By Joseph Maina

More should be done to manage anxiety and minimize hesitancy over COVID-19 vaccines, says a leading health expert, as apprehension wells up over the availability of second jabs amid shifting timelines issued by the health ministry.

Dr John Masasabi Wekesa, Senior Lecturer at the School of Medicine, Kenyatta University

Dr John Masasabi Wekesa, Senior Lecturer at the School of Medicine, Kenyatta University, is calling for more robust and clearer systems at the county level to oversee the acquisition, deployment, and scheduling of vaccines.

Vaccination is among the strategies that Kenya’s 47 counties are banking on to stem the spread of COVID-19, but the vaccination drive has faced varying pockets of hesitancy from the public.

COVID-19 vaccine hesitancy has been further aggravated by poor vaccine deployment in some regions, against the background of stiff bureaucratic constraints. This has only served to disorient deserving people particularly in the more remote parts of the country.

“We need to be more proactive as leaders,” says Dr Masasabi, a chief medical and health systems specialist with over 35 years’ experience in the health sector.

“A CEC for health in a certain county once told me they were waiting for a circular from the Ministry of Health, despite having vaccines at the sub-county level. In other words, they wanted people who are 58 years and above to travel over 24 to 40 kilometres to look for vaccines. How possible is that?”

The Ministry of Health, in a report published in February, stated that COVID-19 Vaccine surveys had indicated a 15% hesitancy level, which could increase due to misinformation, rumours, and conspiracy theories.

Across the continent, a GeoPoll study conducted in Côte D’Ivoire, DR Congo, Kenya, Mozambique, Nigeria, and South Africa, showed that only 42 percent of respondents said they would “definitely” get the vaccine as soon as possible.

By clarifying the vaccine cycle from acquisition to deployment, scheduling, eligibility and side effects, health authorities will be assured of greater public confidence, which will ultimately lessen levels of vaccine hesitancy at the grassroots level. Change in the timelines involved in administering the second dosages has added to the anxiety.

“We need to manage the anxiety,” Masasabi said at a recent virtual press briefing organized by AfriSMC, focusing on county governments’ COVID-19 prevention and mitigation strategies.

“For example, we are changing goalposts, from 8 weeks to 12 weeks. That inconsistency of passing the message can make people hesitant in taking the vaccines. Now the people are asking themselves what will happen if they don’t get the second dosage. Does it mean getting the disease? Why change? Managing those perceptions can be a challenge.”

These are the things that need to be pushed through the media and other community engagement platforms to alleviate fears and create demand, said Dr Masasabi, adding that religious groups and the private sector need to be better incorporated into the vaccine drives, as a way of increasing access points and vaccine affordability.

Leaders have also played a key role in enhancing the willingness of the public to take COVID-19 vaccines.

He pointed at earlier reports showing that some of the country’s health care workers were hesitant to take the COVID-19 vaccine, fears that were allayed in part by public inoculation of key authority figures.

“Nineteen percent of health workers didn’t want to get vaccines, until the governors got vaccinated, and when the president got vaccinated, they rushed for the vaccine”.

Research showed that many health workers cited safety concerns, the need for more information, fear of side effects, lack of trust in the government or the vaccine, rapid development of the vaccines and concerns about efficacy as key reasons behind their COVID-19 vaccine hesitancy.

Health CAS Dr Mercy Mwangangi

At a stakeholder’s webinar organized by AMREF Health Africa in mid-June, Health CAS Dr Mercy Mwangangi conceded the disruptive impact of the shift from 8 to 12 weeks between the first and second jab, and noted that there is need to keep in mind such genuine fears in the public psyche when formulating such far-reaching policy.

She further said that a key element in vaccine hesitancy lies in agility in deploying the response, drawing from past experiences with polio and other vaccination drives. The drive must also keep in mind different people’s unique contexts.

“As the Ministry of Health, we are asking ourselves if this was the best way to deploy the vaccine,” Dr Mwangangi said. “If a Kenyan has to spend Ksh100 to get to a health facility to access a jab, perhaps then we are contributing to the hesitancy, because if I only have Ksh200 that I made that day, I’m not sure that I want to spend my Ksh200 travelling to get a jab, when I have my other daily needs.”

To this end, it may be necessary to look at the wider mechanisms of deploying the vaccines, said the CAS.

“Perhaps certain centres are useful in certain areas – such as urban areas – but it may be useful to look perhaps at outreach services,” she said. “It may also be useful to look at non-conformist mechanisms of deploying this vaccine – such as going to churches on a Sunday and capturing the people where they are. Going to them.”

UN Resident Coordinator for Kenya Stephen Jackson highlighted the apparent disconnect from vaccine hesitancy in the ministry’s senior leadership, who instead focus on vaccine access as the priority issue.

Amref Health Africa Group CEO Dr Githinji Gitahi

Amref Health Africa Group CEO Dr Githinji Gitahi said access to information is becoming a barrier to COVID-19 vaccine access and urged greater government involvement in overcoming hesitancy.

“This is not deliberate hesitancy or skepticism. It is created by the fact that there is a vacuum of information from reliable sources, such as government, that is given proactively to overcome hesitancy. So, people who don’t get information results in inequitable access because they receive information from sources that are giving them skepticism and hesitancy. Therefore, there is need for governments to talk about how to scale up proper communication strategies.”