Nigeria still at great risk of COVID-19 epidemic, NPHCDA warns

•A good number of persons getting infected with virus, still dying from it
•Testing, reporting rates have significantly reduced
•Vaccination uptake has reduced but not significantly to 70,921 persons daily

Despite the World Health Organisation (WHO) declaration that COVID-19 is no longer a public health emergency of international concern (PHEIC), the National Primary Health Care Development Agency (NPHCDA) has warned that there remains a great risk of infection in Nigeria because a good number of persons are getting infected with the virus, and are still dying from it.

Executive Director and Chief Executive Officer (CEO), NPHCDA, Dr. Faisal Shuaib, told The Guardian that testing and reporting rates have significantly reduced, as well as vaccination uptake has reduced but not significantly to 70,921 persons daily.

The public health physician said only 14 states have fully vaccinated at least 70 per cent of their eligible population. Nigeria has vaccinated 74,037,659 of the eligible population with the COVID-19 vaccine and 84,796,658 have taken at least one dose.

The epidemiologist said vaccines would continue to be made available at health facilities within the communities to ensure Nigerians are protected against the virus

He said at the current utilisation rate, all vaccines in country can be used up before their expiry dates. Shuaib said there is no indication that WHO declaration would “worsen” uptake. He, however, said logistics team would sustain measures in place, to ensure potent COVID-19 vaccines are available on time and in full at service delivery points.

The public health physician said the Federal Government has shifted the timeline to upgrade 10,000 Primary Health Centres nationwide to 2030, even as he listed initial interventions implemented to fast track the process.

On what happens to the millions of doses of COVID-19 vaccines, following low uptake, which has been worsened by removal of the disease as an international health emergency concern by WHO, Shuaib said: “As of today, the country has fully vaccinated 63.8 per cent (74,037,659) of the eligible population with the COVID-19 vaccine, and 73.1 per cent (84,796,658) of the eligible population has taken, at least, one dose of the vaccine. It is also noteworthy that 14 states in the country have fully vaccinated at least 70 per cent of their eligible population.

“The WHO has declared that COVID-19 is not a Public Health Emergency of International Concern anymore, but there remains a great risk of infection, especially among people that are yet to be vaccinated or fully vaccinated and a good number of persons getting infected with the virus and still dying from it, even though the testing and reporting rates have significantly reduced.

“It is therefore important for the media to keep raising the awareness and enlightening people about COVID-19 risks and the need to get vaccinated and protected. We are currently focused especially on the states that are yet to fully vaccinate 70 per cent of their eligible population as well as the vulnerable that is, elderly and persons with comorbidities – hypertension, diabetes etc. Booster doses of the vaccines are also recommended to this group of persons if they have been previously vaccinated, to maintain immunity levels.

“It is in the country’s best interest to reach herd immunity. Therefore, the vaccine will continue to be made available at health facilities and within communities, to ensure Nigerians are protected against the virus especially as all borders have been opened and restrictions have been lifted.

“Even though COVID-19 vaccination uptake has reduced as we approach 70 per cent coverage, it is not significantly low (clients vaccinated daily stand at 70,921; that is April 1 to 30, 2023 Call-in-data.)

“At the current utilisation rate, all vaccines in the country can be used up before expiry. There is no indication that the declaration would ‘worsen’ uptake, however the logistics team will sustain measures in place to ensure potent COVID-19 vaccines are available on time and in full at service delivery points.”

Shuaib said NPHCDA would continue daily data triangulation of COVID-19 stock against consumption to guide: redistribution from low utilisation (inter-local councils and inter-States) to high utilisation locations to avert expiration; recommendations for strategy review; and liaison with WHO, United Nations Children Fund (UNICEF), African Centre for Disease Control (AfCDC) and other partners to support supply planning for international redistribution of COVID-19 vaccines as last resort by leveraging on their global stock and utilisation data collation systems.

