Vihiga County Immunization Coordinator Edith Anjere thought she would be a teacher. She even attended a teaching college for three months. However, she quickly realized that her heart was set on nursing. “I have always been intrigued by the process of life. ‘How does a baby start to breathe? What causes a heart to stop beating?’” she says.
Anjere now holds a nursing degree and more than 17 years of experience that includes delivering babies by the light of lanterns and navigating a range of hurdles while coordinating vaccination campaigns. “In all these experiences, I have learned to lead and think like a manager to improve facilities and address challenges,” she reflects.
Her experience has paid off. Today, Anjere leads immunization services in Western Kenya’s Vihiga County, which recently won recognition as the Kenyan county with the highest childhood immunization coverage. According to the 2022 Kenya Demographic and Health Survey, roughly 96 percent of children in Vihiga receive their full course of recommended vaccines. This includes vaccines such as the second dose of measles-rubella and fourth dose of the malaria vaccine that are provided during a child’s second year of life.
High immunization coverage was a main reason for Vihiga’s selection to host the official launch of expanded malaria vaccine use in March, when Kenya’s Ministry of Health announced it was scaling up use of the RTS,S/AS01 malaria vaccine to additional children in the region around Lake Victoria.
Successful vaccine rollout leads to expansion
Vihiga is one of eight counties in the malaria-endemic lake region that has provided RTS,S through the routine immunization system since 2019, as part of a pilot program that is funded by Gavi, the Global Fund, and Unitaid. The program, which also includes malaria vaccination in parts of Ghana and Malawi, is coordinated by the World Health Organization (WHO) in collaboration with the ministries of health of the three countries and partners including PATH, GSK, and UNICEF.
Since the launch of expanded malaria vaccination in March, eligible children from 51 Kenyan sub-counties can now benefit from RTS,S protection—roughly double the number of sub-counties that began providing the vaccine in 2019. A grant from US-based Open Philanthropy to PATH is supporting the expanded provision of RTS,S in parts of Kenya, Ghana, and Malawi through 2023, using vaccine doses donated by GSK, the manufacturer, and in collaboration with WHO and other partners. Since 2019, more than 1.5 million children across the three countries have been reached with at least one dose of RTS,S.
Expansion of malaria vaccination follows the 2021 WHO recommendation for broader use of RTS,S among children in sub-Saharan Africa and regions with moderate to high Plasmodium falciparum malaria transmission. The Kenya National Immunization Technical Advisory Group (KENITAG) subsequently recommended expansion of the vaccine’s use within Kenya’s malaria-endemic lake region. In Kenya, roughly 400,000 children have received at least a first dose.
Education key to vaccine uptake
For Vihiga County, achieving high uptake of the malaria vaccine has required some effort. “In the early days, mothers were concerned about the number of injections that their children would be receiving at each visit,” Anjere remembers. “As it was a new vaccine, the community was also initially skeptical and really wanted to know: Does this vaccine work? Is it beneficial to our children?”
Anjere and the team in Vihiga—including malaria coordinators, health promotion officers, and community health strategists—have used every available platform to respond to communities’ questions and concerns.
“We went to radio stations, we did social mobilization and community engagement to speak to communities about the benefits of the malaria vaccine,” she notes. “Before long, we started noticing children coming into vaccinating sub-counties from non-vaccinating sub-counties, and we knew that our strategies were starting to work.”
The vaccine is meant to complement other WHO-recommended malaria measures. Malaria is a top ten cause of illness and death in Kenya and a leading killer of children under the age of five. The Ministry of Health has been intensifying the fight against the parasitic disease through the scale-up of insecticide-treated mosquito nets, indoor residual spraying, appropriate diagnosis, treatment using artemisinin-based combination therapies, and prevention of malaria during pregnancy.
Findings from the pilots have shown a substantial reduction in deadly severe malaria, a drop in child hospitalizations, and a reduction in child deaths within the areas providing the vaccine in Kenya, Ghana, and Malawi.
Strategy and collaboration drive success
Vihiga attributes the county’s overall immunization successes to a strong community health strategy, one in which community health volunteers (CHVs) work closely with health care workers to track children who miss vaccine doses.
“I can say the community health strategy is working well for us. Every CHV must make sure their households are receiving all the required health interventions,” Anjere says. “If there are gaps, the CHVs pick up the Mother Child [Health] Booklets in the community and bring the books into the facilities for a discussion. This is how we can track [vaccine] defaulters and strategize on how best to reach them.”
Anjere also acknowledges the benefit of partnerships. Support from a range of global immunization partners has helped the county conduct targeted outreach in areas with low vaccine uptake. Partnerships have also helped Vihiga to map eligible children, an activity that allows the county to set targets for community health teams.
Anjere is keen on broad stakeholder engagement during the introduction of vaccines and other interventions into the health system. On the impact of the malaria vaccine, she notes that health care workers, who were the first to realize that severe forms of malaria were subsiding in hospital wards where they were working, became strong champions of the malaria vaccine in the county.
Innovative approaches such as SMS reminders have also played a huge role in Vihiga’s success. As Anjere notes, “SMS reminders are a big contributing factor to our exemplary performance. We have seen poorly performing sub-counties turn and start recording impressive performance due to SMS reminders.”
As the RTS,S malaria vaccine continues to be rolled out in Vihiga and other parts of Kenya, Ghana, and Malawi, other countries are considering malaria vaccine introduction. More than a dozen countries have already applied for Gavi funding for phased, subnational introduction to areas of greatest need. Based on the strength of these country plans and the support from global partners, subnational introduction can begin for new countries in early 2024.