COVID-19: Despite gov’t claims, experts say Nigeria not ready for vaccine distribution

It is almost impossible for Nigeria to start a vaccine campaign in January, according to several global health experts and bodies.

Despite Nigerian authorities’ claims of expecting to receive in January one of the vaccines developed globally for COVID-19, evidence on the ground at the country’s National Strategic Cold Store suggest an exaggeration of the claims.

Osagie Ehanire, Nigeria’s Health Minister, while responding to questions from journalists after the Federal Executive Council (FEC) meeting in Abuja, last Wednesday, said, “We signed up for advanced market participation in COVAX. So, if we will be able to get our own, I think it will be in January.”

But several global health experts and bodies told PREMIUM TIMES it is “almost impossible” for Nigeria to start a vaccine campaign in January.

Distribution campaigns across Africa are not likely to begin until April, the head of the Africa Centers for Disease Control and Prevention estimated. Even then, fewer doses will be sent to African countries than are being shipped to the United States and Europe.

“It will be extremely terrible to see,” said John Nkengasong, the Africa CDC director.

The African continent is “far from ready” to roll out what will be its largest-ever immunisation drive, the UN World Health Organization (WHO) said in late November.

Even the United Kingdom, which became the first country to begin the process of vaccinating its citizens with the new BioNTech-Pfizer COVID-19 vaccine on December 8, can only start a full-fledged campaign at least by December 29 when the European Medicines Agency (EMA) will meet and (is expected to) approve the vaccine.

Depending on COVAX

Most African countries, including Nigeria, are banking on benefitting from the COVID-19 Vaccines Global Assess Facility, or Covax, the World Health Organization-backed programme, which was set-up to divide a billion doses across 92 low- and middle-income countries next year.

“We are looking at the end of the first quarter of next year or the beginning of the second quarter” to approve a shot for use in Nigeria, National Agency for Food and Drug Administration and Control’s Director-General, Mojisola Adeyeye, said last Wednesday.

COVAX, an initiative run by the vaccine alliance, GAVI, aims to ensure equitable access to a COVID vaccine when it becomes available.

So far, Nigeria has submitted a non-binding confirmation of intent to participate.

The agreement would grant the country access to vaccines at a reduced cost but the number of doses procured would depend on how much Nigeria can afford to pay and until all countries that signed up for COVAX have received enough doses to vaccinate 20 per cent of their populations, no one can ask for more.

The National Strategic Cold Store situated along the Nnamdi Azikiwe international airport, Abuja

Asides from solely relying on COVAX, there are no indications that the Nigerian government is trying to secure direct deals with pharmaceutical companies.

Last Monday, Mr Ehanire, while briefing the Senate, said Nigeria is ready for its COVID-19 vaccination strategy. He said the country needs about N400 billion to procure its own vaccines.

But senate president Ahmad Lawan expressed concerns over the country’s ability to effectively store and distribute the doses in Nigeria.

“The Health Ministry would need to convince the National Assembly that they had the abilities and manpower for the COVID-19 vaccination so that the Senate would start making plans to support vaccine funding for Nigeria,” he said.

While European and other western countries are already putting modalities in place to receive and distribute vaccines, Nigeria is not ready yet to receive and run a nationwide coronavirus vaccine campaign, even if they get them for free, checks by PREMIUM TIMES revealed.

How ready is Nigeria?

The Nigerian government, in late November, inaugurated an 18-man national COVID-19 task team to ensure ‘vaccine security’ when it finally gets to the country.

Mr Ehanire, at the Presidential Task Force (PTF) on COVID-19 briefing, said the committee would have a seven-point of reference which will include generating strategies for acquisition, deployment and options for licenced production of the vaccines.

Speaking on Nigeria’s preparedness to receive the vaccine, the Director-General of the National Institute of Pharmaceutical Research and Development (NIPRD), Obi Adigwe, said over the past two to three decades, Nigeria has built capacity in supply chain and logistics which includes cold chain capability.

“I am aware that in every local government area in Nigeria, there is either existing or there was some structure or framework for cold chain storage of products.

“What I would be thinking is that the various stakeholders that are involved in this vaccine roll-out story should at this point be reviewing the validity of those structures.”

But the biggest challenges Nigeria will face when it eventually gets the vaccines, according to health experts is in storage, distribution and determining who needs it most.

This is as a result of a mix of factors including poor storage facilities, epileptic power supply, acute data collection, manpower shortages among others.

Health experts have also stressed the importance of clinical trials in Nigeria to ensure efficacy before arrival.

A fortnight ago, PREMIUM TIMES visited Nigeria’s vaccine plant to ascertain the level of preparedness in place to receive the COVID-19 vaccines.

The National Strategic Cold Store located few miles away from Nnamdi Azikwe International Airport is where all vaccines are stored on arrival into the country. The vaccines are later distributed to various zones across the country.

The facility houses 11 walk-in cold room refrigerators and four walk-in freezer rooms.

But there are no ultra-cold freezers much needed to store some of the frontrunners such as the Pfizer-BioNTech and Moderna vaccines, according to Iyabo Daradara, Director, Logistics and Health Commodities at the National primary HealthCare Development Agency (NPHCDA).

“The National Strategic cold store has 11 walk-in cold rooms refrigerators which store at +2 to +8 and four walk-in freezer rooms which are used for vaccines that need freezing.

“We do not have ultra-cold freezers in the country,” she said, in an interview with PREMIUM TIMES.

