…Say riding on WHO recommendation right but…
…‘100, 000 doses far cry from population size’
…Fault creation of new vaccine producing centres
By Chioma Obinna
In less than one month, Nigeria is expected to receive 100, 000 doses of COVID-19 vaccine. According to the Director-General of the National Primary Health Care Development Agency, NPHCDA, Faisal Shuaib, the doses are not for all Nigerians but about 50,000 vulnerable people, frontline workers and health workers.
However, there have been criticisms over the expected doses and the possibility of achieving the right storage of the vaccines from the Pfizer-BioNTech version donated by COVAX facility.
Although the Federal Government claimed to have procured 2100 cubic ultra-cold chain facility in Abuja, experts are worried about the temperate nature of the country, saying Nigeria does not have adequate storage facilities to hold vaccines at the required temperature of minus 70/80 degrees Celsius required for the Pfizer version of the COVID-19 vaccines recommended by the World Health Organisation, WHO.
To them, the best vaccine option for Nigeria is to produce its own version the way it was done in India, Sunday Vanguard reports.
Towards the third quarter of 2020, there were over 140 vaccine candidates. Before December last year, the Pfizer-BioNTech and the Moderna COVID-19 vaccines were introduced. On the heels of that was the Oxford-AstraZeneca’s COVID-19 vaccine.
Recently, India added to the list by producing a version of the Oxford- AstraZeneca’s COVID-19 vaccines which they called Covishield vaccines.
It was unveiled on January 3, 2021.
This is in addition to Chinese vaccines whose efficacy was put at about 50 percent.
Altogether, globally, there are about five types of vaccines for COVID-19 from different research working groups that are available for use.
But WHO has gone ahead to recommend, before now, the Pfizer-BioNTech COVID-19 vaccine. And riding on that, the Presidential Task Force, PTF, and the Federal Government proposed the Pfizer-BioNTech COVID-19 vaccine for Nigerians.
There has been a preponderance of vaccines going to the richer countries. Some countries in Europe have even vaccinated more than four million of their populations.
Meanwhile, many African countries, including Nigeria, are facing the challenge of securing adequate supplies of vaccines because of the high cost and storage facilities.
According to the Director-General of NPHCDA, the WHO-backed COVAX programme is making sure countries like Nigeria are not left behind.
For example, they are going to be providing up to 20 percent of Nigeria’s population in terms of needs for vaccines free of charge, the NHPCDA boss said.
But the question on the lips of health watchers is: how far can this donation go in a country of over 200 million people?
Worse still, findings have shown that even though Nigeria has the largest population in Africa, and has one of the highest incidences of mortality caused by infectious diseases, it cannot remarkably manufacture vaccines that are considered essential to reduce mortality, improve life expectancy and promote economic growth.
Findings by Sunday Vanguard showed that the demand and cost for vaccines are very high, making it nearly impossible to procure many doses anytime soon in countries like Nigeria.
This may have informed the recent announcement by the Minister of Health, Dr. Osagie Ehanire, that the Federal Government has released N10 billion to support domestic vaccine production.
According to Ehanire, government is exploring local production of vaccines and is already negotiating with producers.
Already, NPHCDA said it has developed a comprehensive deployment plan of these vaccines in phases to cover up to 70 percent. A total of 40 percent of the population are expected to get shots this year
The agency said President Muhammadu Buhari and Vice President Yemi Osinbajo would be the first recipients of the Pfizer vaccine while the rest of the 100,000 doses would be distributed to key political leaders and health workers to raise awareness before it gets to the citizens.
Top among those to be vaccinated first are health workers in isolation centres nationwide, 10 per cent of adults above 50 years of age, 17 per cent of persons with co-morbidity below 50 years, and 12 per cent of other risk groups.
Other frontline workers like immigration at the airport, and personnel at testing centres and targeted uniform personnel would also be prioritised for vaccination because of their exposure.
The Minister of Health had earlier stated that Nigeria needs a total of N400 billion to vaccinate 70 per cent of Nigeria’s population at $8 per vaccine.
According to the NHPCDA officials, the country’s goal is to vaccinate 40 percent of its population by the end of 2021 and the remaining 30 per cent by the end of next year.
But experts differ on this goal as they posited that the cost and storage of the vaccine pose a major challenge to the timeline.
Speaking to Sunday Vanguard, renowned Medical Laboratory Scientist/Public Health Analyst, Dr. Ifeanyi Casmir, said Nigeria is in the temperate region and procuring Pfizer-BioNTech COVID-19 vaccine that requires a -80° storage and a 2 to 8° five days shelve life of same would be a major drawback for the country’s goal of vaccinating her citizens.
