Rethink strategies to increase uptake of Covid-19 vaccination

At the advent of the Covid-19 pandemic, experts argued that less life would be lost once herd immunity was achieved. If that was going to be a protracted process via natural exposure, vaccination would accelerate the attainment of herd immunity.

To many people, mass vaccination would be the silver bullet solution that restores normalcy and resuscitation of economies. The argument was based on solid scientific experience with old infections and hopes that Covid-19 would behave likewise.

But vaccine roll out and herd immunity have met new realities of Covid-19, modern living and expectations. Ugly politics has also added to the conundrum.

First, the coronavirus behaves like a chameleon that camouflages to hoodwink predators. It mutates like no other. Through mutations, several variants have emerged with the latest, Delta, having higher transmissibility rate. Delta variant has successfully evaded the radar in the most highly vaccinated provinces rolling back massive plans to reopen the economy and resume life as we had known it BC (Before Covid) era.

There is an emerging school of thought amongst a section of researchers that each variant should be treated as a separate epidemic which needs its own vaccine. This would necessitate rapid development of a plethora of vaccines in concert with the rate of viral mutation. This is not a new challenge from the family of flu viruses, but it would be a steep climb due to the speed of Covid-19 mutation, spatial spread and its lethality. The political phenomenon of vaccine apartheid would engage a new gear.

Second, the world is witnessing a surge in reported cases of reinfection and infections in the fully vaccinated. The only relief is that the cases are largely less severe and rarely fatal. It is clear that viral transmission continues even as we approach the expected levels of exposure when herd immunity should kick in. Dropping public health precautions after full immunisation would appear to be foolhardy.

Third, debate has shifted from whether to give a third jab or booster shots. Researchers are now investigating the duration after which the vaccine-induced immunity begins to wane. Americans are estimating the eighth month as a critical point of waning immunity after two jabs of Pfizer vaccine.

In addition, experts are seeking to establish which vaccines wane faster; which vaccine(s) make vaccinated people more susceptible to breakthrough infections. This information will guide on when to give booster shots or third doses to people of different ages who have taken certain types of vaccines.

Fourth, vaccine inequity. While these advanced debates are going on, insignificant proportion of population in developing countries has received the first jab (mostly AstraZeneca) and are uncertain if they will ever receive the second one. Vaccine equity is a challenge which must be viewed as a global threat to the war against Covid-19. In Kenya, we are experiencing both regional and national deficit.

Even after the Head of Public Service directed public servants to be vaccinated before August 23,2021, challenges of vaccine quantity and capacity to administer them persist. Lake Region Economic Bloc (LREB) has a huge vaccine deficit in the midst of rising demand. To illustrate this, LREB governors through Committee of Eminent Persons, commissioned Covid-19 preparedness assessment from June 12 to 30.

It found that only 45,292 were fully vaccinated by that time and 215,103 had the first AstraZeneca jab. The targeted adult population in the region stands at 8,003,755 people. Until August 15,2021, only 141,579 people had been fully vaccinated, a paltry 1.8 per cent.

The most vaccinated county in the region is Kisumu where 3.2 per cent or 20,883 persons are fully vaccinated against a population of 656,147. The least vaccinated is Siaya where only 1.2 per cent of the target population is fully vaccinated.

Lastly, with consistent public education in the region, vaccine hesitancy is the lesser challenge. Vaccine quantity, capacity, and bureaucracy are the main problems, requiring immediate attention. In terms of quantity, 7,862,176 people need vaccination. Capacity is a challenge because there are fewer vaccination tents.

Whereas it should take averagely 15 minutes for one person to register and get injected, the queues are longer and people wait for hours on end to be served. Bureaucracy is a challenge because the vaccination strategy does not respect devolution of health services and does not allow counties to source vaccines directly even when donated through a vetted and transparent process.

The war against Covid-19 must be hinged on a multilayer process that includes strict observance of public health guidelines and full vaccination. Global vaccine shortage and hoarding requires a high level of vigilance, including opening up to opportunities to receive short expiry vaccines whenever available. Counties should be prepared to receive and make prompt use of such opportunities, even as we continue to focus on Covax resources at national level. The Covid-19 emergency demands that we learn to chew and walk at the same time.