I am 75, have never been vaccinated, why now?

At 75, Muhammed Duale has neither received any childhood vaccine nor understood its benefits as an adult.

The elder from the nomadic Gosha community in Mandera County says: “I have never received any vaccines since I was born, and yet I do not get sickly, neither have I faced any health problem.”

Failure to receive vaccines can be described as ignorance, and Mr Duale concurs but still maintains he does not know why he or any member of his family should be vaccinated.

Duale is not the only nomad who is reluctant to get vaccinated.

The Gosha live in remote Northern Kenya where acute drought and insecurity from inter-community clashes are part of life’s many challenges, like lack of access to health services.

Like Duale, hundreds of children in the Gosha community have never received a single vaccine — known as zero-dose — thus risking contracting childhood diseases.

According to the District Health Information System (DHIS), the Ministry of Health targeted to vaccinate 21,060 children in Gosha community, but only 14,425 were vaccinated, representing 69 per cent of the target.

Out of targeted  35,100 children in the general nomadic population, only 26 percent were vaccinated, meaning that two-thirds of target was not met. The County Director of Health, Dr Abdi Maalim, blamed hesitancy for low uptake of vaccines. Among nomads, the search for pasture and water points for animals is a priority, immunisation is not.

“Here, people prefer to cross the border for survival of their stock, and not get jabbed,” said Dr Maalim. This results in outbreaks of childhood diseases like measles, which can be prevented by vaccination.

In Kenya, childhood vaccination was established to improve immunisation against six killer childhood diseases; polio, tuberculosis, diphtheria, tetanus and whooping cough.

The vaccines are given at birth, then at six weeks, ten weeks, 14 weeks, nine months and 18 months.

The challenge facing the Gosha community has attracted not only the Ministry of Health but also the Global Alliance for Vaccine Initiative (Gavi) to revamp immunisation against childhood diseases. Besides supplying vaccines, Gavi is supporting capacity building for healthcare workers.

Other challenges facing immunisation include transport, knowledge and operational gaps.

Maalim lamented that transportation of the vaccines from the national depot to local facilities results in missed opportunities and stock outs, yet according to Director of Public Health, Dr Francis Kuria,  the 100-day immunisation initiative launched last November will end in February.

“Each county mapped the population regarding their requirements for all vaccines to raise performance to their expected level,” said Kuria. “Counties are directed to find ways of reaching all children who require vaccination to contain the spread of measles and other childhood diseases.”

Every year, the Ministry of Health aims at vaccinating at least 1.5 million children against vaccine preventable diseases such as measles, polio, tuberculosis (TB) and pneumonia, but at least 300,000 infants miss critical vaccines with geography and insecurity in Northern and North Eastern parts of the country as the biggest hindrances to vaccination campaigns. Low vaccination  coverage results in outbreaks in some sparsely populated counties like Turkana, Marsabit, Garissa, Mandera and Wajir.

Further, the Covid-19 pandemic interrupted routine immunisation and “most children missed out on immunisation, but gradually, we are reaching out to them through routine immunisation that has been scaled up,” stated Dr Kuria.

Last year, at least six cases of polio were reported in the country, but Dr Kuria noted that approval for use of the novel oral polio vaccine (nOPV2) to manage outbreaks and build immunity against the more prevalent polio type 2 (cDPV2), is a reprieve.

“Kenya was qualified to use, in the event of an outbreak. But so far, there is none,” said Dr Kuria. Only two countries in Africa - Nigeria and Liberia - are using the new vaccine, but Kenya will shortly follow Ivory Coast, Mali, Mauritania, Togo and Cameroon in rolling it out.