WILLIAM PALMER: Welcome, everyone. On behalf of the Mayo Clinic School of Continuous Professional Development, I'd like to welcome you to the Mayo Clinic COVID-19 Live Webinar Series. I'm Dr. William Palmer, Associate Dean of the School, your host for today's webinar, Global COVID-19 Pandemic Updates Part One-- Kenya and Ghana.

This webinar is accredited for one AMA PRA Category 1 Credit. A record of attendance will be provided for all other healthcare professionals. This webinar is supported by an educational grant from Pfizer, Inc. Here are the disclosures for this activity. Before we get started, we'll cover a few points.

The first is how to claim credit. If you'd like to claim credit after the webinar, please visit ce.mayo.edu/covid1116. You'll need to log into the site and if this is your first time visiting, you'll need to create an account profile. After you've done this and logged in, you'll access the course to complete a short evaluation, and then you'll have the ability to download or save your certificate. This link will be dropped into the chat box throughout today's webinar.

The second item is how we facilitate questions. You'll see at the bottom of your screen the chat and Q&A function. If you have any questions during the webinar for today's presenters, it's important that you drop them into the Q&A channel. There'll also be a helpful upvote button, so be sure to upvote the questions that you would like to see answered. Here are the learning objectives for today's webinar, which will be covered.

With that, I'd like to introduce today's moderators, Dr. Claudia Libertin and Dr. Prakasha Kempaiah. Dr. Claudia Libertin graduated from the University of Toledo Medical School and completed internal medicine, infectious disease, and medical microbiology training at Mayo Clinic in Rochester. She has been on staff at Loyola University in Chicago and Yale University, until she rejoined us at Mayo Clinic in Florida in 2014.

She is Professor of Medicine, Director of Infectious Disease Clinical Research at Mayo Clinic Florida, and Consultant of Infectious Diseases. During the COVID-19 pandemic, she led the COVID-19 ID Multidisciplinary Team and is primary investigator on five randomized controlled trials, including Active Five. She has also already published nine COVID-19 publications to date.

Dr. Kempaiah is Associate Consultant at Mayo Clinic Division of Infectious Disease in Florida. Dr. Kempaiah received his PhD from the Institute of Human Genetics in Gottingen University, Germany, majoring in Development of Therapeutics for Genetic Diseases. Dr. Kempaiah currently leads the Drug Discovery Program for Protozoan Parasites in the Division of Infectious Disease, and more recently, in COVID-19, and has established long-term research and clinical collaborations based in Kenya, Ghana, South Africa, Japan, the United Kingdom, South America, and India to facilitate the testing and development of new therapeutics in animal models and field samples. With that, I'd like to turn things over to our moderators, Dr. Libertin and Dr. Kempaiah, to personally introduce today's panelists.

CLAUDIA LIBERTIN: Thank you, Dr. Palmer, and thank you, everybody, for attending the second of our six webinars on the global COVID-19 pandemic. We feel that the next two are very important, in that they are going to be giving us the opportunity to learn the impact that the pandemic has had on African countries, and then on the next one, the Indian pandemic. We'd like to first introduce Dr. Kusi from Ghana. He is the Senior Research Fellow, Department of Immunology, and Head, Department of the Electron Microscopy and Histopathology, the Noguchi Medical Institute for Medical Research, College of Health Sciences at the University of Ghana. His educational background is he's from ladened University Medical Center in Netherlands, where he received his PhD in medicine vaccine immunology and then at the University of Ghana, has gotten multiple degrees in biochemistry.

His research is heavy in pathogen induced immune responses, especially Plasmodium. Most importantly, though, he collaborates with us as researchers at the US Naval Medical Research Center in the Walter Reed Army Institute of Research on similar immune responses. He is the lead immunologist of clinical trials in his country and is currently involved in assessing immune responses elicited by the Lassa fever vaccine trial. He leads the immunologic arm of assessing the benefit of prior measles-rubella vaccines on immune responses to the subsequent COVID-19 vaccine. It's a great honor to have him speak with us. And I'll turn that over.