While the Oxford-AstraZeneca vaccine had lower interim efficacy results, it does offer the best possibility for distribution in Nigeria because the temperature required is not as low and manufacturers can produce it at a lower price.

The NPHCDA official also explained how the country receives vaccines.

“Before the vaccine arrives, we have what we call pre-alert or pre-advice. The manufacturers send the pre-alert of incoming shipments of vaccines, notifying us of the freight forwarder. This notice comes one week before the arrival of the vaccines and another notice three days before the arrival.

“Before the vaccines arrive, we identify the clearing agents and give them letters with the airway bill and a job order. The agents go to the airport, customs to the necessary documentation.

“When the vaccines finally arrive the country, they will clear the vaccines and transport them to the National Strategic Cold store.

“At the cold store, the verification officers cross-check the vaccines that arrived with the packing list. The packing list gives details of the quantity per batch.

“For distribution, we have routine immunisation distribution and distribution meant for disease outbreak.

“All vaccines within the country are transported from the National strategic cold store to the zones and then to the states. Before distribution, the allocation committee meets to discuss the availability of vaccines, requirements for the period and the shortfalls in vaccines.

“On the day of distribution, we use the allocation sheet generated from the Vaccines Stock Performance Management (VSPM) to note the vaccines needs across the supply level. We have six distributors from private organizations for the six geo-political zones in Nigeria. So the job order for each zone is given to the company in charge of that zone.”

Power supply challenge

Even though the national cold store has a solar energy that ensures 24-hour steady power supply, epileptic electricity will make storage of large doses difficult in the states and regions.

“Storage issues will be one of the biggest challenges Nigeria will face in rolling out these vaccines”, Confidence MacHarry, a security and health data analyst with SBM intelligence said.

“We would need our electricity generation company to work optimally to run a successful campaign. These are issues the federal government ought to have worked out as modalities by now.”

Another major challenge is that Nigeria is yet to identify the priority population to inject the vaccines due to poor data collection strategy.

Prior to COVID-19 outbreak, there is already an acute lack of accurate data across Nigeria. Experts believe this has limited a data-driven response.

“There will be challenges domestically in knowing the number of people in the country that can be vaccinated since we do not have credible statistics,” Mr MacHarry said.

AbdulFatai Ibrahim, a virologist at the University of Medical Sciences, Ondo State, said “Most PHCs do not have electricity supply in their facilities. So how will they store the vaccine?” he said.

Poor awareness

To run a successful vaccine campaign, there is a need to create awareness in communities ahead of time to build trust and drive demand for immunisation.

There is already an existing poor perception of the coronavirus in Nigeria. Linked to this is the perceived politicization of the pandemic by some state authorities.

Nearly three in every 10 Nigerians in a poll conducted in late April maintained that they have some form of immunity to the coronavirus.

The survey conducted by NOIPolls Limited, a country-specific polling service showed that poor knowledge and perception of the virus is capable of sabotaging gains made in keeping the contagion at bay. Fact-checkers and health officials are working furiously to provide accurate information and save lives.

Despite the recent spike in coronavirus cases officially declared the second wave, many Nigerians reckon it is safe to lower their guards on safety.

About 50 Nigerians engaged online by PREMIUM TIMES in a bid to gauge perceptions on the second wave believe the worst is gone, hence the safety protocols are more or less, a mere protocol.

These factors will make acceptance and penetration of the coronavirus vaccines extremely difficult without a robust immunisation awareness campaign. There are no plans for any yet.

The National Orientation Agency has not started any awareness campaign even though the government said it is expecting to receive the vaccines next month.

The National Strategic Cold Store situated along the Nnamdi Azikiwe international airport, Abuja

‘Lagging’

A recent WHO analysis also revealed that vaccination programme readiness in Africa is lagging.

According to the analysis, based on countries’ self-reporting, the African region has an average score of 33 per cent readiness for a COVID-19 vaccine roll-out, which is well below the desired benchmark of 80 per cent.

Only 49 per cent have identified priority populations for vaccination and have plans in place to reach them, 44 per cent have coordination structures in place, according to WHO analysis. In addition, 24 per cent have adequate plans for resources and funding, 17 per cent have data collection and monitoring tools ready, and only 12 per cent have plans to communicate with communities to build trust and drive demand for immunisation.

“The largest immunization drive in Africa’s history is right around the corner, and African governments must urgently ramp up readiness. Planning and preparation will make or break this unprecedented endeavour,” Matshidiso Moeti, WHO Regional Director for Africa said.

“We need active leadership and engagement from the highest levels of government with solid, comprehensive national coordination plans and systems put in place.”

Health experts speak

Mr. Ibrahim said “Nigeria can receive the vaccines but the problem that awaits us is that of logistics and storage.

“One thing about vaccine administration is that cold chain is very important. You must maintain the standard of the cold chain from the manufacturer to the end dealer, which the patient it is administered to. If we can get this vaccine to places like Abuja, Lagos what about remote communities? How will they store these vaccines? So this is a major implication,” he said.

Uwem George, a virologist also said the major problem is storage, logistics and misconception.

“Nigeria do not have the capacity to store the COVID-19 vaccines. Also, some people are actually having a bad notion on the effect of vaccines. Most people do not believe in the efficiency of vaccines. And there are lots of misinformation in the cyberspace. So administering the vaccine will be a challenge,” he said.

This report was facilitated by the Wole Soyinka Centre for Investigative Journalism (WSCIJ) under its COVID-19 Reality Check project.

 

 

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