Mapping Structural Barriers: A Geospatial Assessment of COVID-19 Vaccine Inequities in Kenya

BackgroundThe COVID-19 pandemic has exacerbated global health inequities, with low-income countries lagging behind in vaccine coverage. By late 2023, only 36% of Kenyans had received at least one vaccine dose, far below the African Unions 60% target. This study examines spatial disparities in COVID-19 vaccination rates across Kenya, exploring how socioeconomic, environmental, and healthcare infrastructure factors shape vaccine access. Unlike previous studies focused on individual determinants, this research employs a spatial epidemiological approach to uncover structural barriers to equitable vaccination. MethodsThis study uses data from the 2022 Kenya Demographic and Health Survey (KDHS), integrating socioeconomic, health, and environmental variables across 1,692 georeferenced clusters. Analytical methods include spatial clustering (K-Means), spatial autocorrelation (Morans I), Random Forest regression, and the Erreygers Concentration Index (ECI) to quantify vaccine inequities. A Development Index (DI) was constructed to assess how financial access, living conditions, and healthcare systems influence vaccination rates. ResultsOur results reveal stark geographic disparities: vaccination rates range from 5.93% in Garissa to 46.02% in Nyeri, with urban clusters achieving significantly higher coverage. Key predictors include bank access (financial inclusion), household crowding, and environmental factors (NO2 levels, precipitation). Wealth-based inequities (ECI = 0.044) were more pronounced than immunization-linked disparities (ECI = 0.025), highlighting financial barriers as the primary exclusionary factor. ConclusionsThis study underscores the need for targeted interventions, including mobile vaccination units, financial inclusion programs (e.g., M-Pesa subsidies), and integration of COVID-19 vaccines into routine immunization programs. Findings offer a replicable geospatial framework for low- and middle-income countries (LMICs), providing data-driven policy recommendations to enhance vaccine equity and pandemic pre-paredness. Addressing these disparities requires multisectoral approaches that integrate health system strengthening, financial accessibility, and climate resilience to ensure equitable vaccine distribution in vulnerable populations.