Formulating policies to curtail vaccine hesitancy and accelerate uptake
By Woubedle Alemayehu, Monitoring, Evaluation and Learning Hub Director and Amy Kracker Selzer, Vice President, Technical Leadership, Kantar Public's Development Practice
According to the World Health Organization (WHO), since January 2022, Kenya has reported 323,035 confirmed COVID-19 cases among its population of 48 million, with 5,640 deaths.1
While the introduction of COVID-19 vaccines in late 2020 has helped many high-income countries deal with the pandemic, middle- and low-income countries such as Kenya have been left behind in vaccine rollout and access.
As part of the COVAX initiative established and led by the WHO to support the equitable distribution of COVID-19 vaccines across the world, Kenya received its first batch of 1.02 million doses in March 2021.
The Kenyan Ministry of Health currently aims to fully vaccinate 70% of its adult population by June 2022: as of February 2022, about 20% of the population has been fully vaccinated – a quarter of whom are 18-29 years old.2
While the number of vaccines supplied to Kenya and the number of doses administered have steadily increased over the last year, there are still questions around access to the vaccine and the need to quickly vaccinate young people.
In this article, Woubedle Alemayehu and Amy Kracker Selzer from Kantar Public draw on recent studies on the perceptions of, and access to the vaccine among young people in Kenya, to present recommendations for the formulation of effective public policies targeting this cohort.
Addressing the potential risks of vaccine hesitancy and misinformation among young people
Because the severity and mortality associated with COVID-19 tend to be higher in older people (65+ years old) than in the younger population, and because the number of vaccines available is limited, countries have prioritised vaccine access among older adults, health workers, and clinically vulnerable people.3
The roll-out of the COVID-19 vaccination programme could trigger unintended consequences among young people, such as increased vaccine hesitancy.
For example, the longer young people go without vaccination, the more likely they may feel able to live with the risks of not getting vaccinated; and the greater the opportunity for the proliferation of misinformation around COVID-19 vaccines, which could result in young people not wanting to get vaccinated at all, or not willing to overcome potential difficulties in accessing to the vaccine.
As the delay in access prolongs young people’s potential exposure to the health consequences of contracting and spreading the virus, it is paramount to identify barriers and understand hesitation.
In Kenya, the government implemented a phased approach to the vaccine rollout. The first phase (March-June 2021) targeted frontline workers – health workers, teachers, and security officers – and later included those aged 58 years and over.
The second phase (July-October 2021) focused on reaching those in phase one not yet vaccinated, and those individuals with risk of severe disease and death. Phase three, which kicked off in November 2021, is currently underway and opens access to the vaccine to all adults over 18, as well as those under 18 with regulatory approval.4
Given the evolving situation around access to the vaccine and the need to quickly vaccinate the youth, Kantar Public explored topics related to COVID-19 vaccination in two waves of our PUBLIC Voice citizen panel , first in August/September 2021 (wave 1) and then in November 2021 (wave 2).5
We drew on the evidence to answer a range of questions including:
By addressing these questions and others, our study provides insights into how the Government of Kenya can best support public health measures to expand vaccine access and accelerate uptake among the Kenyan youth.
A growing willingness to get vaccinated amongst young people in Kenya
Kenyan youth increasingly believe that COVID-19 vaccines are important for their health (figure 1), and show a high willingness to get vaccinated if vaccines are available.
In the second wave of our study, over 80% of young people said they believe COVID-19 vaccines are important (“moderately” and “very” important), compared to 74% in the first wave.
Additionally, most youth (>80%) say they will get the vaccine if it is made available to them (figure 2). Similarly, they report that most of their friends and family members would be willing to get the vaccine if it were recommended to them (figure 3).
Figure 1: How important do you think getting a COVID-19 vaccine will be for your health? (%)
Figure 2: If a COVID-19 vaccine is available to you, will you get it? (%)
Figure 3: Do you think most of your close family and friends would want to get a COVID-19 vaccine? (%)
Access to vaccines is improving for young people, albeit with barriers still for some subgroups
Access to COVID-19 vaccines is improving for young people in Kenya. The proportion of respondents reporting easy access to COVID-19 vaccines increased from 38% in September 2021, to 56% in November (figure 4). This is due to more vaccines being available in the country and reduced waiting times.
However, there were notable differences by gender: in November, a significantly larger proportion of young women (43%) reported the access to vaccines as being ‘very easy’ compared to only 28% of young men.
In terms of location, access among young people in both rural and urban areas increased in parallel between September and November, with no differences in reported ease of access by these two subgroups. Yet, as we will see, this doesn’t mean that the situations in rural and urban areas were equivalent, when it comes to barriers to access.
Figure 4: How easy is it to get a COVID-19 vaccine for yourself?
Identifying both practical and psychological barriers to vaccination among young people
For those young people who reported finding it difficult to access vaccines, the main barriers include location of vaccine sites, poor availability, long waiting times, and being turned away from vaccination centers.
Difficulty in reaching vaccine centers is a key barrier to vaccination for young people, with a growing proportion citing this barrier in November (31%) compared to September (25%). This barrier is more prevalent among young people living in rural areas compared to those in urban areas (33% vs. 26%).
Barriers such as long waiting times and vaccines not being available yet were also cited. However, reports of these barriers declined between September and November, which is likely due to more vaccines being delivered into the country.
Figure 5: What makes it hard for you to get a COVID-19 vaccine?
Similarly, the proportion of young people reporting being turned away from vaccine centers has declined, but still remains a barrier for some.
Overall, young people’s trust in healthcare providers giving vaccines increased across each wave, and this was more pronounced among young people living in rural areas than those in urban areas (Figure 6). This could be due to the communication campaigns that are being rolled out by government and other local partners and international donors throughout the country.
But while trust in healthcare providers has improved, over a third of young people still report not trusting them to give COVID-19 vaccines. This mistrust is higher among young people living in urban areas (52%) compared to rural areas (33%). Young women are also reporting a higher mistrust towards healthcare providers relative to men (41% women vs 35% men).
Figure 6: How much do you trust the healthcare providers who would give you a COVID-19 vaccine? (%)
Implications for policymakers in formulating policies to increase COVID-19 vaccine uptake amongst young people
The growing receptivity to COVID-19 vaccination among young people in Kenya could be an indication that the work of the Government of Kenya as part of its COVID-19 Risk Communication and Community Engagement (RCCE) Strategy, is effective.
However, the barriers cited by young people indicate an outstanding need to consider both policy and implementation efforts in two key areas:
In addition, while willingness to get vaccines is high, when the pandemic becomes less severe it will be harder to convince those who were relatively positive and motivated to get vaccinated to take up the COVID-19 vaccines. Therefore, motivating young people to get vaccinated will still be of importance in the long run.
References and notes:
1. Kenya: WHO Coronavirus Disease (COVID-19) Dashboard With Vaccination Data | WHO Coronavirus (COVID-19) Dashboard With Vaccination Data
2. Kenya Ministry of Health - Situation report on COVID-19 vaccination program on 1st March 2022
3. Why does COVID-19 disproportionately affect older people? - PubMed (nih.gov)
4. National Covid-19 vaccine deployment plan, 2021
5. PUBLIC Voice is a probability-based citizen panel that is is designed to provide governments and policymakers with representative access to the public and answers to challenging policy questions.