KWADWO ASAMOAH KUSI: So good morning, good afternoon, good evening, wherever you may be. My name is Kwadwo Asamoah Kusi with the Department of Immunology, Noguchi Memorial Institute for Medical Research at the University of Ghana. And today I'll be sharing with you what our story has been so far in terms of the COVID pandemic, in terms of how we're managing the pandemic, and also a lot of information on vaccines.

So basically, to start with, and for these disclaimers, obviously I have nothing to disclose when it comes to this. This is the outline of what I'll be presenting, so a bit on COVID-19 epidemiology, contact tracing and testing as has been done in Ghana, control and preventive measures, as have been ruled out. Then there's a bit on SARS-CoV-2 sequencing and how it's being managed. Then I'll also mention something on vaccines, vaccination, and vaccine hesitancy in Ghana, and then end with some new government policy directions, which we think are going to be very, very important for us as a country.

So basically, this is Ghana's current COVID-19 case count as of 11 November. We have 112 active cases, 130,000 confirmed cases in all. 1,200 deaths, and I know this pales in comparison with what is happening elsewhere in the west, but most of the disease is concentrated in the south. That's in the capital city, in Accra, and then also in the second largest city in terms of population, in Kumasi. So these are the two main areas where you have the disease concentrated.

This is the number of peaks we've had so far with COVID. So we had our first peak of infections somewhere in August of last year. And then, in February of 2021, we had a second one. And then, just recently, in July, we had a third peak. And these have been due to various activities that are happening around these times and I'll touch on these as we go on. This is basically how we have done contact tracing.

This is a paper from Professor Ernest Kenu with the School of Public Health at the University of Ghana. And he has been in charge of the national contact tracing. And this is exactly what they did for the very first 30 cases we had, identifying a total of 1,000 and over contacts, but being able to follow 732 of them, meaning that there was still a number who were not able to be traced and therefore not followed. But out of the 732, 53 became symptomatic and then they-- their contacts were also followed and so on and so forth.

Although this is not a perfect system, it still helped a lot in trying to identify persons who have come into contact with those who are sick from COVID. And these are how we have managed our COVID situation mostly. And also because it was limited to a few cities, it wasn't widespread throughout the country, that there are regions in Ghana that experience probably just one or under five infections over the period.

This is a chart that is showing the same graph I've shown previously, but looking at the numbers that are due to routine testing and also in orange and then also those that are due to contact tracing. So you see that a lot more cases have been detected through contact tracing as compared to routine testing. Now one unique thing about my Institute is it was the first to begin the testing cycle. And that's the Noguchi Memorial Institute. And as at December of 2020, Noguchi was testing almost 52% of all, or conducting 52% of all tests, that were being done in Ghana.

That's quite a remarkable achievement. Out of that, 67% of confirmed cases were confirmed by testing in Noguchi. And a few months down the line, by August 2021, we now have down to 30, almost 30% contribution because there's now hundreds and hundreds of labs that were trained and facilitated to also engage in COVID testing. But still, Noguchi contributes quite a significant proportion of the national testing.

This is a graph showing how much, or how many tests have been done by my Institute. And the positivity rate indicated in red here. So at some point, we're testing up to 90,000 samples within a month. And this was made possible because of the pooled procedure that we employed.

Now this is what the Ghana Health Service reports in terms of COVID cases in Ghana. This I pulled out on this date, on 7 November, and as you can see, there's routine testing, there's contact tracing, and then we also have surveillance at our main port of entry into Ghana, which is through the Kotoka International Airport. Luckily for us, that is the main port for most arrivals by air, so it's much easier to control and to be able to check for passengers who might be carrying the COVID virus.

So down here you also see a breakdown of samples and where they are coming from, from routine surveillance, from enhanced contact tracing, and also at the airports. And obviously you see that quite a huge number have been picked up at the airport or have been tested at the airport, with 2,910 being detected or picked up as cases at airports. So basically, this is to show how much testing has been done per million and the number of confirmed cases and an even smaller number of confirmed deaths from COVID.

And if we look at this, it might look disproportionate and it's because it does look like there is a lot of exposure and we have a lot of asymptomatic cases and therefore, these are not even reporting to hospitals and getting tested. This is data showing serosurveillance for antibodies against SARS-CoV-2 that was done in crowded places, as well as in health facilities. And you see that the marketplace and Lorry Parks, where you have crowds and crowds of people, shows the highest levels of seropositivity for antibodies to COVID.

