Investments in Disease Surveillance Support Kenya’s Response to COVID-19

With the enormous strain COVID-19 is placing on health systems, disease surveillance has been challenging but ever more essential. Countries needed to continue monitoring for vaccine-preventable diseases while also launching new surveillance activities for COVID-19. Kenya, which has fortunately seen lower COVID-19 case counts to date than other African countries, got a running start on COVID-19 surveillance thanks to leadership from epidemiologists like Wangeci Kagucia, PhD, a Research Fellow in the Epidemiology and Demography Department at the KEMRI-Wellcome Trust Research Programme in Kilifi.

In a conversation with Maria Deloria Knoll, PhD, IVAC’s Director of Epidemiology, Dr. Kagucia shared how Gavi-supported activities facilitated Kenya’s COVID-19 response by expanding capacity, testing, and partnerships. Among other priorities, Gavi, the Vaccine Alliance also supports monitoring and evaluation activities to measure and optimize the impact of vaccines through Targeted Assessments. That evidence helps to support development of communications and advocacy materials.

Maria: How have surveillance platforms, like Gavi’s Targeted Assessments to ascertain the impact of pneumococcal conjugate vaccine (PCV), helped Kenya understand disease in children?

Wangeci: The Pneumococcal Conjugate Vaccine Impact Study (PCVIS) has informed policy, not only in Kenya, but also globally. A few of the key findings are:

• The annual incidence of serious disease caused by pneumococcal strains that the vaccine is designed to prevent dropped by 92% among children under 5.
• The incidence of invasive pneumococcal disease caused by any serotype, or strain of pneumococcus, decreased by 68%.
• PCV has also shown to reduce pneumonia identified by chest X-ray as well as identified just by clinical signs.

Maria: How have personnel and capacity developed through Gavi’s Targeted Assessment investments assisted with Kenya’s COVID-19 response?

Wangeci: The PCVIS lab capacity has played a role in the COVID-19 response. COVID testing was a huge task for the region, and the KEMRI Kilifi laboratory provided testing services for coastal counties, conducting over 70,000 RT-PCR tests. It was all hands on deck, so we had PCVIS staff, who typically perform microbiology procedures, shift to testing for viruses. They continue to contribute towards lab testing for COVID-19.

Also, PCVIS staff played a huge role in the surveillance studies. PCVIS field staff have assisted with training for blood sample and nasopharyngeal sample collection, which in turn has supported testing for anti-SARS-CoV-2 IgG among different populations. The PCVIS staff’s familiarity with protocols for surveillance within Kilifi has been instrumental in getting a key study testing for COVID-19 antibodies among residents of the Kilifi Health and Demographic Suveillance System off the ground.

It has been great to have that level of capacity to leverage from testing one organism to investigate other organisms— especially one that happens to be causing a global pandemic.

Maria: How has administration of routine vaccines for children been affected by the pandemic?

Wangeci: Some parents are reluctant to bring their children in for vaccination, and we hope to conduct a vaccination coverage survey this year once we can safely resume community-based studies. While data collection has been limited due to COVID-19, there is a need to document measles immunization activities once conditions permit so we can prevent measles outbreaks.

Maria: How does the community feel about a COVID-19 vaccine and will it be welcomed by healthcare workers, the elderly and other populations you plan to target first?

Wangeci: COVID-19 vaccine, at least initially, will be predominantly for adults, who must be either healthcare workers, teachers, or the elderly. Because the vaccine is targeted for adults instead of children, it will require a novel delivery platform which is beyond what we have typically monitored for.

I think, in general terms, the vaccine will be welcomed, but I would not be surprised to see a little bit of hesitancy at first. We are in a setting where there is typically high uptake of vaccines relative to other settings in sub-Saharan Africa. We have a community liaison group and they put a lot of work into explaining what goes into vaccine development and they will continue reaching out to the community to address any misperceptions and misapprehensions about the vaccine.

Wangeci is Research Fellow in the Epidemiology and Demography Department at the KEMRI-Wellcome Trust Research Programme in Kilifi, Kenya where she assists in oversight of the Pneumococcal Conjugate Vaccine Impact Study (PCVIS). Her area of interest is in using epidemiologic methods to generate evidence to inform vaccine policy. Prior to joining KWTRP, Wangeci worked on various vaccine-related projects at the International Vaccine Access Center and Center for Immunization Research, both at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland. She received her Master’s and PhD degrees in International Health with a specialization in Global Disease Epidemiology and Control from the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.

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This article was first published by the International Vaccine Access Center.