“While the government has an obligation to protect its people from serious public health threats, the measures must be reasonable and proportional,” said Adi Radhakrishnan, Africa research fellow at Human Rights Watch. “Vaccination coverage hinges on availability and accessibility, and the government’s new measures could leave millions of Kenyans unable to get essential government services.”
On November 21 Kenya’s cabinet secretary for health, Mutahi Kagwe, announced that beginning December 21, authorities will require anyone seeking government services to provide proof of full Covid-19 vaccination. The services affected will include public transportation, education, immigration, hospitals, and prison visitation. Proof of vaccination will also be mandatory for entering national parks, hotels, and restaurants.
Kenya does not have a sufficient supply of Covid-19 vaccines to ensure that all adults can be vaccinated by the Health Ministry’s deadline, as a result of a lack of doses stemming from vaccine inequities and uneven global distribution.
Kenya’s vaccination campaign began in March prioritizing health workers, teachers, security personnel, and people over the age of 58. Eligibility expanded to all adults starting in June. Currently, AstraZeneca, Moderna, Pfizer, Johnson & Johnson, and Sinopharm vaccines are available in Kenya. However, Health Ministry data indicates that there is a limited supply. Kenya, with an estimated adult population of 27.2 million and a total population of 55 million, has received approximately 23 million doses as of December 11 since the start of the vaccination program.
People wait to register for the first injection of the Oxford/AstraZeneca COVID-19 vaccine during the launch of a vaccination campaign, at the Kenyatta International Convention Centre in Nairobi, Kenya, April 21, 2021. FILE - Photo
Kenya, like other low- and middle-income countries, especially in Africa, has struggled to access enough vaccines for their populations. More than 80 percent of the world’s vaccines have gone to G20 countries, whereas low-income nations have received just 0.6 percent of all vaccines, as the World Health Organization (WHO) reported. Kenya received just 1.02 million doses of the AstraZeneca vaccine in March to begin the vaccination program for its adult population of 27.2 million.
The vast majority of vaccines have not been distributed equitably throughout the world, as reported, due to concentration of manufacturing capacity in a few countries, and a refusal by the nations and pharmaceutical companies that developed the vaccine to share vaccine technology with other capable manufacturers and relevant WHO technology pools.
UN Human Rights experts, including the special rapporteur on the right to health, Dr. Tlaleng Mofokeng, criticized this vaccine hoarding behavior by wealthy nations. The experts stated that “there is no room for nationalism in fighting this pandemic. This pandemic, with its global scale and enormous human cost, requires a concerted, human-rights based, and courageous response from all States.” The experts also expressed concerns that some governments are trying to secure vaccines only for their citizens, which they said would be counterproductive to the goal of mass immunization.
The November 21 Kenyan vaccine requirement announcement does not provide details of how these new measures will be carried out and enforced nor does it provide alternative procedures for those who are ineligible for vaccinations or have a medical exemption, further risking arbitrary denial of access to services. When asked for additional details, Minister Kagwe stated “[a]s much as we will enforce these measures, accountability on implementing these measures will lie on individuals.”
Kenyan media have reported concerns among Kenyans about the government’s decision to issue its directive with just a one-month notice. According to a Frequently Asked Questions Guide on Covid-19 vaccinations published by the Health Ministry, the requirement to be considered fully vaccinated depends on the number of doses required for the type of vaccine used.
The majority of vaccines currently available in Kenya require two doses for full vaccination, with the second dose administered 4 to 12 weeks after the first, depending on the type of vaccine. So, it is likely that even people who get their first shot by the December 21 deadline will still face restrictions.
The Kenyan government has stated that the new policy aims to persuade more people to receive vaccines. “It’s becoming increasingly apparent that as countries battle the pandemic, a lot more emphasis is being placed on the need to have more and more people vaccinated,” Minister Kagwe said in the policy announcement.
Under international human rights law, the Kenyan government has a duty to ensure the right to health for everyone, without discrimination. It should promote vaccination by providing transparent information on the benefits and risks of the vaccine to a person’s health. Requiring proof of vaccination to access public services may act as a powerful incentive for people to get vaccinated, but the way it is carried out should also account for the numerous reasons that a person may not be able to receive the vaccine in time, Human Rights Watch said.
A reasonable vaccination requirement policy that is proportionate to the stated public health purpose should make accommodations so that unvaccinated people may still get essential services such as health care, without endangering themselves or others.
