Concerns over unavailability of yellow fever vaccines until outbreaks

• 10 States Covered In NPHCDA Mass Campaigns- Director
• Also Available For Infants During Routine Immunisation After Birth

Despite the recent outbreak of yellow fever in the country, adult Nigerians cannot access the supposedly free preventive vaccine at health centres.

In fact, the vaccine is only available at Ports Health Service offices for international travellers, and for infants at health facilities during routine immunisation after birth.

“It costs zero naira, when given as part of routine immunisation schedule, and one shot protects for life,” said the Director General (DG)/Chief Executive Officer (CEO) of the Nigeria Centre for Disease Control (NCDC), Dr. Chikwe Ihekweazu.

The Director of Immunisation, National Primary Healthcare Development Agency (NPHCDA), Dr. Joseph Oteri, confirmed this much when he said, “In Nigeria, it is free and it is given once at nine months. One shot gives life-long immunity, but during outbreaks or planned preventive campaigns, the target age group of nine months to 44-year-olds is given a shot since its not known whether they had it in the past. In actual cost, it is about $2 per shot, but like I mentioned earlier, it is free in Nigeria.”

The latest figures on yellow fever in the country as at Expanded Programme on Immunisation (EPI) Week 32 (August 11, 2019), a total of 62 samples were presumptive positive in-country based on IgM serology and sent to the regional reference laboratory, Dakar, Senegal for confirmation. These presumptive positive cases were reported from 42 local councils in 17 states viz- Anambra – one; Benue – one; Borno – 10; Ebonyi – 12; Enugu – two; Abuja – one; Jigawa – three; Katsina – six; Kebbi – 14, Kogi – two; Kwara – one; Nasarawa – two; Ogun – one; Ondo – one; Osun – two; Plateau – one, and Taraba- one.

Commenting on the situation in Ebonyi and Edo states, which recorded the latest outbreak in the country, Oteri told The Guardian that those outbreaks were among the largest in the country in magnitude, geographic coverage and mortality, adding that outbreak response activities had been carried out in all the local areas in both states and neigbouring council areas of Ondo and Delta states that had confirmed cases.

He said following reports of cases and deaths from fever of unknown origin in Izzi Local Council of Ebonyi State, the state’s public health team commenced investigation, which as at July 31, revealed three cases that had tested positive at the National Reference Laboratory, a development he said triggered immediate response.

The medical expert said the state epidemiology team was leading the response, with support from NCDC, NPHCDA and partners on ground, including the World Health Organisation (WHO), and the United Nation Children Fund (UNICEF).

Oteri, who said between May 1 and the August 1, 2019, there had been cases that fit the definition for yellow fever, and 20 deaths in Izzi Local Council, added that as part of the response to this outbreak, the NPHCDA was planning a reactive vaccination for persons most at risk (nine months to 44-year-olds) within the coming weeks.

“Yellow fever vaccine is not available for reactive campaigns, so supplies come from the International Coordinating Group (ICG) that stockpiles the vaccines for emergencies globally,” he said.

Responding to reports that in many cities across the country, Nigerians are unable to access yellow fever and hepatitis preventive vaccines at PHCs, the NPHCDA boss said: “The yellow fever and hepatitis B vaccines are in the immunisation schedule for children under one year. While hepatitis vaccine is given at birth, all others given at six, 10 and 14 weeks are given in combo with other antigens in the penta vaccine.”

He explained that 10 of the states had already been covered, with persons aged nine months to 45 years vaccinated within the past two years, and about 35 millions Nigerians vaccinated since the yellow fever outbreak started in September 2017, through reactive and preventive mass campaigns.

Oteri said, “all Nigerians should go about their normal businesses. Yellow fever is not transmitted by person-to-person contact. Aedes mosquitoes transmit the virus. So, all Nigerians should, as always, protect themselves from mosquito bites, while those that are ill should urgently visit the nearest approved health facility.”

Despite availability claims by NPHCDA, when The Guardian visited some healthcare centres in Lagos State, it was discovered that the centres do not have yellow fever vaccines for immunisation for both children and adults.

Some of the centres visited include Ajibulu Primary Healthcare Centre, Oshodi Primary Healthcare Centre, and Isolo General Hospital, where nursing mothers were seen waiting for immunisation for their newborn babies.

One of the health workers at Ajibulu Primary Healthcare Centre, who pleaded anonymity, said the centre only has vaccines for measles and hepatitis for children, adding that the hospital is not empowered to offer yellow fever vaccines.

A relative of a patient, Mike Bakare, lamented that in Nigeria, most public hospitals were ill-equipped to handle disease outbreaks, such as yellow fever and Lassa fever, while private hospitals are expensive for the largely poor population, adding that virtually all the primary healthcare centres in the country offer sub-optimal services, due to poor funding and mal-distribution of healthcare workers.

In Ebonyi State, where the state government is contesting the figure of victims of the outbreak, the Permanent Secretary in the Health Ministry, Dr. Chris Achi, and the Health Commissioner, Dr. Daniel Umezurike, maintained that even though there was an outbreak of yellow fever in Ndungele community, two persons died as against the reported 16 persons.

The commissioner said: “Presently, we still have six patients on admission, three in Ndingele; one in Iboko General Hospital; and two in Alex Ekwueme Federal Teaching Hospital, Abakaliki. However, the index case has been successfully managed and discharged from Ndingele.

“At present, International Coordinating Group (ICG) process has been completed for possible mass vaccination for all residents of Ebonyi State. The state Ministry of health is working with all United Nation (UN) agencies and other partners to conduct a mass reactive vaccination campaign for those within the target age of nine months to 44 years.”