COVID-19 immunisation plans under scrutiny

• Experts say FG must conduct clinical trials on jab
• Nigeria to isolate, confirm S’Africa strain of virus

Nigeria’s plan to vaccinate 30 per cent of citizens against COVID-19 this year could be delayed for scrutiny, after South Africa paused its rollout of AstraZeneca’s coronavirus vaccine.

The South African move had followed a study, which showed that the vaccine offered reduced protection from the COVID-19 variant first identified in the country. South Africa’s Minister of Health, Dr. Zweli Mkhize, said the hold would be temporary as scientists tried to figure out how to most effectively deploy the vaccine.

Consequently, Nigerian medical experts called for caution and greater scrutiny of vaccines ordered by the Federal Government before they could be administered on citizens. They expressed apprehension over claims that the $8 AstraZeneca vaccine, one of the cheapest and most suited for Nigeria, could be appropriately stored and deployed with the country’s existing cold chain infrastructure.

According to the experts, it could cost the country a lot more than anticipated to procure, distribute and vaccinate targeted population with the COVID-19 vaccine.

Interestingly, the Federal Government on Monday said Nigeria was no longer expecting the 100,000 doses of the Pfizer/BIONtech vaccine through the COVAX facility, but had been allocated about 16 million doses of the AstraZeneca vaccine, which is expected to start arriving the country in two weeks.

COVID-19 Vaccines Global Access, abbreviated as COVAX, is a global initiative aimed at equitable access to COVID-19 vaccines led by the Global Alliance for Vaccines and Immunization (GAVI), the World Health Organisation (WHO), the Coalition for Epidemic Preparedness Innovations (CEPI), and others.

The FG, however, said the country is yet to isolate and confirm the circulation of the South African COVID-19 strain.
A public health physician and Executive Secretary, Enugu State Agency for the Control of AIDS (ENSACA), Dr. Chinedu Arthur Idoko, told The Guardian yesterday that it was important for Nigeria to get more reliable, verifiable details of the exact strains/ variants of COVID-19 it should be dealing with before exhaustively engaging in vaccine procurement.

“There has to be a more organised, precise and focused information gathering from the different hospitals/ COVID-19 service outlets in the country on particular symptoms/ presentations/ pathways of confirmed cases they have experienced in the recent past,” he said.

Idoko said that Nigeria should not abandon the plans but would have to tread cautiously, taking a more appropriate and evidence-based decision on procurement.

He said Nigeria could make its vaccine procurement from any country, depending on whether or not it meets its preferences and set targets. “If China offers that window, then it does serve an option,” the public health physician said.

A virologist/vaccinologist and Chief Executive Officer (CEO) of Innovative Biotech, Keffi, Nasarawa State, and Innovative Biotech, United States of America (USA), Dr. Simon Agwale, said the vaccine’s effectiveness in preventing severe illness was not established in the South African study, but expressed the hope that subsequent study would be looking to address the issue.

Agwale said efforts are already ongoing by manufacturers to develop a new generation of vaccines that would allow protection to be redirected to emerging variants as booster doses.

Agwale, who leads COVID-19 vaccine task team of the African Vaccine Manufacturing Initiative, said the implication would be that Nigeria should immediately set-up a systematic genomic surveillance to first determine the proportion of the various variants in the country and then monitor emerging variants going forward.

Going forward, he said that Nigeria’s rollout should be evidence-based, which would require it to conduct small clinical trials, similar to what South Africa is doing, to determine the effectiveness of the vaccines before implementation.

“Updating the vaccines is not a challenge because it will take about six to 12 weeks to update the current vaccines, but how will the vaccines be manufactured at a scale to meet global demand? We are still battling to manufacture the first-generation vaccines for the world, and when then are we going to get the updated versions of the vaccines manufactured?,” Agwale wondered.

A consultant Obstetrician and gynaecologist and Medical Director, Optimal Specialist Hospital, Surulere, Lagos, Dr. Celestine Ugochukwu Chukwunenye, told The Guardian that Nigeria did not have the health facilities and manpower to achieve the feat of vaccinating 140 million people in two years.

“Develop countries are battling with slow distribution of the available vaccines in their countries. They are able to handle the vaccines from various sources. We are certainly not. It is bordering on mere wishful thinking, to hope that by 2022 Nigeria would have vaccinated 70 per cent of her population.

“However, it is still better to start making the arrangements to vaccinate Nigerians now. With the added costs of Pfizer, Johnson and Johnson, and Moderna vaccines, it will seem practically impossible for Nigeria to vaccinate 70 per cent of her population in two years.”

The physician, however, said Nigeria should not abandon the efforts to vaccinate her populace, but should look at other options of achieving the same objectives.

“China has become one of our trading partners and traditional allies. There is nothing wrong with approaching China. We should be careful in our approach,” he said.

A consultant pharmacist, Dr. Lolu Ojo, however, argued that there was no global rejection of AstraZeneca/Oxford vaccine yet. According to him, the fact that South Africa (SA) was slowing down on it should not invalidate the claims of the organisation regarding the efficacy of the vaccine.

“There’s really no serious threat to Nigeria’s plan on vaccination as a result of SA’s experience,” the pharmacist said.
Executive Director, National Primary Health Care Development Agency (NPHCDA), Dr. Faisal Shuaib, told journalists on Monday that the country’s decision to switch to AstraZeneca vaccine was based on epidemiological and equity assessment done by the WHO.

He said Nigeria was actually considered as one of the ready countries to receive the Pfizer vaccine, “but because the distribution intended to achieve public health value, it was not practical to provide every capable country with the Pfizer vaccine, due to its limited quantity. This necessitated further review by a multi-agency committee to narrow down the selection process. WHO disclosed this information to us.

“As stated by the WHO Regional Director, a number of factors were considered in allocating the small quantity of 320,000 doses of the Pfizer vaccines to the 13 countries in Africa. These include mortality rate from COVID-19, the number of new cases, the population of the countries involved and the availability of appropriate cold chain equipment. Evidently, Nigeria is by no means ahead of a country like South Africa in terms of mortality or incident rate of COVID-19, and it is not the least populated in comparison to the other countries.

“Consequently, the replacement of the initial 100,000 doses of the Pfizer vaccines with the 16 million doses of the AstraZeneca vaccine is in fact a welcome development, as it will enable a wider reach of our population and is a better option using our routine cold chain system; even though we still had an ultra cold chain capacity that would have been able to store more than 400,000 doses of the Pfizer vaccine.”

On the suspension by South African Government of their vaccination with the Oxford/AstraZeneca vaccine in response to findings from a study, which showed that the vaccine was less efficacious against the B.1.351 strain of the COVID-19 virus, which is the predominant strain in South Africa, Shuaib said that Nigeria was yet to isolate the strain. “The NCDC working with Nigerian Institute for Medical Research (NIMR) and other researchers will intensify the search for this strain from samples collected. In the meantime, we will continue to work with National Agency for Food and Drug Administration and Control (NAFDAC) to ensure that only a vaccine which is effective against the predominant COVID-19 strain in Nigeria will be administered.”

Minister of Health, Dr. Osagie Ehanire, said Nigeria subscribed to two multilateral vaccine access platforms; the first being the COVAX facility that will supply members, including Nigeria, vaccines free of charge, to cover 20 per cent of country’s population.