Sensitisation before vaccination

On the 17th of December, 2020, the NCDC recorded 1145 cases per day. It was the first time new cases had passed the 1000 mark. A little over a week later, South Africa became the first African country to reach the grim milestone of one million confirmed cases. By the third week of December 2020, USA had surpassed more than eleven million confirmed cases easily reaching one million cases over every few days. With the rapid spread of an unknown virus, the survival of the human race depends on the expeditious development of a vaccine.

Also, in December, The United Kingdom became the first country to approve and administer the BioNTech-Pfizer vaccine ahead of the European Union. Perhaps, because the island nation has finally and formally cut ties with the European Union, it was also the first to approve and inoculate her citizens with the AstraZeneca-Oxford vaccine. Many European leaders were dubbed the Grinch because they instituted their second national lockdowns during the Christmas period. The Moderna vaccine a third vaccine, was given a regulatory approval by the USA in late December. The UK gave approval on the 8th of January.

While many countries have been severely impacted by the ravaging, cataclysmic coronavirus, Nigeria has been spared surreal images of endless rows of mounds of earth as burial grounds for the dead as we saw in some Latin American countries. Nonetheless, as the virus continued its rampage, scientists did the unbelievable and hitherto before the unimaginable; in less than a year, they came up with a vaccine for the virus. Not just one vaccine but candidate vaccines in their hundreds and at least five are now being given around the world. Under normal circumstances, when there’s no pandemic, research and development of a vaccine takes years. This is usually because there’s a lot of money involved and organizations and governments do not readily invest in vaccine research and development because of uncertainties. If it becomes a failed vaccine, the financial losses could be colossal. If the developed vaccine results in a permanent disability or results in a fatality, it will never see the light of day. In this pandemic era, countries and organizations have readily supported the development of coronavirus vaccines.

Moderna got about $2.5 billion in combined funds from government agencies to carry out research and develop a coronavirus vaccine. The American government even named its coronavirus vaccine development program, Operation Warp Speed resonating the urgency in its nomenclature. The estimated course of research and development of a vaccine can be as high as $5 billion.

Historically, we’ve been taught that Edward Jenner introduced the first vaccine but African slaves had been using the skin crusts from people infected with cowpox to protect themselves from the poxes before Jenner. Vaccines can give a passive or an active immunity to the host. In passive immunity, the vaccine contains antibodies from a human or from animals like horses, sheep and rabbits. An example of a vaccine that gives passive immunity is rabies immunoglobulin vaccine, given as a post-exposure prophylaxis. The advantage with passive immunity is that it gives an immediate response. However, the immunity is not long-lasting. A vaccine that gives active immunity stimulates the production of the host’s antibodies like the cowpox stimulating antibodies against the smallpox. The coronavirus vaccines that are presently out stimulate the production of antibodies. We do not know how long the immunity developed by the coronavirus vaccines will last. An executive of the Moderna pharmaceutical company has said without evidence that the Moderna vaccine confers immunity that can last for up to two years.

In the past, Nigeria has made vaccines and even exported vaccines to neigbouring countries. In my article in The Guardian titled, Made-In-Nigeria Vaccines; Waiting for Godot! I made a case that given the right and enabling environment, Nigeria can develop vaccines again especially coronavirus vaccines. Nigeria has announced plans to import vaccines. However, many Nigerians are skeptical about getting the shots and not without reasons. What are some of the reasons responsible for vaccine skepticism? Vaccine development usually takes several years from exploratory, preclinical trials, new drug application, phases one to four of clinical trials and then authorization through different regulatory bodies. Even after authorization, there’s post implementation evaluation for several years.

Before one can begin to develop a vaccine, one must be able to identify the disease agent, know how it spreads, know how the body can overcome the disease and one must have a strong, political will. In the case of a virus, it has to be sequenced. Genome sequencing of the virus is reading the information on the virus; the arrangement of the protein bases. The Chinese gave the world the genetic sequencing of the coronavirus as far back as January 2020 thereby reducing the steps and time taken in the development of the coronavirus vaccines. Depending on the vaccine type, the vaccine must be produced in enough quantities before testing. Each phase of testing increases the number of test participants as it moves to the next level.