According to him, with a -80°C long-term storage, you would require to keep it in the refrigerator at between 2-8° for only five days after which it will become deteriorated or invalid.
Casmir, a former National Publicity Secretary of the Association of Medical Laboratory Scientists of Nigeria, advocated that the country should begin to invest in a vaccine in the-country to save cost and achieve a temperature suitable for the environment.
He expressed worry that the country does not have what it takes to maintain a proper storage system for the Pfizer version of the vaccine.
According to him, “we know the terrain of Nigeria and we know our peculiarity and we worry that we do not have a cold chain system that will support the use of Pfizer-BioNTech COVID-19 vaccine. That is one major drawback.
“We are aware that government has gone ahead to invest in the ultra-refrigeration with a capacity of about 2,100 cubic meters of storage capacity.
“Be that as it may, that is only limited to the NPHCDA storage facility in Abuja and we know we need the vaccines across the 36 states of the federation including Abuja.
“And across these mentioned states and FCT, we also do know that we have hard-to-reach areas in Nigeria and the truth is that the population of Nigeria is more in these hard-to-reach areas and the more vulnerable persons are also in those areas.
“So choosing a vaccine riding on the recommendation of the World Health Organization, WHO, is rightly done but we should have considered other vaccine options that will suit our peculiarities better.
“With an ultra-refrigerator in Abuja, the Pfizer-Bontech vaccine only has a shelf-life of 2-8oC of not exceeding five days.
“If you fly, for example, the vaccines from Abuja to Kano on 2-8°C or dry ice, how would you take it to the 44 local government areas of Kano?
“How would you ferry it from Kano to Katsina and to the nooks and crannies of the border where Nigerians live?
“Our terrain is very challenging. I understand that the PTF had opted for the Pfizer-Bontech vaccine on the basis that the vaccine was recommended by the WHO.
“In making the vaccine choice, the authorities should have considered our peculiarities and terrain.
“We are in a temperate region. For a vaccine, the option should be more suited for our temperate nature.
“For example, countries like Brazil that are also considered temperate to some extent are deploying the Oxford-AstraZeneca vaccine.
“We have a logistic cold chain system in Nigeria, which we have used for other vaccines which rises from two to eight degrees, or dry ice storage and transport.
“The major issue we will consider here is the logistic chain.”
He argued that Nigeria should allow science to guide its choice, saying the components of these vaccines should be examined.
Continuing, Casmir pointed out that there is a need to look at the issue of acceptance because of the controversy around vaccines.
“Another thing is that all the other vaccines are largely an mRNA vaccine,” he added.
Casmir explained that the Oxford- AstraZeneca’s COVID-19 vaccines have an edge for being a DNA based vaccine, saying it is derived from what has been used to produce vaccines before.
“It is coming from what is known as ChAdOx1. The ChAdOx1 is the common adenovirus that is typically the cause of cold and flu symptoms. That is recoverable from Chimpanzee. It has a non-replicate viral origin”, the laboratory scientist said.
“That is also a whole lot of advantage even though all these targets the spikes on the viral particle of COVID-19, which is distorted with protein with which the virus give instruction,’’ he explained.
According to him, Nigeria should shop for a vaccine that can withstand its terrain.
“Countries in the MINT and BRIC category like Brazil and India have gone ahead to produce Covishield vaccines.
“That is what they have rolled out for the vaccination of their citizens. For me, whereas government has done something commendable they did not factor in the peculiarities.
“They did not consider that we have a challenging terrain that will not enable us to deliver these vaccines at a point when they are potent.
“If you take them from a minus 80-degree storage facility, they can only be kept for five days at two to eight degrees. Even two to eight degrees is very challenging to attain in the country because you will not have power, to power your refrigerator.
“However, because of all the vaccine programmes, we now have solar-powered refrigerators and kerosene-powered refrigerators in several parts of the country.
“But by and large, that will only give you two to eight degrees. That should have informed the choice of vaccine we should choose as a nation”.
100, 000 doses
He described as a far cry the expected 100,000 doses that will only cover 50,000 Nigerians.
“That is a far cry for the vulnerable groups and persons, people beyond the age of 50, healthcare professionals and frontline workers”, Casmir stated.
“A whole lot should be done by government to ensure we get vaccines that will help us contribute significantly to the global efforts of placing a thumb on this pandemic and halting the spread and building the necessary health immunity”.
