Kenya this week joins the world to commemorate the African Vaccination week (World Immunization Week) as well as the World Malaria Day on April 25, 2023.
Commemoration of these important days is key in that it reinforces the need to pay attention to immunization and prevention of disease.  AS WHO celebrates 75 years of existence and member states count milestones and lessons, Kenya can look back on its growth with determination to sustain the 90 per cent target of coverage across all 15 vaccine types it provides. Kenya since 1980, established the Kenya Expanded Programme for Immunization, KEPI, which set its pace to ensure all child diseases are prevented through immunization from birth. These include tuberculosis, pneumonia, diarrhea, polio, measles, diphtheria, whooping cough, tetanus, hepatitis, meningitis, yellow fever, malaria and cervical cancer.
In  February, Kenya launched the malaria vaccine expansion outreach to cover an additional 25 sub-counties, following successful pilot that has brought substantial reduction in severe malaria attacks, deaths and child hospital admissions.
The three-year-old pilot implemented from September 2019, made the vaccine available to children in eight counties in Western and Nyanza region of Kenya targeting 1.2 million children.
The RTS,S/AS01 (RTS,S) malaria vaccine is the first vaccine recommended to prevent malaria in children. If implemented broadly the vaccine could save tens of thousands of lives each year. 
The pilot implementation of the RTS,S vaccine through the national immunization programme, has reached nearly 400,000 children in eight counties in the Western and Nyanza regions of Kenya since 2019. This was part of the WHO-coordinated pilot programme in Kenya, Ghana and Malawi. More than 1.3 million children across the three African countries are now protected by the additional malaria prevention.

The four-dose vaccine is given to children at ages 6, 7, 9 and 24 months in the counties of Kisumu, Siaya, Homa Bay, Migori, Busia, Kakamega, Bungoma and Vihiga, which are areas of moderate to high malaria transmission where children are at high risk of dying of malaria.

The expansion of malaria vaccination follows the first WHO recommendation for a malaria vaccine in October 2021 that was informed by data and insights generated from the pilots. The expanded delivery will enable thousands more children at high risk of malaria illness and death to benefit from the vaccine. 

“I would like to congratulate the Government of Kenya for this step toward increasing access to the first malaria vaccine, as part of a package of WHO-recommended measures to strengthen malaria control. Nearly half a million children die of malaria in Africa every year; we need this new prevention tool now more than ever,” said Dr Abdourahmane Diallo, WHO Representative, Kenya. 

In a visit to vaccination sites in February by the WHO Director of Immunization, Vaccines and Biologicals Dr Kate O’Brien, she said: “I note that this vaccine has generated a lot of enthusiasm and excitement in communities, and the high demand for it is bringing caregivers and children to the clinics where children can also catch up on other vaccines and child interventions for protection. I applaud the Ministry of Health, at every level, for bringing this vaccine forward.”

Pilot results have also shown that there is no negative impact on the use of other malaria prevention measures, such as using insecticide-treated bednets (ITN), and there is increased equity in access to malaria prevention in the areas where the vaccine is being given (vaccine or ITNs).
“We have seen impressive results around Kisumu County where there are now reduced severe malaria attacks and hospital admissions for malaria, said Dr Gregory Ganda, County Executive Committee Member for Health. “Communities are very happy with the results which is the reason the demand for the vaccine is high.”
The county leadership considers the malaria vaccine an innovation that can improve child health and child immunization services, alongside measures to expand a digitized system for immunization records that will help to identify where and how to focus efforts to reach more children with the full range of childhood vaccines. 
In Homa Bay, one of the implementing counties, the County Director for Health Dr Gordon Okomo added: “This vaccine has been a game changer at the hospitals, in communities and for families. We have witnessed a great shift in the disease burden and look forward to more families accessing it.”
The malaria vaccine’s schedule requires children to come for 4 doses of vaccine for the best protection, and this includes at least one visit at about age 2. Community health volunteers, CHVs, have played a significant role in encouraging mothers and parents to bring their children to health facilities to complete the 4-dose schedule. Their role is also to convey health messages on the need to continue other malaria prevention measures, such as sleeping under bednets (ITNs), and benefits of other routine vaccines for children.
“We walk from house to house to encourage parents to complete the malaria vaccine schedule and other vaccines, “said Uanita Majuma, a CHV in Kisumu County. “We have witnessed a great relief in the community in regard to malaria with fewer children experiencing high fevers and severe attacks.” 
Uanita is one of the many CHVs who has supported families to accept the malaria vaccine for their children since 2019. She does this outreach alongside information about other childhood vaccines and adult-related health interventions like family planning, HIV and TB prevention and care. She visits 166 households monthly. 
“I have seen children die and families really distressed because of malaria. But since the introduction of this pilot, we have seen a great difference in the health of children who we see weekly,” she added.
Health workers and medical personnel in the hospitals have reported the same impact that many families in the eight counties have experienced. 
“I have seen severe cases and death from malaria. But I can say we have seen dynamic change - reduction in number of cases and severity”, said Dr Meshack Liru, a pediatrician at Homa Bay County Hospital. “We still see some, but they are much fewer and less intense.”
One mother said: “As long as I have lived, malaria has remained a great problem in these communities and the surrounding areas. People have died of this disease so am grateful that our children have a chance to escape it.”
For Eunice Aoko, a mother of five, who took her youngest child Scovia to Chemelili health facility for vaccination, the vaccine is a health opportunity for children and their families.  She is very happy that two of her younger children have benefitted from the vaccine and have had an easier time than the other three regarding malaria.
“Malaria is a very bad disease, and everyone here knows this because they have at one time or another gone through very difficult times or witnessed loss of life due to malaria”, she said.
In managing the implementation of the pilots, the National Vaccine and Immunization Programme. NVIP, and the counties have learned many lessons that will inform the many new counties that plan to start implementation. This could include use of digital methods like SMS for sharing health information and for reminding parents to complete the vaccination schedule. 
“In the coming years, our objective is to continue to expand malaria vaccination to other parts of the country, as more supplies of the vaccine become available,” said Dr Lucy Mecca, Head of the National Vaccines and Immunization Program (NVIP). 
“This will include applying—along with other countries—for support from Gavi, The Vaccine Alliance, for subnational use of the vaccine in areas of greatest need,” she added. 
In summing up her visit, Dr O’Brien said: “It is such a joy to meet parents and mothers of the children who have been part of this pilot and who have such positive experiences to share about the vaccine.” 
She commended Kenya for its resilience and sustenance of the immunization programme through a difficult time like Covid-19. “There are many lessons to learn from the Kenyan immunization programme which could be shared with other countries”.