Kenya imposes a holiday season Covid-19 vaccine mandate - why this is premature
Kenya is to impose restrictions on access to public spaces for those who have not been vaccinated against COVID-19 from December 21. This, along with the opening up of COVID-19 vaccination to young people over 15, is an attempt by the government to meet its national target of 10 million vaccinated before the new year. Catherine Kyobutungi weighs in on the pros and cons of Kenya's vaccination strategy.
Is Kenya's decision on mandatory vaccinations the right move?
Vaccination mandates are premature in my view. The country has struggled for many months to have adequate and freely available vaccine doses. The supply of vaccines has dramatically improved in the last few weeks and more doses are expected before the end of the year. But even with this improved supply, it is not yet easy for anyone who wants a vaccine to get one. There should be vaccination centres in every corner of the country that are accessible at a time that is convenient and at a location that does not require one to spend a lot of time or money to get there.
It is only after vaccines are freely available to everyone whenever they want them over a sustained period of time that the government may consider mandates. Some people might not be vaccinated because they have not had the opportunity. This could be due to the nature of their work, or because there are no vaccines where they live, study or work. It might also be that some have not given it much thought yet.
What this means is that mandates should be considered only when all the geographical, financial and cultural access issues have been addressed. Mandates should be a last resort because they create resistance and feed into narratives about vaccines having been developed for nefarious reasons. They are also more likely to punish people who are not privileged enough to have enough information, time and money (such as for transport) to be vaccinated.
How do you rate Kenya's COVID-19 vaccination campaign?
There are different ways of looking at this. Kenya has done well in vaccinating its priority population of healthcare workers. However, based on the percentage of the whole population fully vaccinated, Kenya is performing worse than some other countries on the continent.
Another disturbing picture emerges when you dig a bit deeper. There is a huge discrepancy between counties. Nairobi County, which has about 10% of the total population, accounts for about one third of all the adults fully vaccinated in the country. It has a full vaccination coverage of 25% while some eight counties have less than 3% of their adult population fully vaccinated.
What about opening vaccinations to those aged 15 to 18 years?
A huge proportion of African countries' populations are young people. In Kenya the population below 15 years is about 40%. Those between 15 and 19 make up another 11% of the population.
Kenya cannot achieve herd immunity without vaccinating its younger population. Since there is a vaccine approved for children below 18 years, it makes sense that the government would want to use that to increase the proportion of vaccinated people on the path towards achieving herd immunity.
Secondly, while younger people are at comparatively lower risk for severe disease, hospitalisation and death, they are not completely risk-free. Young people also have intense social interactions in schools or sports activities or employment or while socialising. They are also a link to their families and communities.
A school-based approach may mean that a large percent of this population can be easily reachable.
It is therefore important to vaccinate this population, to reduce transmission at the population level and inch towards herd immunity and lower even further the residual risk for infection, severe disease and death in the younger age groups.
Having said that, the government needs to have a targeted communications campaign. For some time it has focused on priority groups that presumably were at high risk, so a shift towards population groups with perceived low risk of the disease needs to be carefully communicated.
The disadvantage of starting vaccinations in this population without adequate targeted communication is that there may be hesitancy driven by strong narratives about a low risk of severe disease and high risk of complications from the vaccines in younger people. While this is false, it's a narrative that needs to be countered.
Has Kenya done enough to meet the targets it has set?
There are some indications that the rate of vaccine uptake has increased in the last few weeks. This is driven by greatly improved supply, the impending mandates, the expansion of the eligible groups (the health ministry expanded eligibility to 18 years and above a few weeks ago), and possibly news of the Omicron variant.
The government needs to do everything to increase uptake. For example, it should have customised strategies for different segments of the population. These would target people in highly vaccinated counties like Nairobi who are eligible and still unvaccinated. Another would address people in poorly vaccinated counties who wish to get vaccinated but have not had the opportunity.