Speaking on the proposed vaccine production by the Federal Government, he said although the effort was commendable, the three institutions – the Nigerian Medical Research, NIMR, National Institute of Pharmaceutical Research and National Arbovirus Research Centre in Enugu – mentioned as the drivers of the vaccine production, were not involved in the country’s history of vaccine production.
According to him, “you cannot re-invent the wheel but what you will do is to build from extant principles.
“Such a huge investment coming from government for vaccine production and building capacity for vaccine production should have been rightly channeled to those who have had a history of vaccine production and to those who have driven the process of vaccine production as driven in the past by the medical and laboratory scientists at the National Public Medical Laboratory, Yaba.”
He said the three centres chosen have no human resource repository in the area of vaccine production, adding that government needs to set up a think-tank of experts, comprising top-notch experts to produce vaccine in-country
“It is not just about throwing money to the research institutes. Who will drive the process of producing vaccines in the country?”, Casmir said quizzically.
“Again, the technology for vaccine production has far advanced. We do not need to go to the rudiment as it were even though the rudiment will help us build capacity.
“Today, just like you have modulus, there is a modulus for vaccine production. Why are we not thinking of getting someone that will drive the modulus to drive the franchise?
“We do not need to re-invent the wheel but we can therefore make enormous savings on our foreign exchange. By so doing, we will build capacity and have in-country self-reliance in vaccine production.
“I expect that going forward even for a common routine vaccine for childhood killer diseases, we should think of getting modulus to produce these vaccines in-country.
“And it need not run on institutions or institutes whose mandate does not cover vaccine production.
“We need to make it clear that this is what we are going to do. The first thing government needed to do was to form a crack group that will drive the process and then accelerate them with institutions that will have the platform to do that than to announce the money for vaccine production.”
Levels of storage
On his part, the Head of the Infection Unit at the Lagos University Teaching Hospital, LUTH, Dr. Iorhen Akase, said there are pertinent questions to be answered before procuring any vaccine for COVID-19.
Akase said Nigeria needs to consider a vaccine that is almost ubiquitous in terms of providing the protection they need and suit our temperate nature as most of the vaccines have varying levels of storage.
“Pfizer vaccine has more than 95, Modena has 90, and slightly less than that. That is the primary question. The second question has to do with the logistics.
“We need to find out whether we will be able to handle them well because Pfizer must be stored at -70o or thereabouts. The Modena requires being stored at -20o. Unfortunately, we have issues with electricity supply”.
He identified the issue of cost as some of the vaccines are more costly than others.
According to him, the Pfizer vaccine is more costly than some of the other vaccines available,
He counseled Nigeria to choose the most efficient vaccine, especially one that won’t cost so much logistics to handle.
Speaking on conspiracy theories around the vaccines, Akase recalled that right from the first vaccine ever produced there has been suspicion.
According to him, there is no basis for claims that the vaccines will change people’s DNA and reduce the population of Africans. The infectious disease expert said with the advancement in technology, it is easier to verify any claim about the scientific method.
“Now, starting from the West, we both know the US and Canada have bought vaccines to vaccinate. If it is a ploy to reduce our population then, are the countries I mentioned also going to reduce their population before reducing ours?”, he said.
“If it was going to change our DNA, it also means that they intend to change their own DNA while they change ours. But from an expert point of view, we have heard over and over again that RNA does not change the DNA of a person.
DNA to RNA
“In fact, the genetic code moves from DNA to RNA. It is not the other way round. RNA cannot change DNA. It is DNA that produces RNA that gives influence on the RNA.
“Most of the conspiracy theories are probably based on a lot of ignorance. I think that regulatory bodies and government need to do some enlightening.”
Continuing, Akase said: “Coronaviruses tend to share a lot of similarities among themselves. If someone develops one type of coronavirus sickness, whether it is COVID-19 or the coronavirus that causes catarrh, they can have some amount of immunity, which can be measured.
“Initially, the infection was mild but now we are having more severe cases, and it is spreading. “We now know that the immunity was supposed to have not been high enough to protect us against any infection at a high level.
“Does that now mean our immunity is high enough for us not to be vaccinated? The obvious answer to this question is no because we are seeing more severe infections.
“So far, the NCDC has recorded about 100,000 infections. There is evidence to believe that the new infection rate is way higher than the first wave.
“If 10 million people are infected, what happens to 190 million people who have not been infected? Are we going to wait for them to be infected and die before the immunity is sufficient to protect everyone against COVID-19?
“The answer obviously is no. For you to develop the kind of immunity that protects against the infection, you have to either have vaccinated up to 80 percent of the people or more than 80 percent of the people have been infected and recovered sufficiently for them to protect the remaining people.”