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Vaccines: It is time medics handed over some roles to experts

By XN Iraki | March 7th 2021

Pediatrician Lucy Kipkemei prepares the covid vaccine at Kenyatta National Hospital. [Jonah Onyango, Standard]

The new Covid-19 vaccines are coming out in droves. Soon, there could be a glut as each country gets its own vaccine or current producers increase the production which carries little risk because of government support or pre-orders.

I will not be surprised if countries soon take each other to the World Trade Organisation (WTO) for subsidising vaccines. Even a developing country like Cuba is about to produce her own vaccines with four on trial.

Which African country will be the first to produce its own vaccine and the pride that goes with that? Do we have one in the pipeline Kenya Medical Research Institute (Kemri)?

Anything happening in our research triangle in Upper Kabete with International Livestock Research Institute (ILRI), Veterinary laboratories and the University of Nairobi (UoN)? Is Covid-19 not said to have come from animals?

What of Upper hill with Kenyatta National Hospital (KNH) and its affiliates? What of all universities with medical schools? What of a philanthropist offering a prize for whoever will come out with a vaccine?

Government funding can be a great incentive just like in other countries. The proliferation of vaccines indicates that our ingenuity has no limit, particularly in times of crisis. For now, the demand far outstrips the supply with nationalism getting in the way.

Hope you have followed what’s happening in the European Union. Countries want to get vaccines before they are exported. This is tricky when the producer has a contract to supply vaccines to another country - different from where the factory is located.

Production bottlenecks are not unexpected; no one expected a vaccine that soon. The next problem is distribution. Getting the vaccine was not enough; how do we get it to the consumers, scattered throughout the country, across the globe?

The vaccine problem now mutates from being a medical problem into a supply chain and mathematical problem.

It sucks in other professionals. Vaccines need to reach the recipients as soon as possible.

We are no longer talking of flattening the curve, but stopping the spread and returning to normalcy. Israel has shown its possible.

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But we can’t build new roads, or airports overnight to reach the citizens. We have to use the existing hospitals, health centres and facilities but within an emergency. Add refrigeration too.

That is why in the past, we have suggested improvisation and a bit of creativity. Can refrigerated flower trucks do the transportation of vaccines?

Their business is low and they often drive back to flower farms empty from the airport.

The big question is whether vaccine transport will be outsourced to the private sector or government has enough transport. Will it be air, road or rail? Which combination will be the fastest and cheapest?

Has there been any simulation on the vaccine distribution? We know where Kenyans live and work and their ages. Cellular phones, geographic information system (GIS) and artificial intelligence can help. We know where health facilities are located.

And computer power is no problem. Are there any existing models of distribution? Have we learnt from bottlenecks experienced elsewhere?

Have we factored in weather patterns? The mathematical part of the problem is who should get the vaccine first. Most countries have a priority list from health workers to the youngest.

Now that Covid-19 was not as devastating as expected, how different should our priority list be from the rest of the world?

My suggestion is, there should be no priority list. Everyone should have an equal chance to be vaccinated.

After all, we should all have equal access to life and death. The best way to ensure this equal access is to use a lottery.

We can use the ID number as the basis of the lottery since those below age 18 do not seem to be seriously affected by the virus as the opening of the schools demonstrated.

A simple computer programme can randomly select the first to be vaccinated and match them to their vaccination centres. If you are selected and not interested in vaccination, the dose can go to the next round of vaccination.

Health is a devolved function and is likely to attract divisive politics which can be mitigated through the use of a lottery.

Each county can get vaccines proportionate to its population then use the lottery to select the citizens to be vaccinated.

Luckily, we are used to betting. Vaccination will be full of fun and entertainment as we randomly select those to be vaccinated. Imagine someone sitting in a matatu and getting an SMS “you have been selected to get a Covid-19 vaccine at Shamakhokho Health Centre at 12.00 on Monday, March 7.”

Lottery could create a buzz that can reduce resistance to vaccination. Beyond distribution and selection, we must confront conspiracy theorists. What of some religions that may bar their adherents from vaccination?

There is a lacuna in vaccination. If someone has suffered from Covid-19 and recovered, does he or she need to be vaccinated? Are the antibodies developed good enough to avoid Covid-19 vaccine? As we start vaccination, how shall we deal with emerging variants?

Vaccinating Kenyans needs a well thought out plan which we can replicate in future crises.

It is not just about medics, other professionals have their role from statisticians (data scientists), to supply chain analysts, operations managers, operations researchers, facility managers, behavioural scientists among others.

We must learn as much as we can from this crisis. Noted how South Korea and Taiwan were successful in controlling Covid-19? They had learned from Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome.

I am a great optimist but Covid-19 is unlikely to be the last global crisis.

We can’t forget that as the vaccine is rolled out, confidence in the economy will rise and we expect recovery particularly if the new variants are controlled.

We expect some inflation as an unintended consequence. Covid-19 was the crisis of our lifetime, like a war or famine.

The generations that went through such crises learned their lessons. We too should. We should end with a quote attributed to Winston Churchill, “Never waste a good crisis.” This applies to Covid-19 crisis.

 -The writer is an associate professor at the University of Nairobi


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