Insights from the 2024 Meeting of the Global Antimicrobial Resistance Partnership (GARP) in Kenya
The Kenya Medical Research Institute (KEMRI) and the One Health Trust (OHT) held a two-day Global Antibiotic Resistance Partnership (GARP) workshop in Nairobi, Kenya on October 30 and 31, 2024, focused on “The Value of Vaccines in Mitigating Antimicrobial Resistance.” The workshop brought together healthcare and research experts from across Kenya to explore the role of vaccines as a core component of antimicrobial resistance (AMR) mitigation strategies. GARP-Kenya focuses on evidence-based solutions to AMR through vaccines, recognizing AMR as a severe threat that hampers Kenya’s progress toward universal health coverage and meeting the United Nations Sustainable Development Goals.
The workshop convened a technical working group (TWG) comprised of experts from the Ministry of Health, healthcare, and academic institutions, marking their first in-person meeting after extensive virtual collaboration. Discussions revolved around vaccine-driven AMR reduction and the associated cost implications, challenges of AMR mitigation strategies, and potential pathways for integrating vaccines into national AMR frameworks. The agenda included data reviews on vaccine impact in preventing diseases and curbing AMR, panel discussions on Kenya’s unique AMR challenges, and drafting recommendations to include vaccines in national AMR strategies. Preliminary drafts of a report and policy brief, which have been in development since February 2024, were presented for feedback. Interactive panels focused on refining these documents to align with Kenya’s health needs and AMR challenges.
The workshop commenced with a welcome speech by Dr. Robert Onsare, Principal Research Scientist and Acting Deputy Director of the One Health Approach Research Program at KEMRI, followed by opening remarks from Dr. Veronica Manduku on behalf of Prof. Elijah Songok, Acting Director General of KEMRI. Representing Kenya’s Ministry of Health, Dr. Emmanuel Tan ui outlined the transition to the country’s second National Action Plan (NAP) on AMR, emphasizing key improvements and lessons learned from the first NAP.
Dr. Christine Makena presenting to the meeting attendees
Dr. Christine Makena, GARP-Kenya Project Coordinator, presented a draft report on the role of vaccines in reducing AMR, covering their impact on vaccine-preventable diseases in Kenya and their benefits to human and veterinary health. She highlighted significant implementation barriers, such as vaccine hesitancy driven by misconceptions, cultural beliefs, and distrust in the healthcare system. Addressing these issues, she emphasized the importance of strategic communication and community engagement to build confidence in vaccination programs.
Later in the day, One Health Trust’s Dr. Erta Kalanxhi shared insights on promoting the value of vaccines in AMR mitigation, drawing on experiences from other GARP countries. She emphasized the cost-effectiveness of a One Health approach and raised concerns about current NAPs, which frequently mention immunization yet lack specific objectives for their implementation.
Prof. Sam Kariuki, Eastern Africa Director of DNDi & former Acting Director General at KEMRI, gave a talk titled “Why Cholera Continues to Threaten Many African Countries.” He discussed various vaccine-preventable infectious diseases impacted by AMR in Kenya, with a focus on cholera. He outlined various cholera outbreaks across Kenya, ranging from informal settlements to high-risk settings such as hotels, and emphasized that cholera’s multiple transmission pathways put everyone at risk. He concluded by advocating for the oral cholera vaccine as an effective control measure. The presentations were followed by in-depth panel discussions that generated valuable insights and recommendations tailored to Kenya’s unique context:
Panel 1: Local perspectives on the link between AMR mitigation and immunization strategies
Panel 2: Impact of vaccines in reducing disease burden
Panel 3: Economic costs of AMR
The discussions of the TWG highlighted several critical challenges and opportunities in Kenya’s approach to fighting AMR and vaccination efforts. Key issues identified included the lack of effective national policy guidelines for antimicrobial use, which has led to inconsistent practices and exacerbated AMR. The TWG recommended developing clear and comprehensive guidelines to guide AMR prevention and control across sectors. Additionally, low awareness of AMR was noted as a major barrier, even among tertiary-level students. The TWG proposed nationwide educational campaigns targeting the public, students, and healthcare workers to promote responsible antimicrobial use. They suggested integrating AMR topics into tertiary education curricula to strengthen awareness and support sustainable AMR practices.