And then if you look by age group, the 41- to 60-year age group is the most exposed for obvious reasons. That is-- that contains quite a significant number of the working population who are always out and about. It seems to disproportionately affect persons with lower levels of education. And that may be linked with their employment status in a way because a lot of those are those who also been informal employment and also be in the lower income bracket. So these plots clearly show the demography that is most exposed in Ghana.

And of course, if we compare the number of deaths that have been occasioned by COVID-19 with our neighbors, at least seven of our neighbors in West Africa, it compares very well. And this is one thing that I would say is probably more accurate than the case counts because deaths would be more difficult to not to count compared to the cases. And like I said the cases are very difficult to manage because not every case of infection actually ends up in a testing center or hospital to be counted.

Now basically our control strategies for COVID has been what everybody else is doing- mandatory face mask wearing, frequent hand washing. And I must say that in this era of COVID, this has been super enhanced in Ghana. Everywhere you go, there is opportunity to wash your hands.

And there is this contraption here, which is not unto described as the Veronica bucket, named after its inventor. So this is just a normal plastic basin that is fitted with a tap at the bottom and this can be placed anywhere for people to wash their hands, so in front of shops, in front of buildings and stuff. And it's very-- it came in very handy during the COVID era and it has been very, very useful.

Now physical distancing is another thing that has been employed. But if you look at the graphs being shown here, it's been more difficult enforcing the wearing of masks. So the bars in red are the proportions of persons who have been shown, especially in crowded places, in vehicles, not to wear masks while the blue ones are those who are actually complying. But physical distancing has been the opposite. And so that has been a very effective tool for us in terms of trying to prevent COVID spread.

And then we've had series of indoor and outdoor disinfections. So you have large companies that have been contracted to decontaminate surfaces in various places, from markets to office buildings to-- and that has been quite consistent and been very helpful. And of course, vaccination, but that is going at such a slow pace. And we'll look at that later.

Now, the pandemic has brought on some innovations, but also some challenges. And I'll just highlight three of these here, the first being the use of technology for testing and tracking COVID-19. Zipline is an American company that has been in Ghana for a while and their initial task was to distribute medical supplies to the hinterlands, where it's difficult to access by road. And so they have been working for a while in Ghana.

But during the COVID pandemic, Zipline has been repurposed to fly samples from very hard to reach areas to the cities for testing. And the results are communicated back to health facilities there. And now with vaccination, you've also been involved in carrying samples or vaccines from centers of distribution to very hard to reach areas for that to be used for vaccination.

And then Ghana also-- the Vice President commissioned an app, our own local app for people to just be able to check themselves, whether they have COVID symptoms and to be able to report. And also this app has been very important for contact tracing because you are able to tell within your locality who would most likely be infected with COVID.

But of course, it has also brought hardship. And this is a picture that is showing a group distributing food packs to the homeless, to people who were more or less stranded because of the partial lockdowns we had. We've had lockdowns in limited places and for very limited times. But for the two or three weeks that we had the lockdown, the economic impact was so much that the government was more or less forced to reopen the system and try to do disease control with other means.

Now we switch gears and talk about sequencing. And I must say that Ghana is doing very minimal sequencing, unfortunately, because of resource constraints. But the sequencing that is being done has yielded quite good information. My institution is doing sequencing for both Ghana and for a few other countries in the West Africa subregion. But this is data I'm reporting from a sister institution at the University of Ghana, the West African Centre for Cell Biology of Infectious Pathogens. And this is an app that has been developed to showcase where the different variants that are being picked up are coming from in country.

So as of August, September, they had done a total of 1,144 samples. Like I said, this is very limited but it does show us quite a good distribution of what we had in country. These are samples that have been collected, at least since the middle of last year, and then these have been selectively sampled for analysis.

And we able to see over time that, some time from November, December onwards, maybe somewhere in January 2021, the Alpha variant has been one that has plagued us. And then somewhere in May, June, July this was mostly taken over by the Delta strain. And so it does look like our peak in February was driven mostly by the Alpha strain of the variant and our peak in July, August was driven mostly by the Delta variant.

