By Alfred Nyakinda
Kenya’s transition to a lower-middle income status has increased the domestic funding obligation for the country’s immunization programme, which is now required to achieve full self-funding by 2028.
Gavi, the vaccine alliance, which has been financing the majority of Kenya’s immunization budget, is leaving by 2027, by which time Kenya will have to shoulder the entire budget for vaccination. The departure will put at risk millions of children who rely on vaccines provided by the government.
“The traditional vaccines are BCG for tuberculosis, measles and polio. For those ones, the government foots the bill, 100 percent,” said Florence Kabuga of the Ministry of Health, “for the rest, which are very expensive, it’s Gavi that supports us through UNICEF, but the ministry gives 10 percent”.
According to the Kenya AIDS NGOs Consortium (KANCO), the domestic funding need for the central government stands at $13.5 million per year against a budget of $7 million, leaving a funding gap of $6.5 million. Meanwhile, the total cost of vaccines is projected to increase to $50 million by 2026.
“We should consider other factors that can ensure that the poor benefit as opposed to using the income status as a priority,” said Allan Ragi, Executive Director, Kenya AIDS NGOs Consortium (KANCO), “in the long term, we are expected to have an accelerated transition phase to full self-funding, yet we can not even sustain what is currently there.”
Kenya is also grappling with unreliable cash flows that cause funding to be released late in the year. This results in unsettled debts and shortages of vaccines, interfering with the immunization timetable.
The current routine immunization schedule for the national program involves eight different vaccines, each with a specific number of doses, administered over the first two years of a child’s life. These protect children from the diseases they are most vulnerable to, with some protecting them from multiple diseases such as the pentavalent vaccine that immunizes children against five diseases.
“For you to be able to develop herd immunity- population immunity-you need to reach 95% coverage across the whole country,” said Kabuga, “the five percent remaining will develop immunity from the herd immunity.”
As of 2018 coverage for BCG was at 84 percent, for the third dose of the pentavalent vaccine it stood at 82 percent and for the first dose of the measles-rubella vaccine that is a major immunization marker for one year old children, it was at 81 percent.
Delays in funding along with other factors such as strikes among health workers led to 502,860 children not receiving their vaccines in 2017. It is estimated 1.7 million children born between 2013 and 2017 did not receive all their scheduled vaccines, putting the entire population at risk.
In addition to the cost of buying vaccines, there is also a need for financing to cover operational costs to ensure the quality and availability of vaccines. The logistics of providing vaccines involve transportation from the central vaccine store, the provision of syringes, foam packs to prevent damage and special fridges which can maintain sufficiently low temperatures for up to two days without electricity for storing vaccines at health centres.