Vulnerability and childhood immunization in Kenya. A systematic review of policy documents protocol.

Introduction

Vaccines are some of the most effective public health interventions with a demonstrated capacity to prevent and/or control the outbreak and spread of infectious diseases^1–3. Improved health outcomes globally can partly be attributed to the use of vaccines which have played a significant role in the reduction of morbidity and mortality arising from life threatening infectious diseases. According to the WHO, immunization against different infectious diseases contributes to the prevention of approximately four million deaths per year globally, hence an increase in life expectancy. Moreover, disease prevention using vaccines can help to avert medical expenditures and other related costs such as loss of wages by caregivers during sickness episodes, travel time and transportation costs to seek treatment⁴.

In the past decades, several concerted efforts have been put in place internationally to promote access and uptake of vaccines targeting different age groups. Key among these was the establishment of the Expanded Programme on Immunization (EPI) by WHO in 1974 and the Global Alliance for Vaccines and Immunization (GAVI) in 1999. These initiatives have so far led to improved childhood vaccine coverage across the globe. However, access and uptake between countries are still characterized by inequities, especially in sub-Saharan Africa where the majority of vaccine-preventable diseases are experienced^5–7. Additionally, immunization coverage at national and sub-national levels in most African countries has stagnated and is disparate⁶. WHO estimates that more than 30 million of under five years children in Africa suffer from vaccine-preventable diseases annually, out of which 500,000 die from these diseases. This is almost equivalent to 58% of the global vaccine-preventable diseases². Moreover, many of these children haven’t received any dose of the recommended childhood vaccines (zero-dose children).

These disparities in access and uptake not only make some children vulnerable to vaccine-preventable diseases but can also potentially form hotspots for future disease outbreaks. Several reviews of published literature have been conducted to highlight vulnerabilities that influence the disparities in access and uptake of childhood vaccines^8,9. For instance, in Kenya, previous studies have shown that children’s vulnerability to vaccine-related disparities is influenced by geographical, household, and mothers’ characteristics^10,11. However, how these vulnerability issues are framed and addressed in grey literature, such as government policies, is lacking. Yet this understanding is not only important but also necessary for the identification of gaps and the formulation of appropriate strategies. We therefore intend to systematically review general health sector and immunisation-specific policy documents in Kenya to examine the extent to which vulnerability issues are framed and addressed generally and in the context of immunization. Specifically, the review will: (1) describe how vulnerability is conceptualized in the general health sector and immunisation-specific policy documents, and (2) examine strategies proposed in the policy documents to address vulnerability issues in general and in the context of immunization.

Methods

Study status

Completion of this review is anticipated to be by September 2023. The study team is currently screening documents identified through online searches.

Conclusion

The review intends to provide an understanding of vulnerability issues in the context of health and immunization in Kenya. Specifically, it will focus on how vulnerability issues are framed in policy documents to identify gaps and opportunities that can be harnessed to address vulnerabilities that influence access and uptake of vaccines. We intend to explore the gaps identified through the review with relevant stakeholders through primary research and contribute to the improvement of the policy landscape around immunization through policy recommendations.