EXCLUSIVE: Questions as Nigeria awaits COVID-19 vaccines

There are questions on the country's capacity for storage, transportation and who are likely to be first set of recipients. Will it be on alphabetical order, as in states, or geo-political groups; or, will it be first with frontline health workers or the elderly?

In an attempt to douse fears, the Director General, Nigeria Centre for Disease Control (NCDC), Dr. Chikwe Ihekweazu, told The Guardian, yesterday: "Every vaccine has occasional side effects; the benefits by far outweigh harm. Nothing else has saved more lives than vaccines,ÔÇØ he said.

Executive Director, National Primary Health Care Development Agency (NPHCDA), Dr. Faisal Shuaib, told The Guardian Nigeria has enough storage space for the initial quantities of vaccines expected January ending and is in process of procuring additional ultra cold chain equipment for wide scale deployment of mRNA vaccines. "There is sufficient storage capacity for COVID-19 vaccines requiring storage at the normal refrigeration temperature at + 2 to +8,ÔÇØ he said.

The public health physician said government has enough vaccine freezers and refrigerators to store both at the ultra-cold chain temperatures and the normal + 2 to + 8. "The vaccines will be transported to the lower level using boxes with dry ice,ÔÇØ Shuaib said.

On the first batch of recipients, the NPHCDA boss said there are four main priority groups for 2021 and 2022. He listed health workers and other identified frontline workers in the country, the elderly (50 years and above), and persons less than 50 years but with co-morbid conditions and areas with high disease burden.

Another public health physician and Lead, Lagos State COVID-19 containment team, Prof. Akin Osibogun, told The Guardian: "The Pfizer vaccine will require lower temperatures for storage, including dry ice for transportation and that may be problematic here.

Fortunately, the Astrazeneca vaccine can be stored at higher temperatures, which can cope with freezers at about 2┬░C compared to the -70┬░C for the Pfizer vaccine. Besides, the Astrazeneca vaccine is only about 10 per cent of the cost of the Pfizer vaccine. Fortunately, the Astrazeneca vaccine is also over 95 per cent effective. From the perspectives of our national budget, ease of storage/transportation and possible support of donors, Astrazeneca vaccine seems a likely choice.ÔÇØ

With regards to who should get the vaccine first, Osibogun said a risk-determined approach is the most appropriate, indicating that frontline health workers, the elderly above 60/65 years, and people with pre-existing co-morbidities should be given priority.

"Every state has all these categories of people and health logisticians can work out the distribution modalities,ÔÇØ he said.

An emeritus Professor of Physiology at College of Medicine, University of Lagos, Soga Sofola, told The Guardian that the country's capacity for storage is questionable.

He explained: "For the Pfizer-Biontech vaccine it is -70 degrees and for Moderna vaccine, it is -20 degrees. There are very few places in the country to get -70. So we may need to think about the Oxford-Astra Zeneca as it is fridge temperature, which may be the only one that we can cope with. Even then, we'll need refrigerated transport means to keep the cold chain.ÔÇØ

The professor of medicine said it was important that frontline health workers received the vaccine first, followed by the aged and vulnerable people with diabetes, hypertension, heart disease, those on chemotherapy and very ill people.

"After these, then we can work downwards from age 60 plus then to the lower age groups and youths who are supposed to be less affected. However, in a country of 200 million plus, the logistics will be improbable. It will require the input of statisticians and demographics to figure this out. For a country that is also vast, the logistics will be very challenging. Hopefully, the situation may assist us to improve on our health delivery system, so that it is more diverse and more encompassing,ÔÇØ he said.

He feared COVID-19 vaccination would be a challenge to Nigeria.

A public health physician and Executive Secretary, Enugu State Agency for Control of AIDS (ENSACA), Dr. Chinedu Idoko, told The Guardian "the country's capacity for vaccine storage is obviously as would have been revealed by other temperature dependent vaccines which over time had been effectively distributed, stored as well as delivered successfully to the target population in Nigeria.

"Such vaccines as the polio, yellow fever vaccines etc. have all been over time efficiently delivered to the populace, so I believe our storage capacity is good enough,ÔÇØ he said.

Idoko said there was already a structure for storage and distribution of vaccines in Nigeria, which the National Primary Health Care Development Agency is principally involved with.

"I believe these established portals would be explored to all stages of vaccine delivery,ÔÇØ he said.

A virologist and vaccinilogist, Dr. Simeon Agwale, told The Guardian that according to Anne Mills in an article published in the New England Journal of Medicine, debates on global health have paid increasing attention to the importance of healthcare systems, which encompass the institutions, organisations, and resources (physical, financial, and human) assembled to deliver healthcare services that meet population needs.

The article added that it has become especially important to emphasize healthcare systems in low-and-middle-income countries because of the substantial external funding provided for disease-specific programmes, especially for drugs and medical supplies, and the relative underfunding of the broader healthcare infrastructure in these countries.

"A functioning health care system is fundamental to the achievement of universal coverage for health care,ÔÇØ it added.

It quoted the World Health Organisation as saying that a well-functioning healthcare system requires a steady financing mechanism, a properly-trained and adequately-paid workforce, well-maintained facilities, and access to reliable information to base decisions on.

Agwale added: "As the COVID-19 pandemic rages across the country, it has brought unprecedented strain on both private and public hospitals, including shortage of medical supplies and holes in the healthcare delivery.

"Now there are reports of emergence of new strains of coronavirus including in Nigeria and the real impact is yet to be ascertained. Unlike the UK where we know that the new strain is becoming the most predominant, we don't know yet whether the new strain in Nigeria is responsible for the spike we are currently seeing in the country.ÔÇØ

He advised that going forward would require investment in scientific research in the country without which, the country would be left out in the scheme of things.

He added: "If eventually we find out that these mutant strains affect the effectiveness of the current vaccines, then we will be in a situation like the Flu virus where new vaccines have to be developed every year because the predominant strain changes annually. If this happens, then we may have endless delays in vaccine supplies because the vaccines would be outdated once they reach Africa, while the west will have access to the newest versions that incorporates the new strains.

"This therefore makes building local manufacturing capacities for vaccines, diagnostics and other medical supplies very urgent so that it would be easy for us to quickly identify, treat and prevent this and future pandemics/epidemics.ÔÇØ