He said the agency will continue stakeholder engagement and mapping of interventions to adequately capture planned coverage in order to guide utilisation projections for agile supply planning; and sustain monitoring and evaluation for reverse logistics of immunisation waste and waste disposal of filled safety boxes and used and unusable vials.

On how far, in terms of figures, Nigeria has gone in achieving 70 per cent routine immunisation, Shuaib said the 2016 Multiple Indicator Cluster Survey and National Immunisation Coverage Survey (MICS/NICS) report showed that the immunisation coverage was very low (33 per cent). Consequently, he said the Federal Government through the NPHCDA declared the routine immunisation as an emergency leading to the establishment of the National Emergency Routine Immunisation Coordination Centre (NERICC) in 2017 to improve routine immunisation coverage across the country. “Since 2017, Nigeria has been striving to improve our immunisation coverage through different initiatives and strategies,” he said.

Shuaib said with these efforts, Nigeria recorded a significant increase as “we achieved 71 per cent coverage according to 2019 SMART survey.

However, there was disruption of health care services, especially the primary health care by the COVID-19 pandemic globally. This also impacted on our immunisation coverage. Despite the pandemic, Nigeria was able to maintain immunisation coverage of 57 per cent according to the 2021 MICS/NICS report. This is because of the efforts led by the NPHCDA to ensure that some PHC services were maintained during the pandemic,” he said.

The public health physician said it is important to note that Nigeria is one of the very few countries across the world that recorded improvement in the immunisation coverage despite the false majeure.

“We are currently intensifying efforts to reach every child with the vaccine, especially the unimmunised and under-immunised during this recovery and catch-up phase.
Using some of the lessons learnt from the Polio eradication initiatives and COVID-19 vaccination campaign, we are implementing the Optimized Outreach Strategy (OOS) and integration of routine immunisation with other PHC services to ensure no child is left behind.

“We will continue to make efforts to improve our immunisation coverage. This also requires a lot of resources and the continuous dedication of the health workers at all levels to reach every child no matter where they are,” he said.

On the threat of outbreaks of infectious diseases because Nigeria is the endemic belt and the period between November and May is considered the peak period for Cerebro Spinal Meningitis (CSM), Lassa fever, measles, cholera, Shuaib said: “Nigeria made enormous efforts last year to conduct measles vaccination across the country despite the pandemic. This effort is critical to the reduction in the reported cases of measles this year. According to the data released by the Nigeria Centre for Disease Control (NCDC), there were 3,063 confirmed cases of measles in Q1 2023 compared to the 16,204 confirmed cases Q1 2022. To sustain the gains recorded so far, we have also done immunity profiling across the country, and we have identified that 13 states would require supplemental measles vaccination this year. We are currently in the preparatory phase of this intervention, which will be implemented before the end of the year.”

He said Jigawa state accounts for over 70 per cent of the reported cases of CSM across the country and the NPHCDA has just concluded a reactive vaccination campaign in Jigawa state to stem the tide of outbreaks and the reported cases have been reducing. “We also plan to conduct more vaccination against the CSM in more identified susceptible Wards in Jigawa, Katsina, Yobe and Zamfara states to prevent the disease outbreak,” he said.

The NPHCDA boss added: “We want to also use this medium to inform the public that robust routine immunisation programme remains the best way to stem the tides of outbreaks of vaccine preventable diseases. That is why the federal government in collaboration with our partners is investing so much in strengthening the routine immunisation in the country. We want to urge all parents and caregivers to ensure they take their children and wards to the health facilities and receive these life-saving vaccines, as they are safe, effective and free. The NPHCDA is also being proactive by collaborating with the NCDC to closely monitor the trends of these diseases for necessary prompt intervention.”

Shuaib said apart for the vaccination, the Federal Government is involved in a lot of risk communication activities for Nigerians to be aware of various ways to prevent outbreaks of diseases including the Lassa fever, cholera and other vaccine preventable diseases. These, he said, also include the need to improve personal hygiene and environmental sanitation.