Fighting Covid-19 in Kibera, one of Africa’s largest informal settlements

KIBERA, Kenya — Nearly 10 months after a grandmother in England became the first person in the world to get vaccinated against Covid-19 outside of a clinical trial, we were finally able to start vaccinating residents of Kibera, one of Africa’s largest informal settlements.

That first jab was a long time coming.

In March 2021, the Kenyan government prioritized vaccination as one of the key measures to contain the spread of Covid-19, reduce community transmission, severe illness, hospitalizations, and deaths. The informal employment sector had significantly closed, four out of five residents of Kibera and other informal settlements had lost their income, and a majority of households were facing hunger. The level of exposure to SARS-CoV-2, the virus that causes Covid-19, was even higher since people had literally nowhere to go every day. A successful vaccination program would allow for the full reopening of our economy.

On a Wednesday morning in late October, we vaccinated an elderly man after having transported 200 precious doses in ice packs from Nairobi’s Mbagathi Hospital to a refrigerator in the Tabitha Medical Clinic, where we work, carefully documenting the cold chain to ensure the vaccines remained viable. This marked part of the successful rollout of a national vaccine deployment program targeting at least 30 million Kenyans, about 60% of the population.

Located just outside of Nairobi’s central business district, Kibera is characterized by overcrowding, lack of infrastructure, and limited health care facilities. Hundreds of thousands of people live in an approximately 3-square-kilometer area, with most families sharing one-room 10-foot-by-10-foot houses. This overcrowding has made social distancing, self-isolation, and maintaining other Covid-19 prevention measures virtually impossible throughout the pandemic, making the need for Covid-19 vaccines even more critical.

Many of the first shots went to women who live near Tabitha Medical Clinic, which is named after the local nurse who started it in 2000 with a $26 grant from a visiting college student from the University of North Carolina at Chapel Hill. These women are participants in the Population and Facility-Based Infectious Disease Surveillance (PBIDS) program operated by the Centers for Disease Control and Prevention in partnership with our organization, CFK Africa. They had been thoroughly informed about the vaccines and were looking forward to receiving them at the nearest facility.

The clinic had long been preparing for the day when we could finally distribute Covid-19 vaccines. We had sent a nurse to the Kenyan Ministry of Health to receive training on the details of the vaccine and vaccination, conducted community- and facility-level sensitization including going to local radio stations to talk about the vaccine, and sending community health volunteers into the community to address misinformation and counter vaccine hesitancy.

Mobilizing against misinformation

Most Kibera residents wanted to get vaccinated against Covid-19 as soon as possible. They began showing up at the clinic as word got around that we were offering it. Some, however, were hesitant, wanting to wait and see how it went for their friends and neighbors — much as happened in the U.S. and other countries.

The same myths and misconceptions concerning the vaccine exist in Kenya as in the U.S. and other countries. But we have the connections and the time to discuss the effectiveness and the safety of the vaccines with each patient and answer their questions. We have a team of staff members and community health volunteers dedicated exclusively to the vaccine drive, providing them with the quality time that some patients need for reassurance. We also have a long-standing history in Kibera — 20 years, to be exact — that has enabled us to build up a sufficient level of trust that would successfully drive the Covid-19 vaccine initiative among the highly dynamic and hard-to-reach populations.

Existing and emerging challenges

We are, however, working against time. As in other informal settlements, many residents of Kibera are migratory, often living in the community temporarily until they are able to find a stable job, save money, and move to an area with greater infrastructure and opportunity. Many may travel out of Nairobi during school holidays and will not necessarily get vaccines from centers near them. Some may be lost to follow-up, leaving the community before they receive their second dose.

Residents of informal settlements like Kibera often work from sunup to sundown, six or seven days a week, limiting the time they have to visit a clinic to get vaccinated. Our organization has worked with the Kenyan Ministry of Health to identify and take vaccines to major workplaces, markets, and manufacturing industries.

The Omicron variant of the coronavirus, which was first reported in South Africa, has renewed our efforts to get people vaccinated. Our goal is for 60% of the residents of Kibera to get at least one shot by June 2022. This, however, will depend on a steady supply of the vaccines by the Ministry of Health, the establishment of as many distribution centers and mechanisms as possible, local partnerships, and community engagement.

To date, the Kenyan government has received approximately 20 million doses for a population of 54 million people. Although 50% of those doses have already been administered, only 16% of Kenyan adults have been fully vaccinated.

For as long as vaccines will be made available, community engagement and trust will remain the single most powerful mechanisms to successfully combat vaccine hesitancy and resistance in highly fluid and dynamic settlements such as Kibera.

Improving public health beyond Covid-19

Before the pandemic emerged, Kibera was doing well with the distribution of other lifesaving vaccines. Because the Tabitha Medical Clinic focuses on maternal and child health, we vaccinate approximately 300 children every month. Our community health outreach program helps to ensure that all children are vaccinated against MMR, polio, pneumonia, and rotavirus, among other childhood infectious diseases.

We’ve seen a similar spillover effect with hand-washing. We started the Water, Sanitation, and Hygiene (WASH) program in 2014 to provide clean water and soap mainly to fight diarrheal diseases, the second leading cause of death worldwide for children under the age of 5. We have doubled our efforts during the pandemic and have seen a more aware and interested community in disease control and prevention, which is one silver lining amid the devastation caused by Covid-19.

Hillary Omala is the executive director of CFK Africa. Eddah Ogogo is the organization’s primary health care program coordinator. Both live in Nairobi.