Now this is a summary of the major receipts we've had on vaccines in country. So I think the major one has been the AstraZeneca vaccine, which we have received quite a number of from different quarters. And then, too, received Sputnik vaccines, the Moderna, and the Pfizer/BioNTech vaccines as well. These are just rough numbers of vaccines that have come in, and have indicated at times that they've come in because our vaccination has been slowed down because vaccines have trickled in in bits.

The estimate was to vaccinate 20 million Ghanaians by the end of December but as of now, what has come in is less than 10 million vaccines. And though the year is not over, it does look like we might not meet that target. So currently the Ghana Health Service reports having vaccinated 3.2 million persons in Ghana out of the targeted 20 million that are supposed to be vaccinated.

And this is the breakdown of which vaccine has been used at what time. So AstraZeneca being the one that has been used a lot and then you have the others follow in that manner. And, in all, we have 838,000 Ghanaians who are fully vaccinated those who have gotten either the double shot of all the vaccines or the single shot of Johnson & Johnson vaccines.

So if you look across the West Africa region once again, Nigeria seems to be ahead in terms of the total number of persons who have been vaccinated, Ghana in third position. But if you look closely at the persons vaccinated per 1,000 persons, you see that Nigeria is not on top of that because they have quite a huge population, almost 300 million people. So in terms of this, Togo and Cote d'Ivoire ahead, Ghana in the third position.

When we look at immune responses regarding [INAUDIBLE] vaccination, unfortunately we do not see any boosting effect. So this is data coming from our lab where we looked at post-vaccination samples and then the post-first vaccine and then the post-second vaccine samples. And we do not see any boosting effect in terms of antibodies.

This is in the persons who had or reported prior exposure or prior infection of SARS-CoV-2, and then in persons who had no prior infection. But the only thing we see that is that in those with prior infection, quite a few of them have higher levels of antibodies although this is not significantly boosted by vaccination. And then you have a lot of those without prior vaccination having very low levels of antibodies.

This of course, does not mean the vaccines are not effective. We are yet to look into T cell responses for these vaccines. But in terms of antibodies, it looks like very little is happening. And this is not surprising compared to other vaccines, where it does very well in the West, but when it comes to our part of the world, the efficacies are so much reduced, probably because of a high background of infections.

Now if you look at attaining herd immunity, which most countries are driving at, it looks like we have a long way to go because you need a certain minimum population to be vaccinated in order to come close to achieving that. And I pulled this information from a paper in Vaccine, where modeled data on attaining herd immunity and that's depending on two things. One, the level of efficacy of the vaccine that you're using but also on the level of contagiousness of the viral variants that you have in the population. And looking at these two factors, it looks like most African countries will really struggle to be able to achieve herd immunity through vaccination. Maybe through natural infection, but through vaccination, may be a very tall order.

Then I look at vaccine hesitancy and how people are either directly or not readily accepting even the few vaccine doses that we have. So this paper published recently shows that [INAUDIBLE] of the persons who are willing to take vaccines, have quite good knowledge of what the vaccines are and what they do. In like manner to the same group who are willing to take vaccines. So the first is those who are willing to take vaccines, sorry. You have a lot of them in the 20- to 40-year group. And for the group that are also willing to take vaccines, you still have that same age group turning up.

Reasons that have been given for whether there is willingness or unwillingness to take vaccines are listed here. So for those who are willing to take vaccines, one of the key things they mentioned is the fact that it's a life saving medication and they think it's good to take it in order to preserve life. But of course, for those who are unwilling, given the myriad of reasons why they are not taking the vaccines, from doubts about the safety of vaccines, to religious beliefs, to lack of information or education on what the vaccines really are supposed to do, and also, their perception of what the vaccines are, generally. Then there is this other studies are more or less corroborate these findings. So this study looks at reasons why people would be willing to take vaccines. And what comes on top is the fact that people want to protect their families, their friends, and those around them. And also the fact that some people believe the vaccines are effective from preventing them from getting COVID 19. And then, if you look at those who are undecided as to whether they will take these vaccines, what ranks highest in terms of their reasoning is this year that I am not well informed about the possible effects of the vaccine. So they are looking for more information. And I think this is a group that with the proper education will be willing to take the vaccine and to reduce the levels of hesitancy that we have.

