Global politics, distribution bottlenecks may impede Nigeria’s Covid-19 vaccination quest

Nigeria’s quest to vaccinate its citizens against Covid-19 and attain herd immunity is now hugely threatened by looming disruptions in the global supply chain on the back of ongoing vaccine politics, hesitancy as well as local distribution bottlenecks, experts warn.

There are concerns that although Nigeria has rolled out vaccination after receiving nearly 4 million doses of the Oxford/AstraZeneca supply from the COVAX facility, there is still uncertainty on whether other batches of the life-saving vaccines will arrive as expected. About 12 million more doses are still expected from COVAX, a programme that seeks to equitably distribute vaccines across countries, regardless of income level – and 41 million doses from the African Union.

Osagie Ehanire, minister of health alluded to this concern recently when he solicited President Buhari’s support to ensure continuous access and distribution of the vaccines in the country.

Rich countries like the UK, US and the European Union (EU) are being accused of hoarding the raw materials and supplies for production. They are also said to be frustrating plans by the World Health Organisation (WTO) to waive Intellectual Property (IP) rights around the vaccines inorder to raise production and advance equity.

Early March 2021, vaccine manufacturers held a summit were they shared concerns over insufficient raw materials and a looming supply chain problem.

The COVAX Facility which Nigeria signed up to, also appears to be in difficulty. COVAX is expected to supply 1.3 billion vaccine doses to poor and middle-income countries this year, but has had a slow roll-out. Just more than 14.6 million vaccine doses have been delivered to 22 African countries since 24 February.

The hoarding of these vaccines by rich nations is affecting manufacturers’ commitment to COVAX. “Some countries are still pursuing deals that will compromise the COVAX supply, without a doubt,” WHO senior adviser Bruce Aylward told a press briefing recently.

The support for the proposed IP waiver has however gained momentum, and now counts 57 countries, mostly in Africa, as co-sponsors. 31 U.S. lawmakers have also backed the proposal, including 115 of members of the European parliament as well.

But, many wealthy countries including Japan, Canada, the United States, and United Kingdom have refused to support the deal, arguing that intellectual property barriers aren’t as big an obstacle to vaccine access as manufacturing capacity.

With these developments, Nigeria may not being able to vaccinate 70% of her population, with 40% in 2021 and 30% in 2020, reach herd immunity and exit the pandemic as targeted.

The 3.92 million doses of vaccines received from COVAX have been described as grossly inadequate for a population of over 200 million, and there is no certainty yet, on when the next batch will arrive.

But, the ongoing vaccine politics is not the only nightmare for Nigeria which lack capacity to produce vaccines locally and is relying on foreign supplies and pursuing bilateral deals which come at a cost.

Though the Central Bank of Nigeria (CBN) recently awarded more than N234million in grants to five beneficiaries to support research and development of vaccines in the health sector, experts say the initiative may be coming late, though commendable.

“This pandemic would have been an opportunity for Nigeria to begin local research, drug and vaccine production. Nigeria has already lost a big opportunity”, Obinna Ebirim, a Public health analyst said.

Those who spoke to BusinessDay equally raised concerns around vaccine hesitancy, the willingness and capacity of states to begin and sustain vaccine roll out, as well as low capacity for genome sequencing as major challenges.

There are also concerns around logistics, distribution, storage, personnel, and equitable access to the vaccines across states.

According to Patrick Dakum, CEO, Institute of Human Virology Nigeria (IHVN), reaching the goal to vaccinate 40% of the population by 2021 is also hinged on availability of the Vaccines at the vaccination sites and acceptability by the populace.

Despite the public vaccination of key leaders in the country to boost the confidence of citizens in the vaccines, Onyechi Adaobi, a public health expert noted that hesitancy will make herd immunity difficult.

Olufemi Babalola, president, Guild of Medical Directors (GMD), is worried that government lacks a systematic plan to vaccinate health workers in the private sector amid logistics challenges.

“I wrote to the CEO of National Primary Health Development agency, complaining that there is no systematic plan to capture the 70% of health workers in the private sector. I am yet to get a feedback. Not to mention the rest of the population. An App put out by NPHDA does not yet give dates, I guess because the structures are not in place”, he lamented.

Also, an official at the Nigeria Primary Health Care Agency (NPHCDA) said states are still struggling to meet the most basic requirements for vaccination and some have not shown enough interest in the vaccines.

The Kogi state governor, Yahaya Bello has for example publicly rejected the vaccines stating that he will not allow the people of his state to be used as “guinea pigs”.

Another threat to Nigeria’s vaccination goals, is the poor capacity for genomic sequencing. Genomic surveillance helps detects variants of concern which could affect efficacy of vaccines.

In South Africa, for example, genomic sequencing helped to detect limited efficacy of AstraZeneca vaccines against the new variant of virus found in the country, which prompted them to switch to Pfizer and Johnson & Johnson vaccines.

Chikwe Ihekweazu, director general, Nigeria Centre for Disease Control (NCDC) had said that the fact that only two variant of concern have so far been detected in Nigeria, does not mean that only two exists. He admitted Nigeria lack adequate capacity as only three laboratory across the country has capacity for genomic sequencing.

Experts fear the implication is that Nigeria may not detect variants of concern when they emerge, which can affect efficacy of vaccines, and citizens administered vaccines will live in false hope of safety while the virus continues to transmit and prolong the pandemic.