Understanding and Addressing Vaccine Hesitancy in Kenya

As the supply of COVID-19 vaccines has increased globally, including in East Africa, vaccine hesitancy has become a new public health challenge. In recent times, COVID-19 has both impacted and informed healthcare and research all over the world, in addition to bringing global healthcare inequities to light.

In Kenya, where access to COVID-19 vaccines had been limited, the nuances of hesitancy are influenced by cultural beliefs, the structure of the country’s healthcare system, and misinformation on social media among other factors.

A recent article in the journal Vaccines analyzes and discusses these nuances and develops potential interventions to address vaccine hesitancy tailored specifically to Kenyan contexts.

A team of researchers from Aga Khan University (AKU) in Nairobi and the University of Michigan (U-M) collected and interpreted data on attitudes toward COVID-19 vaccines. Their findings emphasize the importance of developing country and region-specific strategies to decrease hesitancy and increase vaccine uptake.

Addressing vaccine hesitancy in a way that helps us understand the social, cultural, and economic factors behind vaccine decision-making means connecting with communities and asking questions at a very granular level.
–Jasmit Shah

Despite a vast majority—over 80%—of the 3,996 survey-takers stating they felt it was important to be vaccinated against COVID, and most saying they would recommend the vaccine to others, this has not translated to high vaccination rates within Kenya. As of early June, about a quarter of Kenyans have received at least one dose of a vaccine and only 17% are fully vaccinated.

Jasmit Shah, a biostatistician at AKU and Data scientist with AKU’s Brain and Mind Institute (BMI), led the survey design process with Sayed K. Ali, an Associate Professor of Medicine at AKU. Their initial work focused on how mental health disorders were associated with COVID-19 among healthcare workers and then transitioned to examining attitudes around becoming vaccinated as COVID vaccines became more available in the country.

Kenya’s healthcare system is composed of government, private, and faith-based sectors, each providing different resources in different ways, including access to COVID-19 vaccines.

You have to start by asking if people trust who or what the vaccine is coming from. You also have to improve infrastructure for transporting and storing vaccines.
–Ryan Rego

Because existing data on vaccine uptake was outdated, the team created a survey to gauge attitudes about COVID-19 vaccines based on literature. They distributed the survey to adults at 6 healthcare facilities across Kenya and included patients and relatives at private, government run, and faith-based clinics. The questions asked participants to share demographic information, medical history, and attitudes and perspectives on getting a COVID-19 vaccine.

Ryan Rego, an Impact Scholar with the U-M Center for Global Health Equity, began working with the AKU team in 2021 to examine existing data sets, hoping to understand the general magnitude of vaccine hesitancy in Kenya. AKU researchers then proposed collecting and analyzing their own data and began to design the survey that was distributed at these 6 healthcare facilities.

Survey design was paramount here, given that the study relied on the responses of patient-participants across Kenya. The questions needed to measure and reflect accurately how Kenyans felt about the vaccines. The survey was based on existing research on vaccination attitudes in Kenya and other low- and middle-income countries.

“The survey used in this study involved a sub-population of Kenyans who were already patients at the healthcare facilities at which the survey was distributed or were relatives of the patients,” said Shah. “Addressing vaccine hesitancy in a way that helps us understand the social, cultural, and economic factors behind vaccine decision-making means connecting with communities and asking questions at a very granular level.”

Rego said the survey helped them see hesitancy through the lens of access—itself a multifaceted issue that needs to be addressed through building trust, sharing knowledge, and improving healthcare delivery and infrastructure. “You have to start by asking if people trust who or what the vaccine is coming from,” he said. “You also have to improve infrastructure for transporting and storing vaccines. And then get enough people who are qualified to physically administer the vaccine.”

One of the more pressing challenges in Kenya is getting vaccines to people in rural communities, where access remains limited and hesitancy can also be more prevalent when information on and trust around vaccination are lacking. The AKU team is concurrently working on an intervention where community members take part in the vaccine administration process as a way to increase uptake within their communities.

“Whether in rural or urban areas, we know that education and awareness can help create a solution to address hesitancy,” Shah said. “Providing materials to healthcare facilities that emphasize the advantages and importance of getting vaccinated can make a difference, as can combating misinformation on the efficacy and side effects of vaccines.”

This research from Kenya shows that developing strategies to reduce vaccine hesitancy should be tailored to individual countries and cultures.

The ongoing nature of this work both challenges and motivates globally minded researchers like Rego and Shah.

“A great aspect of working with the University of Michigan is its intent to help us work alongside our global partners. The university supports us in our co-design processes, supports our partners in doing work that is important to their contexts, and fosters long-term collaborations with partner institutions,” Rego said. “This gives us confidence that a study like this can provide a genuinely local health enhancement, like reducing the burden of a vaccine-preventable disease with creative, local engagement.”

Investigators at Aga Khan University and the Center for Global Health Equity are continuing to work on vaccine hesitancy issues in Kenya and other countries, expanding their work beyond COVID-19 vaccines to HPV, Malaria, and routine childhood vaccines, including significant studies among refugees in Kenya.

–Jaynab Akhtar

Other authors on the paper include Abdulaziz Abeid, Karishma Sharma, Soraiya Manji, Jamila Nambafu, Robert Korom, Keya Patel, Mohamed Said, Mohamed Ali Mohamed, Mohamed Sood, Victor Karani, Patrick Kamandi, Sarah Kiptinness, Rajiv Patel, Reena Shah, Zohray Talib, Sayed K Ali.