A Qualitative Examination of the Distribution Strategies, Access, and Equitable Uptake of the COVID-19 Vaccines in Kenya: Lessons for the Next Pandemic

Stephen Mulupi¹John Ele-Ojo Ataguba^2,3,4,5Grace Njeri Muriithi⁴Daniel Malik Achala⁴Elizabeth Naa Adukwei Adote⁴Chinyere Ojiugo Mbachu⁶Senait Beshah^4,7Chijioke Osinachi Nwosu⁸Dr Elias Asfaw Zegeye⁹Vincent Okungu^10*

• ¹LVCT Health, Nairobi, Kenya
• ²Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
• ³School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
• ⁴African Health Economics and Policy Association, Accra, Ghana
• ⁵Partnership for Economic Policy, Nairobi, Kenya
• ⁶Department of Community Medicine, University of Nigeria, Enugu Campus, Nigeria, Enugu, Nigeria
• ⁷Ethiopian Public Health Institute, Addis Ababa, Addis Ababa, Ethiopia
• ⁸University of the Free State, Bloemfontein, Free State, South Africa
• ⁹Africa CDC, Addis Ababa, Ethiopia
• ¹⁰University of Nairobi, Nairobi, Nairobi, Kenya

Background: The WHO and international partners identified vaccination against the coronavirus as one of the important public health interventions in controlling Corona Virus Disease (COVID-19) infections. The COVID-19 vaccine uptake was however low and characterized by inequitable distribution and access in Kenya. This study aimed to examine in depth the causes of inequity in vaccine uptake to inform the future rollout and successful uptake of new vaccines. Methods: The study employed a qualitative approach involving in-depth key informant interviews with stakeholders across various aspects of COVID-19 healthcare, public health, vaccine distribution, and community engagement in Kenya (n=32). Data were analyzed using the framework approach to allow for the identification, examination, and interpretation of patterns or themes emerging from the interview and review data. Findings: Centralized leadership provided by the Ministry of Health (MOH) utilized the existing distribution system, leveraging the Expanded Program on Immunization (EPI); enhancement of stakeholder collaboration and communication through government agencies, civil society, and community health workers was essential for the distribution of COVID-19 vaccines. Key barriers to vaccine uptake included organization and coordination of the vaccination rollout, socio-cultural barriers, and geographic challenges, particularly in rural areas, hindering vaccine access. Communication problems, particularly misinformation, were associated with public mistrust in vaccination efforts. Conclusion: Efforts to increase vaccine coverage should target organizational, social, political, and cultural norms to enhance access and uptake of quality vaccines. This study presents important lessons for health system adaptation, re-organization and preparations for future pandemics.