johnson, by early August; the country is also in discussion with Pfizer.
Kenya’s national drug regulator- Pharmacy and Poisons Board issued emergency authorization for local use of AstraZeneca vaccine and Sputnik V, MOH is in discussion with Pfizer and is expecting Vaccine Johnson and Johnson vaccines.
Delta variant and the unvaccinated mix
In May, Kenya announced findings of a variant spreading widely in India, known as B.1.617 among factory workers who had arrived from India.
Despite what is known about the delta variant, its easy transmissibility, the country relaxed its mass gathering restriction and held the Madaraka Day celebrations in Kisumu. The country did not react in time to prevent the spread of the new mutations that were already causing havoc in India.
There has been a spike in transmission rates in the western part of Kenya driven in part by more transmissible variants, according to Dr. Patrick Amoth; acting Director General.
Health officials warn of ‘breaking point’ as hospitals are at risk of being overwhelmed by COVID-19 cases as ICU beds and Oxygen are inadequate.
A study published in The Lancet suggests patients who are critically ill with Covid-19 in Africa are far more likely to die than in other parts of the world because of limited healthcare resources.
In Uganda, which borders Kenya western counties announced record cases and deaths, forcing President Yoweri Museveni to impose a strict 42-day lockdown.
Although, the World Health Organization (WHO), says that the African continent has avoided the huge death tolls seen in Western countries because of a combination of factors, ranging from the swift imposition of lockdowns to its relative lack of inclusion in global networks of travel and trade, and other factors, including biological ones, that are still being studied, it insists that vaccination will be the only way out of the pandemic.
Shorter Shelf life
Another limitation apart from tight shelf life is freezer capacity. While the Pfizer vaccine needs to be stored in a freezer at -94 degrees, most freezers are not designed for that level of cold most are designed for -20 degrees.
The AstraZeneca jab, which must be stored at 2C to 8C, has a shelf life of six months. The BioNTech/Pfizer shot can be stored for six months at -90C to -60C but only lasts up to five days once thawed and refrigerated.
Sinopharm’s vaccine is an exception, with a fridge-temperature shelf life of 24 months.
In the backdrop of inefficiencies in the global supply chain of vaccines, the relatively short shelf life of leading jabs has meant that doses have arrived in most African countries, Kenya included too late for the shots to be used.
Some countries have been forced to burn expired shots while others forced to send them to other countries.
Malawi publicly burnt almost 20,000 doses of the AstraZeneca vaccines, the shots had been marked with an expiry date of April 13. The manufacturer said it would be safe to use the jabs for another three months, but the government feared damaging vaccine confidence by expired jabs.
South Sudan, which has administered only 8,600, sent 72,000 doses to Kenya, concerned that it would struggle to administer before the expiry date.
Kenya is exploring a local vaccine manufacturing option as its top research agency- Kenya Medical Research Institute (KEMRI) tasked with leading the identification of facilities.
Although the spread of the virus can be mitigated through physical distancing, face coverings, and testing and tracing and potentially with therapeutics, the risk of outbreaks and disruption to economic and social life will probably remain until effective vaccines are administered to large portions of the population.