‘Government needs N2tr to immunise over 200 million Nigerians’

• May spend N921.2b on 140m people by 2022
• Logistics three times cost of procuring vaccines says PSN
• ‘Engage consultant public health pharmacists to reduce costs’

Nigerians yesterday decried the high cost of COVID-19 vaccines and asked for interventions to tame prices. Two doses of Pfizer/BioNTech vaccine could cost as much as $28, while AstraZeneca goes for $8.

Medical experts, who spoke to The Guardian, at the weekend, said immunising more than 200 million Nigerians could gulp over N2 trillion, as the Federal Government might require N921.2 billion to vaccinate 140 million people in one year.

Leading the call for downward review of vaccine cost is former Governor of Anambra State and Vice Presidential candidate in the 2019 national election, Mr. Peter Obi, who described the cost of the vaccines as “too high and should be brought down.”

Responding to enquiries, President of the Pharmaceutical Society of Nigeria (PSN), Mazi Sam Ohuabunwa, however, argued that, at $8, “this vaccine is not expensive,” especially when “compared to the cost of so many vaccines of equal relevance.” Ohuabunwa anchored his argument on economies of scale. “Remember that the least percentage any country can vaccinate to achieve herd immunity against the coronavirus is 70 per cent. That is huge.

“So it reasonably underwrites the investment in research and development of the vaccine. Moreover, most of the companies behind the vaccines have pledged to serve humanity with this success than concentrating on profit.”

The pharmacist said so much goes into vaccine production, research and development as well as in first, second, and third clinical trials. “This requires a huge investment,” Ohuabunwa said, describing the vaccine as a product of race against time. Logistics, he said, were stretched and multiple laboratories were set up simultaneously. According to the PSN President, researchers who worked overtime will be compensated. “Some may have left their homes to alternative accommodation closer to the work station to allow for late-night reviews.

“To vaccinate 70 million Nigerians, the country needs more than 140 million doses of COVID-19 vaccine,” he explained, pointing out that vaccine requirement cannot be linearly calculated. “I’m sure that is why Mr. Peter Obi, former governor of Anambra State is alarmed. I believe if the procurement follows due process, there are consultant public health pharmacists in government employment, skilled in vaccine procurement protocol, ranging from vaccine need quantification based on doses, frequency of administration and wastage factor.

“It is a bit complicated. I can tell you that transportation, handling, logistics and administration will cost three times, the cost of procuring the vaccine. As pharmacists, we will advise on how to reduce waste.”

A consultant pharmacist and, Dr. Lolu Ojo, said the cost of the drug is determined by the many elements involved in its discovery, manufacturing, marketing and distribution.

“In this particular case of COVID-19 vaccines, we are facing a unique case of uncharted territory.
Development of vaccines usually takes many years from conception to production. In this extraordinary case, it took about one year and this must have severely tasked the resources of the organisations involved.”

On what really goes into the making of vaccines, Ojo said the usual ingredients of a vaccine consisting of antigen, an active component which generates the immune response. It may be a small part of the disease-causing organism, like a protein or sugar or maybe the whole organism in an attenuated form.

Others, he said, include stabilisers to prevent unwarranted chemical reactions and this could be sugars, gelatin, amino acid or proteins. Ojo said there are also surfactants, residuals, diluent and adjuvant, with each one playing specific roles.

The pharmacist explained that the $8 and S28 costs for COVID-19 vaccines actually ranked among the cheapest. “It could have been more; the details lie with the companies and it will remain a trade secret,” he said.
He remarked that prices would certainly drop as more companies come out with solutions. “As it is now, the Pfizer vaccines are significantly lower in price compared to Moderna’s. The newer ones from AstraZeneca and others are cheaper,” he said.

On implications of procuring about 140 million doses to vaccinate 70 million Nigerians by end of 2022 as promised by the Federal Government, Ojo said: “It is a huge investment, which must be done; a very important public health investment. The Federal government must work with the National Assembly for a creative way to provide the funding.”

