By Mary Hearty

A new study analysis on COVID-19 vaccine scale-up in Kenya conducted by researchers from the KEMRI-Wellcome Trust Research Program has found that COVID-19 vaccination campaign can achieve greater value for money when targeted to older age groups and other vulnerable groups in settings that have constrained fiscal spaces, low risk of severe disease, deaths and high natural immunity due to previous exposure.

This is because studies have shown that age groups beginning from 50 years and above, even though they are low in numbers, are at a high risk of developing severe disease from COVID-19.

The researchers categorized the study population into four groups: the susceptible population who are naïve to the virus and could be infected; persons who are potentially infectious; those infectious; and the recovered population.

“We looked at four scenarios, first, we assumed that Kenya did not carry out any vaccination at all as 80% of the entire population had a prior natural immunity,” Dr Cameline Nafula, researcher at KEMRI-Wellcome Trust Research Program explained during a media briefing with Africa Science Media Centre.

She further stated that they also looked at 30%, 50% and 70% adult coverage, whereby they prioritized over 50 year olds, while aiming to cover at least 80% of that population.

These analyses were made against assumption of a new immune escape variant arriving in the country in November 2021. By mid-November same year, it had rapidly dominated the country.

The time frame of the analysis was one and a half years, while the specific costs included were: COVID-19 treatment cost; the vaccines procurement costs of US$ 7 as well as the delivery cost which ranged from US$3.90 -$4.11 depending on the vaccine strategy.

Data was collected from public health facilities in Kilifi County and Kakamega County, with application of two vaccination strategies; rapid and non-rapid vaccination approach with a timeframe of six months and one and a half years respectively.

Stacy Orangi, health economist and one of the researchers of the study said results for non-rapid vaccination strategy showed that 30% coverage compared to not vaccinating would avert about 3.2 million infections and 8,132 deaths.

Whereas the 50% coverage compared to the 30% coverage would avert a further 400,000 infections and 810 deaths; and the 70% coverage compared to the 50% coverage averting 200,000 more infections and prevent 282 deaths.

For rapid vaccination strategy, they found that 30% coverage compared to no vaccination prevented about 3.9 million more infections and 9,433 deaths.

In terms of cost effectiveness, Orangi noted that they found that the rapid roll-out used resources more efficiently and is more cost-effective than a non-rapid vaccination strategy.

Also, they noted that efforts to rapidly deploy the vaccines during an outbreak not only avert more cases, hospitalization, and deaths, but are also more cost-effective.

Therefore, they suggested that addressing vaccine equity is key to ensure that Kenya and other African countries do not get vaccines late.

Data used were from: vaccines available in Kenya with AstraZeneca being the dominant one at the time of the analysis; how vaccines have been rolled out in; COVID-19 cases; results of the tests overtime; and we also needed; costs for vaccines and health management which primary analysis was done.

Prof Edwin Barasa, director at the Nairobi Programme of the KEMRI-Wellcome Trust said the vaccination approach translates to much fewer doses than targeting the entire population.

For instance, if Kenya decides to vaccinate everyone, just one dose would cost about Ksh40 billion, which is almost 20% of the budget that the Kenyan government spends on health.

“We derive much more value when we target these individuals (over 50 year olds) that have high risk of severe disease hence we end up spending less money and optimizing the benefits of the vaccines,” Prof Barasa noted.

As an expert in health economics, Prof Barasa pointed out the importance of applying economic principles to the health sector, especially when there are unlimited needs while the resources to those needs are inadequate.

“We have to think about how to mobilize resources to vaccinate our population over the long term. Considerations therefore should be: what can we afford? And more importantly where can we derive the best value for money?” he said.

Prof Barasa noted that even though the number of health economists in Africa are insufficient, efforts are being made with the few to support governments in making of evidence-based health policies.