And then we have the group that are not willing at all to take these. And their major problem is the clinical safety of the vaccines and also the possible side effects that they have heard other people talk about. More recently, there's also hesitance in taking some types of vaccines, because there was information regarding some countries not accepting vaccine certificates if you were vaccinated with certain vaccines. So for example, people are a bit hesitant when they have to take the Sputnik vaccine, or the AstraZeneca vaccine, because they think it will not be accepted in certain jurisdictions. So that has also created a bit of a problem for patients, especially who are regular travelers.

Now overall, the government, in knowing how Africa is suffering, in terms of getting access to vaccines, is taking steps to ensure that going into the future, we become self-sufficient. At least the groundwork has started, and we hope that this will be sustained. So the Ghana government has taken some steps, set some short-term, medium-term, and long-term goals to ensure that there is a roadmap for Ghana becoming self-sufficient in vaccine production.

And the short-term goals are expected to be achieved within two years, and include what you see on the slide-- to be able to upgrade Ghana's Food and Drugs Administration to a level where they can do lots release locally. That's within the first two years. To be able to have domestic vaccine manufacturing plants that will do fill and finish vaccines, and to have at least three educational institutions, or research institutions, to establish vaccine-related development programs. Currently, there are a few around, but the capacity is very low.

So the government is taking that responsibility to ensure that there are additional institutions that would have programs relating to vaccine development, in order to build a needed human capacity. And then, to establish at least two financial partnerships that will ensure sustainability of this agenda, and then to establish scholarships that are targeted at capacity building still. So to train people in the West and get them to come back to contribute to the vaccine manufacturing process. And then to implement at least one technology transfer partnership with big pharma out there.

And then, in the medium-term, the expectation is that the Ghana FDA will achieve a WHO level 4 maturity, to have a number of additional companies locally producing vaccines, to establish at least three vaccine plants in Ghana, to have at least five research institutions with fully functional vaccine related research and development programs, and to establish at least three technology transfer agreements.

And in the long-term-- to have, in the next 10 years, Ghana being able to produce its own vaccines for the expanded program on immunization. Ghana currently gives some 13 vaccines to children between birth and the age of 5. And the plan is that in the next 10 years, at least those 13 vaccines can be locally produced in Ghana.

And it is also because, by 2027, Ghana will wind off GAVI support. GAVI currently supports the extended expanded program on immunization in Ghana. By 2027, that funding will be pulled. So this is also in line with making the country self-sufficient in this area.

And then, to have domestic vaccine research and development programs that are capable of developing candidates for production. And then, to have the Ghana FDA fully capable of regulating the vaccine manufacturing space. So to conclude, I think Ghana, relatively, has fewer cases of severe COVID-19 and related deaths. And that is compared to what we are seeing in the West. And indeed, that is also the case for most of sub-Saharan Africa.

Despite that, we need improved health systems, because these are very important, especially as we are not sure of what the future holds, in terms of the variants that are likely to come up. So improving health systems is one thing that urgently needs to happen.

And then, there is also the need for continuous education, because there is a lot of people who are not well-informed concerning the collective fight against COVID-19. And therefore, a lot of education is needed to ensure that even with our limited capacity, and our limited efforts, we are able to effectively control the disease.

And then, looking at how the vaccines are trickling in bits, it looks like vaccination may not be our primary strategy for controlling the disease-- because even when people are vaccinated, and it takes so long to get others around them vaccinated, it doesn't help for the attainment of herd immunity by vaccination. And so enforcing the other protocols-- preventive protocols like wearing of face masks, social distancing, hand washing-- those are low-hanging fruits that I think should be enhanced and enforced to be able to make sure that we keep ourselves in control of the disease.

And then, also the investments that have been proposed in the vaccine production space will be very important, although they might not be readily relevant to the current pandemic. They will be very important going into the future, as we need to prepare for any future pandemics that come on. So with this, I'll end by thanking these persons who have contributed in one way or another to putting this package together. And I would say thank you very much also to Mayo Clinic for the invitation to do this presentation. Thank you.

