In this Q&A, Dr Collins Tabu, head of Kenya’s National Vaccines and Immunization Program, reflects on the country’s malaria vaccine pilot experience on the recent 1st anniversary of RTS,S/AS01 introduction, particularly in the context of COVID-19.
1. Kenya recently marked the first anniversary of the introduction of the malaria vaccine in Kenya. Why is that milestone important?
Malaria is a major public health problem in Kenya, and a leading killer of children under the age of five. It’s also one of the top 10 killers among our entire population. The vaccine’s introduction represents the aspirations of our country and our communities to save lives and to fulfill the dreams of many children and families by way of stopping the effect of malaria within our borders. It’s a major milestone for us that complements other interventions we have in place, such as insecticide treated nets, indoor residual spraying and diagnostic and treatment interventions. Its potential to save lives as well as save healthcare related costs and allow us to redirect funds to other priorities in the country is what makes it very important for us.
2. What have you seen in communities regarding acceptance or interest in the malaria vaccine?
Contrary to our early expectations, we have witnessed very high acceptance and demand for the vaccine. The demand has been so high, we’ve even seen an influx in some instances of individuals who are not from the vaccinating counties coming to ask for the vaccine. This is a tool against a disease that is well known, that has—in one way or another—affected most of the people living in these areas. Awareness of malaria is high, hence the level of interest. This is something that is a bit unprecedented for us with new vaccines.
3. Where are we now, one-year later?
We’ve surpassed our targets, at least in certain regions. As of August 2020, we’ve given at least 293,000 doses of the vaccine to children. I have seen in most areas the coverage approximating that of the other routine vaccines, namely the pentavalent vaccine. The drop-out rate also appears to approximate that of other vaccines.
We had an initial drop-off from the first to the second dose of about 5%. That drop off is slightly higher from the second to the third dose, but this could be due to the COVID-19 situation as well as the fact that the third dose is not given during routine visits for other vaccines. We know we have a bit of an uphill task with the malaria vaccine to ensure children receive all four doses, but the early uptake—especially in the context of COVID-19—is commendable and reflects the level of interest in this vaccine. We are doing well, and we will strive to do even better. We’re also using these early lessons to inform next steps.
4. What has the country learned in the past year?
First, we’ve learned that the huge investment we made in community involvement, engagement, ownership and participation paid off. And we hope that we can integrate that into other new vaccines. Secondly, we had a deliberate integration within legal frameworks at national and international level, which gave the vaccine greater credibility, and anchored it within the law of our country.
The opportunities presented by the malaria vaccine pilot have served to strengthen our national immunization program more broadly. The deliberate integration of key aspects of routine immunization in trainings, the formation of the national vaccine safety advisory committee and the enhancement of our immunization monitoring and evaluation framework have all served to strengthen our broader immunization program. These have given us valuable lessons for new vaccine introductions.
5. Are there any collateral benefits to the immunization programme or public health overall generated by this pilot?
The introduction of the malaria vaccine has rejuvenated interest among communities about vaccines in general and their involvement thereof. The introduction of the malaria vaccine also got the vaccine conversations going in the country, which is really a positive thing for us. It placed it on the policy agenda and opened policy windows to allow us to sit at the table and advocate for other vaccines.
6. How has COVID-19 affected your work, and the roll-out of the malaria vaccine?
The impact of the COVID-19 pandemic is unprecedented and the spread has been unpredictable. Initially, it had a significant effect on the immunization program, but we consciously went out to mitigate against this. At the beginning we had restrictions of movement on people, vehicles only being allowed to carry limited numbers of people, a curfew, restrictions of movement in and out of Nairobi—all of this affected the ability of health workers to reach health facilities and it affected last mile distribution.
The implementation of the malaria vaccine hinges a lot on community engagement and participation, which means people have to meet. Restrictions meant that most of our planned community engagements could not be done, but we quickly shifted to virtual meetings to be able to turn it around. Added to that there were restrictions on resources, government expenditure went to COVID-19 support, and health facilities had to reallocate staff to the COVID-19 response.
But we have come through that thanks to mitigating measures and strong political will, and the effect of COVID-19 on immunization has not been as significant as expected. For routine immunization, we’ve dropped by 2-3 points during COVID.
7. What are some specific strategies used to mitigate the challenges posed by COVID-19?
The use of virtual meetings was one strategy. We also turned to social media platforms and did a lot of our coordination and information sharing through WhatsApp. We formed a nationwide group for immunization service providers so they could receive and disseminate information form all corners of the country. Right now, we have about 1,000 members, from all levels: health facility, county, national level. Members are actively engaging, reflecting on issues, raising concerns and reflecting on them real-time.
8. What’s been the most memorable part of being involved with the roll-out of this vaccine?
The most memorable part of this roll-out has been the opportunity to engage with communities as active participants, allowing them to be in the driving seat of their own healthcare. In addition to that, the optimism that health workers have expressed regarding the vaccine’s potential to protect children against malaria has been extremely heartening.