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Achieve high vaccine coverage to herd Covid-19 out of Kenya

By Francis Wafula | April 5th 2021
Elderly residents at Rift Valley Provincial General Hospital (PGH) in Nakuru for Covid-19 vaccine on March 30, 2021. They complained about the slow vaccination process. [Kipsang Joseph, Standard]

A few days back the Ministry of Health banned private importation of Covid-19 vaccines, setting stage for a heated debate on ‘why’ and ‘what next’. The ‘why’ debate has thrown up three theories. One, that there is a genuine desire by government to manage the vaccine process for public good (I and most Kenyans want to believe so).

Two, that this was merely a response to the public outcry that demanded a more transparent process devoid of profiteering and State-granted monopoly power. Three, that there is a well-connected rival camp working an angle, where they would supply the vaccines after ‘clear government protocols’ have been established, preferably, one that has a seal of approval from WHO.

Our view is that these debates are neither sensible nor beneficial to the ordinary Kenyan. What we need to do is focus on the ‘what next’. To do this, we must define a clear goal, then elaborate the pathway(s) that would get us there. We must look at both the past for lessons and plan ahead with the knowledge, recognising the uncertainties around Covid-19.

But to quote Abraham Lincoln, the best way to predict the future is to create it. So, let’s try and create an acceptable future in these times of uncertainty.

First, we define a clear goal and pathway. The goal is easy – crowd-out Covid-19 from Kenya. The pathway too is clear, achieve high vaccine coverage as fast as possible to help build herd immunity.

At the moment, we have the Oxford-AstraZeneca vaccine which despite misleading rumours, has good efficacy and is fully protective against severe disease and death. However, short of a miracle, we won’t achieve meaningful coverage in the coming two years. So then, what next?

We propose going back in time to try and find meaningful lessons. And lucky for us, we have a perfect example in a decade-old malaria medicine initiative, the Affordable Medicines Facility - Malaria (AMFm). Most Kenyans will remember the ‘green leaf’ logos on malaria medicines that only cost about Sh50, which could be found virtually in all local shops.

What most wouldn’t have known, is that just a few months prior to that, the same medicine (Coartem) cost over Sh800 a dose, and was completely unavailable even in fairly large public hospitals. So, what was the magic? Private sector involvement.

A ‘factory-gate subsidy’ arrangement resulted in the opportunity for both public and private sector actors to get the highly subsidised medicines and sell them for roughly half a dollar. There was a clear goal: To crowd-out what were referred to as Sulphur-based antimalarials (most of you would recall brands like Fansidar and Metakelfin), which had become ineffective to the resistant malaria parasites. The goal was achieved, nay, surpassed, resulting in a good problem – excessive availability of affordable and effective antimalarial medicine.

In fact, so efficient were the private sector supply chains that some African governments stopped importing altogether and started purchasing locally, from the private sector, and still managed to sell at the set/agreed price. This saved them a tidy sum, and the headache of managing complexities of supply logistics.

The lesson is simple: A whole market approach crowded out cheap ineffective antimalarials and replaced them with cheaper but effective antimalarials.

So, you see, we have done it before. Now then, what next? We propose that the Health ministry takes full control of the process and quickly define a mechanism towards a whole market ‘all hands-on deck’ approach. Through a clear leadership framework, the ministry could define how private sector involvement could create shared beneficence. And part of that conversation should include a decision on the pricing policy.

We either go the price controls way (defining private sector price ceilings) or go the free market (letting competition set the prices). Both models have their strengths and shortcomings, but it may be prudent to have price controls initially, considering the nature of the problem and prevailing economic circumstances.

We urgently need to start normalising our economy, which is driven mainly by small and medium business enterprises that heavily rely on direct human interaction. Curfews and lockdowns are a temporary, and frankly speaking, not so effective solutions. Global and local Covid-19 politics aside, we need a scorched earth approach to the pandemic.

Unlike us, Covid-19 isn’t engaging in politics. It is learning, mutating, and causing havoc as it permeates society. Our focus must be expanding vaccine availability.

We can’t be caught up in the Global North vaccine superiority wars. And as we expand availability, we must also strive to deal with the ‘infodemic’ and stress the ‘pata chanjo’ (get vaccinated) message – all the way to the remotest parts of the country.

Finally, even as we start these discussions, we all must recognise the importance of government leadership in all these. The private sector must shun profiteering and focus on fair profit. Regulators must ensure that Kenyans get good quality vaccines, and that these are deployed by qualified professionals in a safe environment.

This really isn’t the time for pussyfooting around with local and global vaccine politics and ideological sensitivities around the role of private sector. Focus – lets crowd out Covid-19 together.

Dr Wafula is Academic Director and Senior Lecturer, Institute of Healthcare Management, Strathmore University.  

Covid 19 Time Series


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