Kenya Pediatric Association Conference, Immunization in Kenya Strengthening Vaccine Coverage and Utilization and Introducing New Antigens in the Setting of Devolution Dr. Collins Tabu Kenya Pediatric Association Conference, Mombasa, 12th April 2019

Immunization Performance, Kenya- Key Principles To be able to interrupt transmission of disease, a critical number/ Proportion of children must be vaccinated National Immunization targets for every vaccine is 90% Nationally and at least 80% in every County, through: Increasing access to Immunization- More Health Facilities equipped and vaccinating daily Mobilization of Communities to utilize immunization services Provision of immunization outreach services The vaccine quality needs to be maintained to ensure effectiveness in preventing disease Ensuring vaccines are stored in recommended cold chain equipment Ensuring effective vaccine monitoring

Performance of the Immunization program, Kenya Reported Immunization Coverage Trends (2013-2018) Unimmunized Children & Penta 3 Coverage 2013 - 2018 Number of unimmunized children is lowest since devolution.; general improvement leading to better coverage numbers.

Select Vaccines Impact- Rotavirus Following Rotavirus Vaccine Introduction: Proportion of children aged <5 years hospitalized for rotavirus declined by 30% in the first year and 64% in the second year of vaccine introduction Hospitalizations for all-cause acute gastroenteritis in children <5 years of age decreased by 31% in the first year and 58% in the second year of vaccine introduction Seasonal peaks were reduced substantially The cost effectiveness ratio for PCV versus status quo was US$ 38 per DALY averted From the Government perspective, introduction of Rotavirus is cost saving

Polio Eradication: Significant decline in number of persons paralyzed by wild polioviruses, 1988-2014* Last case of type 2 polio

Distribution of measles and Rubella Cases in Kenya, 2012- 2016 2013 2014 2015 2016

Childhood mortality trends

Unimmunized Children in ESAR (2017) Country Imm. Coverage (%) # Un-immunized Ethiopia 73 853,470 Angola 52 557,280 South Africa 66 385,560 Somalia 42 343,360 South Sudan 26 308,580 Kenya 82 266,940 Uganda 85 253,650 Mozambique 80 214,600 Madagascar 74 212,680 Malawi 88 76,680 Tanzania 97 62,490 Zimbabwe 89 56,210 Burundi 91 38,070 Zambia 94 37,080 Namibia 8,400 Eritrea 95 7,750 Rwanda 98 7,160 Lesotho 93 4,060 Eswatini 90 3,700 Botswana 2,600 Comoros 2,250 ESAR 3,702,570 92% of the total burden in 9 countries Nothing interesting? Source: WHO-UNICEF 2018

Key Drivers of Non Performance Interruptions in Service Delivery Health Worker Strikes Interruptions in Vaccine Supply Scheduling of immunization Services- Vaccination services offered on specific days Health Worker & Facility capacity Health worker capacity to offer immunization services- Lack of vaccine storage equipment, Lack of knowledge & Skills Missed Opportunities for Vaccination Health Worker Practices and Attitudes towards Immunization Clients

Key Drivers of Non Performance Community Engagement issues Rumors, Myths and Real or Perceived Vaccine Reactions Weak community engagement and or participation Economic Barriers to Immunization Communities not prioritizing immunization- No visibility to vaccine preventable diseases Lack of IEC materials on Immunization

National responsibilities in immunization Overall policy Procure traditional vaccines Maintaining and operating national and regional stores GAVI co-funding demands Resource mobilization and partnerships Update immunization needs forecast Forecast informs budget allocation Develop procurement and workplan based on budget Implement plans and ensure that immunization remains a priority during budget implementation

County responsibilities in immunization Counties receive vaccines from central government. Counties are responsible for the following procurements and operational costs: Injection devices Cold chain equipment and maintenance Collection and distribution of vaccines and related supplies HR for immunization Outreach activities & Demand creation (mobilization) Immunization data tools production and data management Other operating costs (electricity, rent, building maintenance)

What do we need to do? Ensure un-interrupted supply of vaccines in all Health Facilities Ensure every health facility reports Ensure ALL Vaccines are offered on a daily basis in ALL Health Facilities Ensure ALL Government vaccines are offered free of charge Implement outreach services at least twice a month for all Health Facilities Facilitate community engagement and participation in immunization Invest in community health systems and train health workers Strengthen immunization program management and oversight Strengthen link between planning for immunization and budgeting persists

Costing Immunization services in Kenya(Per Child) Total cost per child is estimated to be 3,324 per child per annum. The cost of vaccines, syringes is the main cost driver. Immunization unique cost are only 192 shillings per child while the rest are shared cost with services. COUNTY IMMUNIZATION SPECIFIC COST

…..who is for us?

Political Commitment for Immunization Presidential Declaration on Immunization: All children to be vaccinated before joining school All Counties to ensure all unvaccinated children are reached Country continues to fully procures all traditional and emergency strategic vaccines and honors its co-financing obligations to Gavi Country has a dedicated line item for immunization in the Printed estimates Country has put in place the necessary Governance structures for Immunization:- NITAG, NICC, NVSAC, TWG Devolution of Health and Immunization, increasing resource allocation, accountability, community ownership and participation

New Vaccines Plans, 2019 HPV Vaccine Yellow Fever vaccine expansion Meningococcal Vaccine Malaria Vaccine Change in Vaccine Formulations: Pneumococcal Vaccine Two dose to Four dose formulation Tetanus Toxoid to Tetanus Diptheria Vaccines for the Future: Typhoid Vaccine

Thank You