Kenya Third Wave Response:  A time to synergize and re-energize

 In the wake of a COVID-19 spike in new cases and deaths the Kenya government responded swiftly to increase measures that are aimed at taming rapid transmissions. In his 15th presidential address to the Nation on Corona Virus pandemic, H.E President Kenyatta issued a public order restricting movement in or out of the declared disease infected zone consisting of 5 counties. In this Zone, comprising of the five counties that are contiguous, the daily curfew was tightened among other measures on public gatherings, bars and restaurant operations. The capital city Nairobi County accounts for close to 60% of the recorded cases. The other affected counties are Kajiado, Machakos, Kiambu and Nakuru. The order came into effect on the midnight of 27th March 2021. “The positivity rate is at its highest since the pandemic hit us; the death rate is devastating by all measures; and the stress the pandemic is placing on our health system is unparalleled,” President Kenyatta said in his address to the Nation.

The situation is not any better in the region as the entire East African region is experiencing a third wave of the pandemic driven largely by rapid increase in cases in Ethiopia and Kenya. However, the roll-out of the AstraZeneca Vaccine for front line health workers and inclusion of those who are over 58 years of age is a step in the right direction. According the Ministry of Health, the decision to prioritize those who are over 58 years was informed by data showing that they are at most risk of severe disease and account for 60 percent of the recorded deaths.

The previous lock-down measures in 2020, which included school closures, left a heavy toll on both the social life and the economy. The present measures though necessary are coming at a time when many businesses were trying to find their footing in the new scenario. The Government had introduced tax relief and also managed to work with the banks to proactively assist businesses through the pandemic. Most of those measures have lapsed and unless the government is able to put together new relief mechanisms, the pressure on the economy is going to be immense.

The public is experiencing a measure of prolonged pandemic fatigue that is characterized by complacency in adhering to COVID-19 measures. The momentum that the Ministry of Health was able to galvanize community cooperation has ebbed away. This calls for creative strategies to reinvigorate the community through persuasive means and sustaining the high knowledge level while increasing compliance to the COVID-19 measures through purposeful community engagement. The use of punitive measures may aggravate the situation. Recently, the courts have moved in the right direction by giving curfew offenders community service in a bid to spur their conscience towards more responsible behavior.

Kenya had set out to build capacity to handle COVID-19 disease by having a minimum of 300 ICU beds in each of the 47 Counties. This aspiration has largely not been achieved and remains one of the biggest gaps in COVID-19 response. Increasing the nationwide ICU capacity is urgent especially as the third wave seems to be causing higher need for hospitalization. This has not been made easier by challenges with shortages of piped oxygen. The oxygen challenge is two-fold; one is out of investment interests in the supply chain and the other are gaps in hospital infrastructure such as dysfunctional hospital oxygen systems that may hamper delivery of oxygen to the patients, even if it is made available.

The vaccine roll-out will need substantial technical monitoring to ensure that the strategic plan is adhered to. Globally, WHO has noticed a disturbing trend of nationalization of vaccine resources.  This might jeopardize equitable distribution especially to countries in the middle and lower economies that rely on assistance such as the COVAX facility, as is being illustrated by the current export suspension by the Indian government of vaccines produced in that subcontinent. AstraZeneca vaccine needs to be administered in two doses hence close follow-up is needed to ensure each recipient receives both doses in the mass vaccination phase.

Kenya’s Risk Communication and Community Engagement (RCCE) strategy and plan has also been affected by community fatigue in regard to adhering to the COVID-19 containment measures. There are inadequate resources to sustain public awareness through information and sharing of experiences to enable appreciation of infected cases. A low uptake of the vaccine among health care workers who are a priority group in the first phase of roll out is perhaps due to this. Lessons from the past year also show gaps between the national and sub-national level in the coordination and stewardship of the roll-out of RCCE activities, capacity in planning, implementing, monitoring and reporting as well. The need to actively engage health care workers and other frontline and influential workers so they can help model behavior change and vaccine uptake is critical. The RCCE plans which include awareness campaigns through local and national radio stations and other media platforms, community engagement with support from religious and community leadership need to be re-energized and be implemented across the whole county.  This will require substantial technical and financial injection.

Urgent Responses

National Technical Assessment:

 In-depth examination of hospital preparedness and home care support strategy. This should include a comprehensive review of response plan in the light of the third wave and coordination of all the protocols, case management and vaccine roll-out.

Revamping Risk Communication and Community Engagement:

 In order to address the gaps and raised concerns and issues in RCCE, a re-energized RCCE approach and responsive plan needs to be put in place. Part of these plans should include use of community advocacy, communication and social mobilization strategies to enhance knowledge on Covid-19, benefits of the vaccines and the need to change and sustain safety protocols across all communities and populations. These can be attained through the strengthening of Ministry of Health (MOH) capacity in providing stewardship and coordination in collaboration with counties and partners, consistent and responsive awareness creation among communities and the public, support for health workers, school communities and other targeted groups. Monitoring and evaluation of activities and behavior change to enable evidence-based response to the pandemic is also essential and needs to be continuous and supported.

Economic Cushion Packages:

There is urgent need for resources and collaboration to cushion the most vulnerable economically in respect of health care, keep supply chains open and extend the government tax relief measures, business stimulus initiatives to keep the economy running.

Vaccine Roll-out Support:

 Vaccines need to be available for the identified population in a timely manner to tame any adverse effects of the third wave. This should be accompanied by strict monitoring to prevent any more public mistrust or hesitancy. If possible there should be support beyond the Covax facility to ensure adequate coverage of the population.

Front Line Health Care Workers (HCWs):

 Priority should be placed on ensuring that HCWs are safe, feel safe and are sufficiently equipped as well as supported. This includes psychological support since they have to isolate from family and may work long hours under stressful conditions. Resources and support Health workforce protection strategies should be availed for debriefing and counseling as needed.

Kenya is on the right track regarding COVID-19. Moving forward, all the right things need to be expanded. The capacity of the health system needs to be supported so that health protocols and case management can be applied at the same standard consistently in all the 47 counties. In order to make this possible, Kenya needs to re-assess and address the gaps, create synergies across Government and with non-Government actors and to fully re-energize and support its Risk Communication and Community Engagement with resources.

Funding projected needs against the COVID-19 Vaccine roll out: 2,651,451

For more information on this appeal, please contact: Dr EGGERS Rudi – WHO Kenya Representative: EggersR [at] who.int; Dr WOLDETSADIK, Solomon Fisseha – WHO Kenya Incident Manager: woldetsadiks [at] who.int ;  or Nadia Nsabimbona – Regional Resource Mobilization Officer: nsabimbonan [at] who.int