Kenya prepares for biggest vaccination drive ever

MoH says 430,000 frontline health workers will receive the first shots

In Summary

• Kenya has immense experience in mass vaccination to prevent measles and polio. The largest such exercise in May 2016, reached 19 million children

• A study in the Vaccine journal indicates it costs an average of Sh34 to deliver a single dose of vaccine in Kenya, which is considered expensive. Then there's the cost of the vaccine itself.

A medic holds a vial labelled Vaccine Covid-19.
COVID VACCINE: A medic holds a vial labelled Vaccine Covid-19.

Kenya will need to vaccinate at least 25 million of her people to achieve population immunity against Covid-19, studies indicate.

The first beneficiaries of the vaccine will be the 430,000 frontline health workers in both public and private facilities, representing one per cent of the 53 million population.

The elderly people and those with pre-existing medical conditions will be next and this will continue until 20 per cent of the population is vaccinated in 2021.

The rest of Kenyans will be vaccinated as more doses become available, probably in 2022, the Ministry of Health says.

The choice 

Health CS Mutahi Kagwe says the National Emergency Response Committee, responsible for the Covid-19 guidelines, has settled on the Oxford-Astrazeneca vaccine for Kenya.

This is because it can be stored in the normal refrigerators within Kenya's cold chain. Most vaccines are sensitive to heat and become useless if their temperature is not controlled.

The temperature-controlled transport and storage of vaccines are referred to as the 'cold chain'. The Oxford vaccine can be stored at a ‘fridge temperature’ (2-8  degrees Celsius) and distributed using existing logistics.

The Pfizer and Moderna vaccines, which have been given emergency authorisation in some countries, require ultra-cold conditions to be effective. Transporting them around Kenya, especially to remote areas, would be a nightmare —nearly but not impossible.

The Pfizer-BioNTech vaccine must be stored at -70 degrees Celsius. Moderna's must be stored at -20 degrees Celsius.

"In terms of efficient distribution in poorer countries, the Oxford/AstraZeneca vaccine appears to be the winner so far. It is stable at standard refrigerator temperatures,” said Andrea D. Taylor, assistant director of programmes, Duke Global Health Institute. She spoke to Thompson Reuters on November 26.

According to a study by DHL, a global logistics company, advanced cold chain technology is lacking in almost two-thirds of the world.

“Billions of people are in countries that don’t have the necessary infrastructure to maintain the cold chain for either existing vaccines or more conventional coronavirus candidates,” the DHL study indicated.

A 2013 study in the Vaccine journal showed it costs an average of Sh34 to deliver a single dose of vaccine in Kenya, which is considered expensive.  That will increase the cost of the vaccine itself.

"For Pfizer and Moderna, there are a few different prices out there but basically very high prices per dose that will definitely restrict their access by low- and middle-income countries,” Roz Scourse, policy adviser to Medecins Sans Frontieres, told Thompson Reuters.

Once Kenya receives its vaccine through the Gavi-led Covax Facility, the next headache will be delivering it around the country and getting adults to be vaccinated.

The country has immense experience in mass vaccination from the measles and polio drives. The largest such exercise in May 2016, a measles-rubella (MR) vaccination campaign, targeted 19 million children aged nine months to 14 years. It achieved 95 per cent coverage.

Experts say Kenya still needs to streamline its vaccine supply chain, which includes all personnel, systems, equipment and activities.

They are necessary to ensure vaccines are effectively delivered from Jomo Kenyatta International Airport to the point of injection, say, a remote village in Hindi, Lamu county. 

From the JKIA, the vaccines will be taken to the Kitengela National Vaccines Storage deport. From there, they will be redistributed to the regional storage centres across the country.

Vaccines in Kenya are administered through a network of over 9,000 public, private, NGO and faith-based health facilities. The government rarely hires commercial operators to assist in delivery.

The World Health Organization says a portion of vaccines globally is lost to wastage due to exposure to heat or breakage of vials while in transit.

“If people can figure out how to transport ice cream, they can transport vaccines,” a researcher at Johns Hopkins University, Tinglong Dai, said in an interview.

Global network

Outside Kenya, manufacturers are already in end-stage planning of how their vaccines will be distributed around the world.

DHL estimates more than 15,000 cargo flights will be required to ensure the supply of vaccines throughout the world.

Last month, the airlines' group, International Air Transport Association, released guidance to ensure the air cargo industry is ready to support the large-scale handling, transport and distribution of a Covid-19 vaccine.

“Delivering billions of doses of a vaccine that must be transported and stored in a deep-frozen state to the entire world efficiently will involve hugely complex logistical challenges across the supply chain. 

"While the immediate challenge is the implementation of Covid-19 testing measures to reopen borders without quarantine, we must be prepared for when a vaccine is ready.  This guidance material is an important part of those preparations,” Iata director-general and CEO Alexandre de Juniac said.

The advisory says timely regulatory approvals and storage and clearance by customs and health authorities will be essential.

Priorities for border processes include introducing fast-track procedures for overflight and landing permits for operations carrying the Covid-19 vaccine. They also include potential tariff relief to facilitate the movement of the vaccine.

Iata said airports like JKIA must have temperature-controlled storage facilities and contingency plans when such facilities are not available.

“Arrangements must be in place to ensure that shipments remain secure from tampering and theft. Processes are in place already, but the huge volume of vaccine shipments will require early planning to ensure that they are scalable,” the advisory says.

Unicef is leading efforts to procure and deliver vaccines from manufacturers that have agreements with the Covax Facility, the Gavi-led effort to secure vaccines for poor countries.

Gavi is the Global Alliance for Vaccines and  Immunisation. It is a global health partnership of public and private sector organisations dedicated to 'immunisation for all'.

At least 500 million syringes are already being moved around the world ahead of the vaccines supply.

“Unicef is stepping up efforts with airlines, freight operators, shipping lines and other logistics associations to deliver life-saving vaccines as quickly and safely as possible,” Etleva Kadilli, director of the agency's supply division, said.

Kenya expects to receive 24 million doses of Covid-19 vaccines for 20 per cent of the country's population. 

As the largest single vaccine buyer in the world, Unicef usually procures more than two billion doses of vaccines annually for routine immunisation and outbreak response for about 100 countries.

(Edited by V. Graham)