PRAKASHA KEMPAIAH: OK. Thank you very much, Dr. Kusi, for providing the overview of pandemic in Ghana, as well as the West African region. Moving on to the second presentation, it's my great honor and pleasure to introduce our speaker, Dr. Bernhards Ogutu. In the remainder of this session, Dr. Ogutu will be covering the COVID-19 pandemic situation in Kenya, and broadly address same in Eastern African region.

Dr. Ogutu received his medical degree-- MD As well as the PhD-- from the University of Nairobi in Kenya. And Dr. Ogutu is a pediatrician, and trained in clinical pharmacology. And he is a pharmacologist by training, and is a certified physician investigator, as well.

So he currently serves as a Chief Research Officer at KEMRI, which is Kenya Medical Research Institute, similar to the CDC what we have here. And he also is a scientific team leader of the Centre for Research in Therapeutic Sciences at Strathmore University in Kenya. And Dr. Ogutu currently is a lead clinical trial list of several product evaluation protocols, including recently approved in order to assess malaria vaccine in children.

His research area includes studying disease pathogenesis, primarily in the malaria, also conducted clinical trials-- as well as involved in capacity-building in Africa. With that, please welcome Dr. Ogutu.

BERNHARDS OGUTU: Thank you very much. Dr. Bernhards Ogutu from Kenya, and I would want to share with you what the COVID situation now to Kenya. And thank you for the opportunity to be with the audience at Mayo Clinic and the other places that we are watching this presentation.

Just possibly to see that this COVID-19 is just part of the epidemics that we have seen in the last two decades. This has been, possibly, one of the things that is really shaping the way medical care and medical biomedical research is being conducted around the world. And this, basically, if you look at the last two decades, where you had yellow fever-- we had Zika, influenza. And then, we had Ebola. And now, we had MERS-CoV. And then, we have had cholera, and now SARS-CoV1.

And I think these are some of the things that, possibly, we need to look at-- and what is really happening in the last two decades, and what are going to possibly be some of the things that are looking at what might be considered as the biological pandemics that possibly is going to shape the way we react to health situations around the world, in this world that has become more of a [INAUDIBLE]-- communication and the flow of information basically in a matter of seconds from one end of the globe to the other.

So we know that there's a high prevalence on the long incubation period of the symptoms of the COVID-19. And this is what has really plagued the world by having several people getting infected across the globe. And this is what led to the COVID pandemic-- has now spread at leisure in 2019.

So some of the key components of this virus are that I think has really been the target of a number of developments, especially when we are looking at developing drugs and vaccines, has been basically the spikes-- which are basically the components of the vaccine that it used to latch onto the host cells. And that, also, is the entry of the virus into the host system. And then, another key component is basically the envelope that covers the virus. And this basically allows the viral assembly and release into the host cells, and possibly in the extracellular space.

Then, we have the membrane proteins, which basically help to stabilize the cell of the virus. And I think bodies have been targets for-- when we are looking for interventions and possibly drug and vaccine targets-- and then you have the nucleocaspid proteins, which is basically the RNA replication, which is involving the RNA replication and also the messenger RNA, and also the viral budding as it tries to propagate, once within the host.

So in the last couple of months, we have seen the [INAUDIBLE]. And basically, these deaths are that-- the genetic code of this virus is fairly versatile, that we've seen a number of variants that are possibly trying to eclipse one another. And now, we know that the Delta variant has become the predominant variant from the time it was first reported in India in 2020 October. And now, it has become the most dominant variant across the globe.

And there are several other variants that have been reported. And it is a matter of time before we know which other variant becomes much more the predominant one, and possibly going to cause more havoc, depending on whether it is more transmissible or the way it possibly will evade some of the control strategies, the drugs and the vaccines that have been good for us.

And the key interventions for the control of COVID-19 currently-- obviously, the vaccines, and then the supportive care for those who are severely ill, and basically the treatments that are also currently not very clear. We have, basically, antivirals, and the anti-inflammatory agents, which are basically supportive care once you more or less to tame the hyperimmune reaction that possibly might be the reason behind severe disease in COVID-19.

So these this lines are just possibly looking at the major milestones that have happened in the period that we've had COVID, from December 2019 to the current situation, what has happened and some of the things that have been put in place. One of the things that has happened is basically the fact that, within the time period, within a couple of months, less than a year, we were able to get a functional and effective vaccine that has been deployed within the last one year.