Chairman, Pharmaceutical Manufacturers Group of the Manufacturers Association of Nigeria (PMG-MAN), Dr. Fidelis Ayebae, said that politicians should not attempt to dictate prices to a man who took risks to invest.

“I don’t think $14 is very expensive for a vaccine, considering what goes into manufacturing it,” Prof Chimezie Anyakora, a pharmaceutical chemist and Chief Executive Officer (CEO) of Bloom Public Health, told The Guardian.

“Here in Africa, we are used to getting free vaccines but it does not mean that they are not expensive. Someone usually pays for it. Vaccines are produced by for-profit companies that need to recover their investment to encourage them to continue researching into new drugs. Having said this, we also need to ensure health for all and vaccine access for all. This is where COVAX comes in. COVAX aims to ensure equitable and fair access to COVID-19 vaccines for every country in the world.”

On calls for cheaper COVID-19 vaccines, Anyakora, who was the Chief of Party of Promoting the Quality of Medicines Programme (PQM) of the United States Pharmacopeia Convention (USP) in Nigeria, said the speed involved in the development of COVID-19 vaccines must have been more than usual. “I am sure that all the manufacturers are aware of the seriousness of this situation and will have an over-riding public health interest in the cost structure they put in place.”

Dr. Simon Agwale, a virologist/vaccinologist said that multiple types of COVID-19 vaccines being used in different countries required different expertise, technologies, equipment and supply chains. According to him, it costs between $500m and $1billion to bring a product to the market.

Agwale, who was unanimously elected to lead COVID-19 vaccine task team of the African Vaccine Manufacturing Initiative towards building Africa’s vaccine manufacturing capacities and solutions to the coronavirus pandemic, said the costs have to be recouped by manufacturers; the reason new vaccines tend to be more costly. “I can tell you that COVID-19 vaccines are cheaper than others like hepatitis B, Human Papilloma Virus (HPV). This is because of government funding, which enabled these companies to cover most of the costs associated with vaccine development,” he said.

The vaccinologist further explained: “The AstraZeneca vaccine costs just $3 to $4 per dose. In comparison, the Pfizer and Moderna candidates cost around $20 and $30 per dose, respectively; and this, in part, is because AstraZeneca has committed to not profiting from the vaccine during the pandemic.”

He added: “I wish we can vaccinate at least 70 per cent of our population within a year to enable us to achieve herd immunity and this is because the longer the virus circulates without intervention the faster it will mutate and thereby making it more difficult to control. However, we still don’t know what proportion of the population needs to have immunity to stop the coronavirus from circulating.

“One study estimated that to stop transmission, 55 per cent to 82 per cent of the population would need to have immunity, which can be achieved either by recovering from an infection or through vaccination. Surprisingly, herd immunity was not achieved in Manaus in Brazil even after an estimated 76 per cent of the population had been infected. There is however still reason to believe that mass vaccinations will have a more powerful effect because vaccines appear to elicit stronger and more durable protection than a prior infection.

“My advice is to set-up a genomic surveillance system in the country to systematically monitor the emergence of variants and to also strengthen our institutions to be able to conduct good clinical practice type clinical trials. This will provide the needed data to guide us in updating existing vaccines if the need arises. A typical case is the recent data from South Africa, from J & J and Novavax vaccine trials where there were reduced vaccine efficacies, which was attributed to the variant of the virus which has now been found in at least 30 countries.”

A consultant obstetrician and gynaecologist and Medical Director, Optimal Specialist Hospitals Limited, Surulere, Lagos, Celestine Ugochukwu Chukwunenye, told The Guardian: “The vaccines are costly because they are products of recent and expensive research work. The manufacturers have factored in the cost of their research and development activities.

“Biotechnology is the main cost. The ampoules, their contents, needles and syringes, and cold storage are not that expensive.”

Chukwunenye said the prices could be brought down where there’s tremendous goodwill from the manufacturing countries towards poor countries, which cannot make their own vaccines.

The physician advised: “For us in Nigeria, it’s better we continue the public health preventive measures while using the money set aside to challenge our scientists to produce our own vaccines. Spending that amount of money overseas, with the crippling effect it will have on our local economy, is hardly justifiable.”