The Kenyan government’s human rights obligation to ensure that Covid-19 vaccines are available and accessible to everyone is severely undermined by the failure of high-income governments to collaborate globally and share technology to ramp up vaccine production. For over a year, efforts to promote equitable access to Covid-19 vaccines and therapeutics by waiving provisions of the Agreement on Trade-Related Aspects of Intellectual Property Rights (“TRIPS”) have been blocked by high-income nations.
All governments have obligations to cooperate internationally, not to interfere with other countries’ ability to fulfill human rights obligations, and share the benefits of the scientific research they fund, Human Rights Watch said.
The Kenyan government also has an obligation to ensure that any restrictive policies or measures do not arbitrarily bar people from accessing essential services or from meeting their basic needs. The right to health includes an obligation to prevent and control epidemic disease, for which widespread vaccination is an important tool. But the right to health applies to everyone, regardless of their vaccination status. Vaccine mandate should be designed with careful attention to social, political, and economic barriers people may face; including vaccine availability and accessibility issues.
“Although vaccine mandates may be useful, they ought to be implemented within a broader public health strategy that emphasizes accessibility of vaccines and other preventive measures for Covid-19,” Radhakrishnan said. “A vaccine mandate should not arbitrarily create undue burdens for any population group, or disproportionately infringe on human rights.”
But even with this improved supply, it is not yet easy for anyone who wants a vaccine to get one. There should be vaccination centres in every corner of the country that are accessible at a time that is convenient and at a location that does not require one to spend a lot of time or money to get there.
It is only after vaccines are freely available to everyone whenever they want them over a sustained period of time that the government may consider mandates. Some people might not be vaccinated because they have not had the opportunity.
This could be due to the nature of their work, or because there are no vaccines where they live, study or work. It might also be that some have not given it much thought yet.
What this means is that mandates should be considered only when all the geographical, financial and cultural access issues have been addressed.
Mandates should be a last resort because they create resistance and feed into narratives about vaccines having been developed for nefarious reasons.
How do you rate Kenya's Covid-19 vaccination campaign?
There are different ways of looking at this. Kenya has done well in vaccinating its priority population of healthcare workers. However, based on the percentage of the whole population fully vaccinated, Kenya is performing worse than some other countries on the continent.
Another disturbing picture emerges when you dig a bit deeper. There is a huge discrepancy between counties. Nairobi County, which has about 10 percent of the total population, accounts for about one-third of all the adults fully vaccinated in the country.
It has a full vaccination coverage of 25 percent while some eight counties have less than 3 percent of their adult population fully vaccinated.
What about opening vaccinations to those aged 15 to 18?
A huge proportion of African countries’ populations are young people. In Kenya, the population below 15 years is about 40 percent. Those between 15 and 19 make up another 11 percent of the population.
Kenya cannot achieve herd immunity without vaccinating its younger population. Since there is a vaccine approved for children below 18 years, it makes sense that the government would want to use that to increase the proportion of vaccinated people on the path towards achieving herd immunity.
Secondly, while younger people are at comparatively lower risk for severe disease, hospitalisation and death, they are not completely risk-free.
Young people also have intense social interactions in schools or sports activities or employment or while socialising. They are also a link to their families and communities.
A school-based approach may mean that a large percent of this population can be easily reachable.
It is therefore important to vaccinate this population, to reduce transmission at the population level and inch towards herd immunity and lower even further the residual risk for infection, severe disease and death in the younger age groups.
Having said that, the government needs to have a targeted communications campaign. For some time it has focused on priority groups that presumably were at high risk, so a shift towards population groups with perceived low risk of the disease needs to be carefully communicated.
The disadvantage of starting vaccinations in this population without adequate targeted communication is that there may be hesitancy driven by strong narratives about a low risk of severe disease and a high risk of complications from the vaccines in younger people. While this is false, it’s a narrative that needs to be countered.
Has Kenya done enough to meet the targets it has set?
There are some indications that the rate of vaccine uptake has increased in the last few weeks. This is driven by greatly improved supply, the impending mandates, the expansion of the eligible groups (the health ministry expanded eligibility to 15 years and above a few weeks ago), and possibly news of the Omicron variant.
The government needs to do everything to increase uptake. For example, it should have customised strategies for different segments of the population. These would target people in highly vaccinated counties like Nairobi who are eligible and still unvaccinated.
Another would address people in poorly vaccinated counties who wish to get vaccinated but have not had the opportunity.
Kyobutungi is Executive Director, African Population and Health Research Center