By Nosmot Gbadamosi
On January 6, Nigerian authorities announced that they expect to receive 100,000 doses of the Pfizer-BioNTech vaccine at the end of January through the Covax initiative, the World Health Organization program to provide equitable access to Covid-19 vaccines.
But despite the good news of the first vaccines on the horizon for Nigeria, experts said that the Pfizer vaccine’s temperature requirements limit the country’s ability to distribute them. “It’s not possible” for Nigeria to effectively store Pfizer vaccines, said Oyewale Tomori, a virology professor who was a member of the World Health Organisation’s SAGE committee on immunisation.
The Pfizer vials must be stored at minus 70 degrees Celsius, way below the capacity of standard freezers, and many countries globally have struggled to accommodate this. It has a limited shelf life once defrosted. Dr. Faisal Shuaib, chief executive of Nigeria’s National Primary Health Care Development Agency said on Monday that the country had ultra-low temperature storage facilities at its National Strategic Cold Store in the capital Abuja, but had yet to provide any details on how frozen vials could be transported beyond it.
Currently Nigeria has around five standard cold storage facilities, mainly in major cities Abuja, Lagos and Kano, and these freezers are already occupied with other medicines, professor Tomori said. Health facilities beyond the main cities struggle to keep vaccines stored at minus 20 degrees Celsius, and the country’s electricity shortages compound the Pfizer vaccine’s distribution.
Tomori said Nigeria would only be able to manage vaccines developed by AstraZeneca and Oxford University, by China, Russia or India, because they do not require a deep freeze. The Moderna vaccine requires storage at minus 20. “I would push for the regulation and approval of those vaccines rather than waste our time on Pfizer,” he said.
Nigeria hopes to receive 42 million COVID-19 vaccine donations through Covax to cover 20 percent of its population. An additional 40 percent will be procured to achieve herd immunity, Ben Akabueze, director general of the Budget office, said during a virtual 2021 budget presentation. However, so far Nigeria has only secured enough vaccines for less than 10 percent of its population, according to data analysed by consultancy firm Development Reimagined.
The Seychelles and Morocco are currently the only African countries to have secured more than the 70 percent minimum required for herd immunity. The African Union hopes to secure a provisional 270 million doses for the continent by the end of 2021. 600 million doses are also expected through Covax, although that scheme “can only cover 20% of the African population,” Dr Matshidiso Moeti, the World Health Organization’s regional director for Africa said.
Nigeria has vast experience in widespread vaccination campaigns. In the summer of 2016, after two years without incident, a four-year-old girl named Aisha became the first new case of wild polio in Nigeria. Her family had trekked two days to escape Boko-Haram seeking an internally displaced persons’ camp in Jere, Borno State, north-eastern Nigeria when the girl became paralysed with illness. It triggered an aggressive revaccination campaign across the country, and in August 2020, Nigeria became the last African country to be declared free from wild polio.
Aisha’s case and Nigeria’s response illustrate both the enormous challenges Nigeria faces and the capability it already has to vaccinate enough of its more than 200 million population against COVID-19.
“We’ve had a lot of experience with vaccination campaigns given the intensity of the work we did around polio,” Dr Chikwe Ihekweazu, head of Nigeria Centre for Disease Control (NCDC) told reporters during a press briefing last week. “The target population might be a little different, but we understand very well the steps required,” he said. Like polio vaccines, most COVID-19 vaccines available require more than one dose.
The Nigerian government was initially quick to lockdown and close land borders when its first coronavirus case was confirmed on February 27, but the lockdown’s harsh economic impact led to the easing of some restrictions.
Nigeria’s confirmed COVID-19 cases have surpassed 110,000, with more than 1,400 deaths reported as the country battles a larger second wave in cases. Its worst affected region is the country’s financial hub, Lagos. Professor Tomori believes the real figures may be higher. “In a situation where a lot of people don’t go to the hospital or the hospitals are not there, how do you know how many people are dying with Covid?” he asked.
A new variant was identified on August 3 and October 9 in Ogun State in the southwest of the country, according to the NCDC’s Dr. Ihekweazu, but there’s no current evidence that the strain is more infectious. “While we do have genomic surveillance in a few centres in Nigeria,” Dr Ihekweazu said, “the relative difference in scale in Nigeria versus the UK and even South Africa may obviously imply a reduced likelihood to detect such changes when they do happen.”
Officials were looking to identify the UK and South African strains (which are more transmissible) among the current surge of cases in Nigeria, he said. The NCDC has urged the country’s 36 federal states to take greater ownership. “Unless states actively test, they will not know their disease burden, putting local communities at greater risk,” it said in a statement.
Officials plan to roll out rapid diagnostic testing in five health facilities in Abuja and Lagos, but there is no planned roll out to other states until February.
Overwhelmed hospitals have struggled with access to oxygen. “The biggest indicator that will put us under pressure is the number of deaths,” Dr Ihekweazu said. “We must keep working very hard to save as many people as we possibly can given the limitations that are clear in the deficit of [African] health systems.”
The local production of vaccines in Nigeria through the set-up of Biovaccines Nigeria Limited, a jointly owned venture by the federal government and pharmaceutical company May & Baker, has seen little fruition since its incorporation in 2005. Professor Tomori, who is the board’s chairman, said, “now that Covid has come, things are being ramped up.” Yet there is little evidence to indicate it is at a stage ready for vaccine production.
Professor Tomori suggested that while Nigeria is waiting to finalize its vaccine purchases, it should be actively learning from other countries’ vaccination campaigns. “This is the time to be monitoring what is happening in Europe and what is happening in America, because whether we like it or not, these challenges they are facing will also be with us,” he explained.
Even with the arrival of vaccines in Nigeria, Dr. Ihekweazu warned that the process will be slow. “It will take another two years to get to the levels of coverage that we need.”
UPDATE January 19, 2021, 5:12 pm GMT: Dr. Faisal Shuaib, chief executive of Nigeria’s National Primary Health Care Development Agency, said on Tuesday that Nigeria now expects its 100,000 dose shipment of the Pfizer vaccine to arrive in early February, not late January as he previously stated.