And we've seen that ramped up deployment of the vaccine across several countries and territories across the world to basically help to tame the pandemic. And this has been one of the most important things that happened, because that would not have been the case for us-- the fatalities must have been fairly large over the period of time.

If you look at some of the places like East Africa, where I come from, we look at the number of cases that have been reported, and these have been fairly high-- not as high as we've been seeing from the West. And this possibly also reflects the extent of diagnostic capabilities within those countries, and within the region, as well, because some of the issue on the report, what you have tested, and the diagnostic capability is not that great. Then you might not report many cases.

And I think so most of these that you see, the number of cases that have been reported. And even the deaths are related to what can be tested. And we know that the testing rates in most of the sub-Saharan Africans are fairly low. Now, over time, you realize the shift from community screening and targeted testing much more to health facility-based testing, where the focus has been much more on those who are severely ill, or those who are able to seek help from health facilities, rather than the mild to moderate cases that will not possibly require hospitalization, that might not report to hospital.

So in a place like Kenya, this has been fairly the trend on the number of the waves we have seen. This also just looks at the number of waves that we've seen now, more or totaling around four peak transmission periods that we've seen over the last period-- from the time that Kenya recorded the first case to us, in March 2020. And this, also, has seen the interventions in the polls that some of the things that have been possibly interventions put in place in Kenya. And by the time we started doing much more of the deployment of the vaccine, in the last one year, as well.

So what can one get away from this? That in Kenya, basically a majority of the cases have been asymptomatic. And this is basically one of the trends that we see across sub-Saharan Africa, that most of our cases are asymptomatic, with a few that had been severe. But despite that, the health system has been fairly straight that the capacities of being able to manage the severe disease have been quite stretched, that sometimes you literally cannot get bed space in some of the health facilities.

And during this time, some of the things that were done in Kenya-- because it also coincided with the time that we are trying to align with the universal health coverage, health care for all the population. And we did a survey just to see how well the health system was ready for universal health care. And you can see that a number of counties, which is basically shown in the different color shades-- this shows how well-prepared those areas were for universal health care, because that mirrored how well the counties were basically going to be ready to possibly tackle some of the things around COVID-19.

And we also looked at the COVID-19 preparedness, which was basically whether they had quarantine units. They had the bed space that we could isolate the people suffering from COVID. And at the beginning of the pandemic, which was basically around the middle-- that was the end of 2020, a number of counties were not very much fully prepared for the money, the cases of COVID-19. And this was basically related in terms of the health facilities that have the necessary equipment and bed space that will take care of the patients that are having severe disease.

So some of the framework that had been put in Kenya basically was set up with the National Emergency Response Committee for COVID-19, which was chaired by the Cabinet Secretary to the Head of the Ministry of Health. And then, that brought in a number of government departments so that they could be able to raise the resources and ensure that the security system of the country took a good look at what was happening around COVID.

And then, the technical bit of this was basically the National COVID Task Force, which was chaired by the Principal Secretary of Health and the Director General of the Medical Services. And this was basically the technical arm which brought all the experts from the public sector and the private sector and the academia to make sure that we had all the people that would cover all the aspects that the areas that needed to be covered around COVID-19 containment.

And these were done within several subcommittees. Those were resource mobilization-- and those were in the clinical care. And those were the public response and emergency response. So all these committees met every week, and sometimes several times a week, depending on how serious the situation is, and report back to the main task force, and then was filtered out to the National Emergency Response Committee, which reported directly to the head of state.

So basically, some of the things that were being addressed were enhanced surveillance in the community, health facilities, and points of entry in the country-- which is basically the airports and also the border points, so that we could take good control of those who are coming in, the number of cases that are coming in, and those who are leaving the country. And also, increasing the testing capacity through the National Laboratories, and also the Kenya Medical Research Institute, that was initially running most of the testing across the country-- and then, the regional labs, and also introducing new testing capacities that platform. That needed to be done.

And initially, those mandatory quarantine and testing of everyone arriving from outside the country. And also, with the time, because of the testing and not quarantine and possibly tracking down those who have come into the country within the last 96 hours. And this was also followed by aggressive contact training. And then, we have case management-- what was being done quite a bit.