Thirty thousand volunteers participated in the clinical trials for Moderna vaccine and forty-four thousand volunteers participated in the BioNTech-Pfizer vaccines. At any of these stages the trials can be stopped depending on the type of adverse reactions. If after passing through all the hoops, the vaccine is found safe then the regulatory body can approve it. In the case of the present pandemic, the regulatory body has only given an emergency use authorization. An emergency use authorization is not open-ended but allows the vaccine manufacturer to proceed with the distribution of the vaccine for human use; observations are still ongoing but so far it has been deemed safe. However, many questions like what are the long-term effects of the vaccine especially messenger RNA vaccines like BioNTech-Pfizer and Moderna that have never been used on humans before lingers. It is not all the vaccine types that are messenger RNA. The AstraZeneca-Oxford is not a messenger RNA vaccine. It is made from an inactivated common cold virus, a method that has been used in gene and anti-cancer therapy since 2000s. Other vaccines similar to AstraZeneca-Oxford type are Sputnik V (from Russia), CanSino Biological Incorporation (from China), Johnson and Johnson (from USA).

Sinovac and Sinopharm vaccines; both from China used an inactivated coronavirus vaccine type. Further, the manufacturers of some of these vaccines have been absolved of any liability should a recipient suffer severe adverse reactions fueling more skepticism.
Nigerians are aware that the vaccines being imported have not been tested on Nigerians. Vaccines cannot be tested on every nationality. Seven thousand Blacks participated in the Moderna vaccine trial. Brazil a country with sixty percent of the population Black has been a testing ground for several vaccine candidates including China’s Sinovac, AstraZeneca-Oxford and Johnson and Johnson’s. Sinovac and AstraZeneca-Oxford have gotten emergency use regulatory approval from some countries.

Concerned Nigerians feel that since these vaccines are imported from countries with hordes of confirmed cases and in some cases, the vaccine is from China, they have an element of mistrust. Further, there has been speculations that Nigerians might already have some antibodies against the virus and that an altered strain might be circulating amongst Nigerians, which would work better if the vaccines were made from strains found in Nigeria. Nonetheless, we cannot speculate that Nigerians have antibodies without actually testing for them. Considering that Nigeria just reached a belated landmark of testing about one million samples on the 7th of January 2021, we should not think of testing for antibodies. Truth be told, we have made vaccines in the past but in this present dispensation, we need the vaccines now and cannot dabble into the immediacy of vaccine production in Nigeria.

Importantly, whether the imported vaccines were developed in less than a year or the manufacturers are still observing for long term effects, we need a vaccine but we also need a heavy dose of vaccine sensitization before bringing in the vaccines. Many Nigerians are harboring conspiracy theories about the virus and are fatigued from coronavirus news. If we can get vaccine sensitization to the tempo and zeal our political elites take over the air waves, bill boards, radio jingles, full page newspaper adverts when elections are near, Nigerians would get the needed sensitization before they can get the vaccine shot.

It would be a sad tale if we import vaccines worth billions of dollars and the intended recipients refuse to take them. Before we begin to talk of importing vaccines, not to forget all the logistics of storage, distribution and post implementation evaluation, we need to sensitize the citizenry on the need to get vaccinated. We need to debunk the conspiracy theories, articulate ideas that would encourage people to want to get vaccinated, educate ourselves that getting vaccinated is not a ticket to throw COVID-19 cautions to the wind. Elected officials, public figures including royal fathers should advocate for the vaccination and may be filmed taking the vaccines. Primary health care centers should engage in massive health education at the grassroots. Pregnant women should not get the vaccines yet because the trials did not include pregnant participants. No one knows how long the immunity conferred by the vaccines would last because the observations for long term effects are still ongoing. Even after being vaccinated, we should still wear masks because you can still get infected. An infection with the coronavirus post vaccination is not supposed to be severe. Therefore, even though one may not display symptoms one is still able to spread the virus. Keep all the COVID-19 protocols until at least up to seventy percent of the national population is vaccinated. Continue with daily recommended doses of zinc, vitamins C and D and get a daily dose of sunshine.

As Nigerians are not in a hurry to get vaccinated, we can use the time to observe other non-life-threatening side effects from the different vaccines given in other countries but at the same time keep the COVID-19 protocols. There has also been reports of an anaphylactic shock which did not result in death because the affected person, a medical doctor had an antidote at hand. He was allergic to shellfish. The doctor had reacted to a Moderna vaccine. If you have any allergies you should speak to a health care provider before taking the vaccine. There have been reports of other adverse reactions but none involved death. Everyone is fatigued about the virus and if the vaccine would reign the virus in, we should take it!
Obilade, an associate professor of public health is of College of Health Sciences, Nile University, Abuja.