How elections pose disruption to vaccine access

The national vaccine coverage in Kenya has over the last one decade increased to reach over 80 per cent of children under the age of two, largely due to a heightened awareness of the importance of immunisation.

But the challenge remains that the number of those vaccinated tends to fall around election time when people move from place to place or stay indoors due to fears of poll-related violence or conflict. That means it could again happen this year as elections are due in two months’ time though there has not been cases of widespread violence so far.

The Economic Survey has in the past shown that the average countrywide coverage stood at 63 per cent in 2006 and the World Health Organisation (WHO) has in recent times reported that this number has risen to 81 per cent.

Statistics from Ministry of Health show that the number of children accessing vaccines dips in the months before and after the elections.

Collins Tabu, head of the immunisation policy and performance monitoring at the Ministry of Health confirmed the pattern where coverage goes down in the period around general elections as people remain indoors or move to safer areas. 

Further, he noted that tension remains high during such periods, and in some regions people are afraid to visit public institutions like dispensaries for fear of attacks.

“During the past two elections there was a more than five per cent slump in the national vaccine coverage each time, with the ministry recording a 5.8 per cent dip during the period around the 2013 polls,” he said while noting that it is not elections per se that affect the coverage but related factors like displacement of people and violence.

“The disruption in service delivery is what causes a dip in immunisation coverage,” he said.

Mr Tabu further says the delivery of services during the 2007 elections was mainly affected by the violence that followed the disputed polls.

The worst affected regions were the Rift Valley and Western part of Kenya where chaos paralysed services in the health institutions. People went into hiding while others remained indoors for fear of being lynched, and taking children for vaccinations remained the least of their priorities.

The 2013 elections ushered in a devolved government which also saw the functions of the ministry of health get devolved, delaying the take-off of the immunisation programmes.

“The 5.8 per cent dip after the 2013 elections was mainly because of the change in governance system, from the central to devolved governance. There were challenges as health workers were moving due to transfers, the ministry was also setting up necessary infrastructure to support the devolved function and so the coverage again dipped,” he said.

This year Laikipia County has seen cases of violence related to the dry weather periods as pastoralists moved in search of pasture although there were also claims that there were some political undercurrents.

The conflict was between the pastoralists and ranchers but the impact on health is still unknown.

Robin Nandy, Principal Adviser and Chief of Immunisation at Unicef agrees with Tabu that conflict cripples health, nutrition, water, sanitation and hygiene services.

“Access to life-saving immunisation too often is a casualty of the breakdown of these essential systems. The result is that during conflict, millions of children miss out on the basic vaccines they need to stay healthy and have a fair chance in life. Most often the children affected are the most vulnerable to disease,” said Nandy.

For instance, conflict in Syria has led to a sharp decline in immunisation rates which have plummeted from 80 per cent in 2010 to 43 per cent in 2014 and as a result the first polio case in 14 years was reported.

“Children affected by conflict are pushed into a downward spiral of deprivation that robs them of their health and by extension, their futures. Vaccines can help to break this vicious cycle,” said Nandy.

“In addition to protecting children from disease, the immunisation supply chains, workforce and infrastructure that reach into remote regions of the planet also have the potential to serve as a platform to deliver other health services and also build health systems.”

Mr Tabu says his department has put in place structures to ensure that the supply of vaccines is not interrupted at any time although he remains fearful that the period around elections remains unpredictable.

“There are structures in place to ensure continued service delivery. However, with this one (coming election) we cannot predict factors that will come into play. But the ministry has made sure that we are better prepared, we have employed electronic monitoring systems to ensure that supplies are there to guarantee continuous service delivery.”

The national immunisation programme involves interventions put in place to prevent deadly diseases that claim thousands of infants in Kenya every year.

Kenya’s national programme involves a number of vaccines against deadly diseases and infections that include Hepatitis B, malaria, tetanus, measles and diphtheria administered to infants from birth to at least 18 months.

The immunisation interventions are a cost-effective preventive measure taken instead of dealing with ravages of the diseases.

Although the immunisation coverage in Kenya has grown over the years, the country has not reached the 97 per cent recommended to prevent an outbreak of diseases like polio and measles.

Still, the measures have led to a 30 per cent reduction in mortality rate of children under five years for the past half a decade to 34,000 deaths every year, according to the 2014 Kenya Demographic Health Survey. Other surveys indicate that the cases have gone down since the report was published.

“Vaccines provide benefits beyond health outcomes, including averted medical costs and reduced time spent by parents and health care workers caring for sick children. These savings accrue to families, communities and nations as improvements in education, economic growth and poverty reduction,” says the Ministerial conference on immunization in Africa report.

“…And despite increased costs–due in part to research and development costs and use of more complicated technologies–vaccines remain one of the most cost-effective interventions in public health.”