Nigeria’s most vulnerable omit vaccination in plans to survive COVID-19

People managing underlying medical conditions are typically forced to embrace a radical shift in how they live, once their diagnosis is revealed.

With the outbreak of the deadly and highly infectious COVID-19 virus, they have had to double down on measures to lessen their risk of vulnerability and exposure to complications that at times lead to a journey of no return to intensive care units.

They seem to have developed increased caution towards personal choices and actions of others around them but there is still a staggering deficit in their layer of protection, especially among those dealing with hypertension, diabetes and cancer, BusinessDay found.

Health workers now dread having contact with patients who have comorbidities, having seen their colleagues across the country die from exposure to the virus through patients

Two years into a pandemic that has claimed over 3,000 lives spawning five distinct variants, Nigeria’s most vulnerable population is still at risk.

They are shuttling between lifestyle adjustment and compliance with public health measures to stay afloat. But vaccination remains missing in the architecture of protection for most, exposing them to the fading wave of the corona virus.

For a 40-year-old businesswoman, diagnosed of breast cancer after the four-month lockdown of 2020 was lifted (name withheld for privacy concerns), the doctor’s advice to eat healthily, comply with prescriptions, mask up and avoid crowds has been her life manual.

She was quick to quit old habits as she wriggled through the rude shock that the aggressive treatment of cancer slammed on her system, her livelihood and her family.

She suspended church attendance and the use of public transportation till she completed the treatment course. She lived by homemade foods, fruits and supplements while avoiding folic acid contents.

However, she has never considered taking COVID-19 shots despite residing near a local council development secretariat where the shots were administered for free.

She was aware of her vulnerability to the COVID-19 virus but popular accounts of myths about the vaccine and wild tales of side effects clouded her judgement. Also, the positive outcome of her treatment seemed to have reinforced her belief that she was better off without the vaccine.

“I don’t want it. I don’t like the experience of those who took it. Some complained of body pain, vomiting and stooling after taking it. So I don’t want it,” she said.

“When I wake up, I take warm water and then move on to fruits and food. My weight when I started my chemotherapy was 99kg in 2020. Now, I’m 97kg despite the treatment being harsh. My lowest was 96.6kg. Even after my surgery, I didn’t need blood. I went in with my PCV at 35 and came out with 28. A week after I bounced back to 37.”

She counts herself lucky but data shows it could have been a fatal fiddle with the pandemic.

Eight in 10 people who died of COVID-19 in the last quarter of 2021 were unvaccinated people with underlying medical conditions, Ifedayo Adetifa, director-general of the Nigeria Centre for Disease Control (NCDC) told BusinessDay in an exclusive chat, citing data from some centres on vaccination status.

People with comorbidities remain at the highest risk of severe disease and adverse outcomes from the virus, despite waning infections and emerging variants.

Read also: Lagos may soon experience fifth COVID wave – Health Commissioner

In a worsening trend, the risk is 10 percent higher than in 2020 when 70 percent of total COVID-19 deaths in the country occurred among people with diabetes, hypertension and cancer among other diseases.

Nigeria has lost over 3,000 people to the virus. Yet, many in the most vulnerable group regrettably fall among 84 percent of the unvaccinated population.

Suleiman Achimugu, 67-year-old former managing director, Petroleum Products Marketing Company (PPMC) was the first Nigerian to take a hit as a combination of diabetes and cancer crippled his ability to fend off COVID-19.

Following his death were other notable Nigerians including 69-year-old Abba Kyari, former Chief of Staff to Nigeria’s President Buhari; Abiola Ajimobi, 70 and former Oyo state governor; and Bayo Osinowo, 64 and former senator representing Lagos East Senatorial District. Age and comorbidities were major risk factors.

A 2021 study on outcomes of COVID-19 patients with comorbidities shows that out of 2,184 laboratory-confirmed cases of COVID-19 in Lagos, a significantly higher proportion of patients with comorbidities died compared to those with none.

The research led by Akin Osibogun, a professor of Public Health, College of Medicine, University of Lagos found that 492 patients (22.5 percent) had at least one comorbidity.

The most common were hypertension (74.2 percent) and diabetes (30 percent). The comorbidities that predicted death were hypertension, renal disease, cancer and HIV.

