Dr. Collins Tabu, Head of Immunization Program, Ministry of Health, Kenya

In this Question, Dr. Collins Tabu, Head of the Kenya National Vaccine and Immunization Program, looks back at the pilot experience of a malaria vaccine in the country of the recently announced 1st anniversary of the introduction of RTS, S / AS01, especially in the context of COVID-19.

1. Kenya recently marked the first anniversary of the introduction of the malaria vaccine in Kenya. Why is this milestone important?

Contrary to our early expectations, we are witnessing a very high acceptance and demand for the vaccine. The demand was so great, we even saw an influx in some cases of people not from the vaccination counties who came to ask for the vaccine. This is a remedy against a well-known disease that has – in one way or another – affected most people living in these areas. Awareness of malaria is high, hence the level of interest. It is something that is unprecedented for us with new vaccines.

3. Where are we now, a year later?

We have exceeded our targets, at least in certain regions. As of August 2020, we have given children at least 293,000 doses of the vaccine. In most areas, I have seen coverage close to that of other routine vaccines, namely the pentavalent vaccine. The drop-out rate also appears to be close to that of other vaccines.

We had an initial drop from the first to the second dose of about 5%. This decrease is slightly greater than the second to third dose, but this could be due to the situation with COVID-19, as well as the fact that the third dose is not given during routine visits to other vaccines. We know we have a comprehensive task with the malaria vaccine to ensure that children receive all four doses, but early acceptance – 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 try to work even better. We also use these early lessons to inform you about the next steps.

4. What has the state learned in the past year?

First, we learned that a huge investment in community participation, engagement, ownership, and participation paid off. We hope we can integrate this into other new vaccines. Second, we had a deliberate integration into the legal framework at the national and international levels, which gave the vaccine greater credibility and anchored it within the laws of our country.

The opportunities presented by the malaria vaccine pilot served to broaden our national immunization program. The deliberate integration of key aspects of routine immunization into training, the formation of a national vaccine safety advisory committee, and the improvement of our immunization monitoring and evaluation framework have served to strengthen our broader immunization program. These have given us valuable lessons for new vaccine introductions.

The introduction of malaria vaccines has rejuvenated the interest of communities in vaccines in general and their participation in them. The introduction of a malaria vaccine has also sparked talks about vaccines in the country, which is a really positive thing for us. It put 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 introduction of the malaria vaccine?

The impact of the COVID-19 pandemic is unprecedented, and the spread was unpredictable. Initially, this had a significant effect on the immunization program, but we consciously came out to alleviate it. Initially, we had movement restrictions for people, vehicles were allowed to carry a limited number of people, curfew, movement restrictions in and out of Nairobi – all affected the ability of health workers to reach health facilities and affected the distribution of the last mile.

The use of a malaria vaccine depends largely on the engagement and participation of the community, which means that people need to meet. The limitations meant that most of our planned community engagements could not be done, but we quickly switched to virtual meetings so we could reverse that. In addition to resource constraints, government spending went to support COVID-19, and health facilities had to redeploy staff in response to COVID-19.

But we went through this thanks to mitigation measures and strong political will, and the effect of COVID-19 on immunization was not as significant as expected. For routine immunization, we dropped 2-3 points during COVID.

7. What are some specific strategies used to mitigate the challenges posed by COVID-19?

Using virtual meetings was one of the strategies. We also approached social media platforms and coordinated and shared a lot of information via WhatsApp. We have formed a national group for immunization service providers so that they can receive and disseminate information from all over the country. We currently have about 1,000 members from all levels: health facilities, counties and the state level. Members are actively involved, thinking about problems, causing concerns and thinking about them in real time.

8. What was the most impressive part of participating in the introduction of this vaccine?

The most striking part of this introduction was the opportunity to interact with communities as active participants, enabling them to be at the forefront of their own health care. In addition, the optimism expressed by health professionals regarding the vaccine’s potential to protect children from malaria was extremely gratifying.