And then, we also had a lot of going to quarantine isolation facilities. In every country, that has made sure that there was a facility that we have those who are [INAUDIBLE] isolated in. And also, at the same time, making sure the health workers were trained on how to handle those cases of COVID.

And one of the things that we had for quite a long time, until October 2021, was the nationwide curfew, which restricted the movement at some time, restricting movements across certain counties, and also movement during the night. And this helps possibly to tame the spread of the virus across the different countries. And then, the other thing was the deployment of the vaccine, which was a new committee that was set up just to make sure that we deploy the vaccines rapidly and mobilize more vaccines for the country.

So some of the things that we used to do is basically had a daily update, which was initially led by the Cabinet Secretary for Health and the technical leads at the Ministry of Health. And this was just to update the population, to tell them the gravity of the problems and the number of cases that we are seeing, the number of deaths, those who have been recovered from the disease. And this was done daily so that everybody is in tandem, and everybody across the country knew what was going on so that we can do a bit of public education. There's not much time.

And this is just looking at the distribution of the deaths which had occurred by the time of today's presentation, which was basically October 20, 2021. And you can see that majority of the deaths are still in the older age group. But we're still not missing-- we're still having some people in the younger age group that we are seeing a number of deaths.

So this also informed some of the way the interventions were being deployed-- like targeting the older age group with vaccination, as we started off. And also ensuring that those who are vulnerable were tested to make sure that, if they had any symptoms, they can be tested, so that appropriate care can be taken. And also, if the need inpatient care, they should be given priority.

So currently, the Kenyan government targeted possibly to vaccinate around 10 million people by December 2021. And we hope that by that time, we might get around 26 million Kenyans vaccinated by the end of 2022. And I think these are some of the things that, currently, most of the activities are geared towards-- and trying to expand the vaccination framework to make sure this can be done.

And currently there are multiple vaccines that have been deployed across the country. And that was from AstraZeneca, Moderna, or Pfizer. Yeah, Johnson and Johnson, and also, some [INAUDIBLE]. And this has improved over time because initially, access to the vaccines was a problem. And we could go flat-out as a country to inform the populace on where to go and get the vaccine because the numbers were limited.

But this has improved over time. And we have quite a number of people that we hope will be able to get the doses that possibly they need by the end of 2022. And this, basically, the roadmap of what the government hopes to achieve in Kenya.

So with time, now that we have more vaccines, there's a bit of expansion of the priority groups. Initially, it was those with co-morbidities, and those who are older than 58 years old that were the initial target. But now, this has been expanded. And we hope that we are going to get more people, especially the adult population, over time, and also looking at those who are the front-line workers, especially those working in the health sector and the security, and also in the education sector.

And this is basically to make sure that we can cover the most likely people that are going to possibly be the super-spreaders, or are going to be at risk of possibly coming down with the disease. And this is making sure that now, as we move towards January 2022, then we are going to look at persons greater than 18 years old, possibly to make sure that we get this population covered, and basically add that group. But you can see that this still leaves the younger age group, which is quite a big population in the country, knowing that we have a very young population in Kenya.

So these are some of the vaccines that currently, possibly have in the country, and what is being possibly received. And we know this gets updated on a daily basis, depending on when new vaccine does this arrive in the country. And this is just the way they have been coming in, from August, when we received the first batch of the vaccine in the country, which is basically the AstraZeneca vaccine. And now, more or less, the whole array of vaccines that come into the country. And this is the main thing that we possibly should be able to reach the population that we want to reach with this vaccine coverage.

So if we look at the people who have been vaccinated over time-- and you can see that the older age group, quite a good portion have been vaccinated. But we also see the younger age group, above 18, being also vaccinated. And this is something that the government is really trying to ensure-- that more people get the information, and possibly attend to the vaccination center so that they can be vaccinated.

There has been a bit of liturgy and possibly hesitancy on a number of people coming in. And this also is affected by when the waves go down. And then, people feel like, oh, there might be some pulsatility that things are getting better, and we might not get the vaccine.

And also there have been quite a lot of false information which is flowing around through the social media. Again, this is the vaccine-- and think this is the information that the government is trying to deal with to inform and possibly to make sure that people get the right information so that they can go for the vaccination.