Adetifa said this same group of people are still susceptible but that susceptibility could be significantly reduced if people are vaccinated.

“If you look at adverse outcomes including hospitalisation and admission to intensive care units and deaths, the numbers are still higher among the elderly people with comorbidities. But when they are vaccinated, they do better compared to their unvaccinated counterparts,” Adetifa said. “We have shared data about the impact of vaccination on hospitalisation and deaths but people who are vaccine skeptics are not necessarily always open to being convinced.”

More sceptics

Sadly, there is a significant pool of other vaccine sceptics like the 40-year-old businesswoman lucky to be recovering from cancer.

At the oncology department of the Lagos State University Teaching Hospital (LASUTH), BusinessDay found that eight in 10 patients undergoing chemotherapy, aged 50 and above, often still nurture an anti-vaccine sentiment.

Mrs. George, a 55-year-old widow being treated at the hospital has for instance been through several devastating moments since she got her diagnosis of breast cancer, before the pandemic began.

She was initially sceptical about the reality of her diagnosis and abandoned medical advice for traditional solutions. When she returned to her diagnosis last year, the condition had advanced, demanding more from her body, her only child, Temitope and her aging mother.

The pain, weakness, loss of healthy body cells and dwindling financial support are gradually culminating into a perfect condition fit to be preyed on by COVID-19.

Yet, she has refused to take the vaccine. Like the other woman, she had access to vaccination since she worked at a local council secretariat in Ikorodu. But she’s still unconvinced that a COVID-19 vaccine will not leave a harmful effect on her health.

Another woman, aged 53, who didn’t want to be mentioned shares similar apathy for the vaccine despite her cancer diagnosis and awareness of the benefits of vaccination. She is heading into the third round of her chemotherapy with steady progress on her lifestyle modification but is happy to have achieved that without getting vaccinated.

Remarkably, a 56-year-old psychiatry nurse who is equally a 16-year survivor of breast cancer has a different view. Apart from being a healthcare worker, she has imbibed a positive disposition towards boosting her immunity since she beat cancer and has stopped at nothing to stay fit.

She plans to get a booster shot having completed two-regimen of the AstraZeneca vaccine.

“The major thing I do is to boost my immunity and eat well. If it is not well boosted, it is like a house without a fence. This means it will be easy to fall prey to COVID-19 infection. The virus can worsen situations for people with underlying illness, which is why I don’t joke with supplements,” she explained.

Care struggle

Speaking from the point of treatment, Kehinde Ololade, a consultant oncologist at Jacaranda Cancer Centre and senior special assistant on health to the Ogun state governor said those who have COVID-19 coexisting with comorbidities don’t do well.

He said the challenges are minimal and outcomes better for patients who have underlying conditions and are favourably disposed to vaccination.

In one of Ololade’s experiences with a patient who has hypertension and diabetes, it took him about five months to convince the patient to get vaccinated. The patient’s main excuse was a lack of trust in the vaccine source and the potential to complicate his condition. When he finally gave in, he insisted that Ololade stood by his side until the process was over.

Now, he is due for his second dose and still scared. He believes it was God’s intervention that saved him from collapsing after the first dose.

According to the oncologist, the trust deficit in the system is high with the common inclination that vaccination talks are hoaxes.

And the trickle-down effect is that, health workers now dread having contact with patients who have comorbidities, having seen their colleagues across the country die from exposure to the virus through patients.

“If you take them to the isolation centre, officials there will complain they can’t manage cancer. If you take them to the oncologist, he or she will insist that they first get rid of COVID-19. Most of such patients end up in teaching hospitals. It’s a lot of struggle,” Ololade said.

Ensuring vaccinations are up to date is one of the recommendations of the World Health Organisation for people at higher risk of severe COVID-19 because it reduces hospitalisation.

In the United Kingdom, for instance, over 38 million booster doses have been administered, helping break the link between infections and hospitalisations. Even with the omicron variant, the number of cases, hospitalisations and deaths continue to decline and are far below the levels of previous waves, with boosters offering strong protection against severe illness and hospitalisation.

If Nigeria will achieve similar goals, 70 percent of the eligible population needs to be fully vaccinated and those with comorbidities must personalise the goal.