In the realm of vaccination, the TWG emphasized the importance of building public trust through effective communication. To increase vaccine uptake, especially for diseases such as typhoid and malaria, culturally sensitive, clear messaging should be developed. The TWG also stressed the need for self-sustained vaccine production in Kenya to reduce dependency on international suppliers and ensure timely and equitable access to vaccines. Another key concern was the gap in adult vaccination coverage, as current programs primarily focus on children under five, leaving the adult population vulnerable. Healthy adults often do not recognize the importance of vaccines unless it’s mandatory, such as for international travel. The TWG recommended expanding vaccination efforts to include adults, particularly for typhoid and malaria, and addressing the affordability of vaccines, as many adult vaccines are not covered by health insurance. It is noteworthy that members expressed concern about the slow adoption of certain vaccines, such as the Rotavirus vaccine, PCV, and cholera vaccine, despite WHO approval over 20 years ago.
The GARP Kenya experts also called for enhanced data collection and research to better understand the impact of comorbidities on vaccine efficacy, which would help tailor vaccination strategies. The Typhoid Conjugate Vaccine (TCV), crucial for controlling endemic typhoid, was recommended for inclusion in the routine immunization schedule, especially in areas with high rates of typhoid. The TWG also urged fast-tracking the malaria vaccine into the routine immunization program to address the significant malaria burden in Kenya. However, since the malaria vaccine requires up to four doses, a key challenge is integrating it into the already extensive National Expanded Programme on Immunization schedule.
Dr. Robert Onsare presenting the draft policy brief
On the second day of the workshop, Dr. Onsare presented a draft policy brief on vaccines and AMR in Kenya that was under development. This provided another opportunity for the TWG members to give their feedback on the draft policy brief. The workshop ended with an interactive wrap-up session led by Dr. Kalanxhi, reflecting on specific feedback for the upcoming GARP-Kenya policy brief. Members recommended that priority sections be featured in the upcoming Kenyan AMR policy brief. Other specific recommendations made were:
- Efforts should be made to address gaps in vaccine accessibility and distribution, especially in remote and highly mobile populations.
- To ensure the success of vaccination efforts, there is a need for Public and Private partnerships; key stakeholders such as Health Insurance companies must be engaged in the planning and implementation process.
Group photo from the 2024 GARP–Kenya meeting
Acknowledgments:
Dr. Robert Onsare – GARP-Kenya Chair,
Dr. Christine Makena – GARP-Kenya Coordinator
Felix Bahati – Research Analyst, One Health Trust
Dr. Erta Kalanxhi – Director of Fellowship and Fellow, One Health Trust
TWG members:
Prof. Sam Kariuki – Eastern Africa Director, DNDi; former Acting Director General, KEMRI
Dr. Christine Karanja – Kenyatta University Teaching, Referral and Research Hospital and Kenya Paediatric Association
Dr. Sylvia Gachoka – Physician, Kenya Defense Force Memorial Hospital
Dr. Anthony Sifuna – Masinde Muliro University of Science and Technology
Dr. Andrew Nyerere – Jomo Kenyatta University of Agriculture and Technology
Dr. David Githanga – Pediatrician and Vaccination policy practitioner, Nairobi Hospital
Dr. Emmanuel Tanui – National AMR Focal Point person, Kenya Ministry of Health
Simon Kiambati – Medical student, Jomo Kenyatta University
Dr. Veronica Manduku – Director General and CEO representative, KEMRI
Written by Dr. Christine Makena, Felix Bahati, and Dr. Robert Onsare
Photo credits: Catherine W. Ndirangu
