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Nigeria’s vaccination campaign is hampered by ad hoc procurement and distribution efforts

By Ope Adetayo

The Nigerian government plans to vaccinate 40 percent of the country’s population, an estimated 80 million people, before the end of 2021, and 30 percent more by the end of 2022. But according to medical experts in the country, its vaccination campaign is being undermined by haphazard vaccination purchases, a doctors’ strike, and poor communication. Doctors said that judging by the progress made so far, its vaccination goals will not be attainable.

In February, Dr. Faisal Shuaib, the executive director and chief executive officer of the National Primary Health Care Development Agency (NPHDCA), the ministry of health’s parastatal primarily in charge of the vaccine distribution, told reporters the country is expecting 57 million vaccine doses by the end of April. He clarified that 41 million doses will come from the African Union, which has procured 270 million doses for member states, and 16 million doses through the World Health Organization’s Covax program.

The 41 million doses purchased from the African Union were slated to be a combination of the three coronavirus vaccines currently available. They are 7.6 million doses of Pfizer-BioNTech vaccine, 15.3 million of the AstraZeneca shots, and 18.4 million doses of the Johnson & Johnson jabs. But the ultra-cold storage facilities meant to store the Pfizer vaccines never made it to Nigeria, and talks of a Pfizer shipment have evaporated.

“There is no coherent plan; they don’t know what to do. They knew there are three vaccines but they do not even know which one would be taken by Nigerians, which one would be favorable to us,” Dr. Solomon Bakarey, a senior research fellow of virology at the University College Hospital, Ibadan, told Sahelien.com.

At the end of March, Nigeria quietly jettisoned its AstraZeneca-heavy strategy in favor of more Johnson & Johnson vaccines, arguing that it would be easier to distribute because it’s just one shot, unlike the other vaccines which require two shots, three to four weeks apart. As of March 31, the country expects to receive up to 70 million Johnson & Johnson doses by the end of the year.

On March 2, health authorities received a shipment of AstraZeneca 3.94 million doses in Abuja through the Covax program. So far, an estimated one million doses have been distributed by the NPHCDA.

“We are in April and we have only collected 3.9 million doses of AstraZeneca. If you look at the population of Nigeria, you would know that the way the government is running it, it will not meet its target by the end of 2021,” Bakarey said.

In January 2021, the ministry of finance released 10 billion naira ($27,027,027) to support local production of the coronavirus vaccine in Nigeria, though that program has not been talked about publicly since.

The AstraZeneca shot has been highly controversial, with health regulators around the world pausing and resuming its usage for different issues related to its efficiency against the 501Y.V2 variant and the appearance of blood clots in some patients. A number of governments have restricted its use to people above 60 years old.

After receiving the first vaccine shipment in Abuja, the Nigerian government directed citizens to register online to get an appointment for the vaccine, with the vaccination of frontline workers taking precedence, then the elderly, then people with underlying health conditions, and then the general public.

Nigeria’s first batch of Oxford/AstraZeneca vaccines against coronavirus disease (COVID-19) arrives at the international airport of Abuja, Nigeria, March 2, 2021. REUTERS/Abraham Archiga

In a news report describing the delivery from the World Health Organization, Thabani Maphosa, managing director for country programs at Gavi, praised the Nigerian government for “the excellent level of preparedness put in place” to combat the coronavirus pandemic. Many Nigerians disagree with Maphosa’s assessment, due to the lack of enforcement of health guidelines across the country and the dilapidated state of the country’s public hospitals.

The National Association of Resident Doctors (NARD), a major doctors’ union, is on an indefinite strike over non-payment of salaries and the government’s refusal to honor agreements made during the peak of the coronavirus outbreak. The strike, which has paralyzed the public health sector, coincides with President Muhammadu Buhari’s medical tour to England.

The strike could hamper the vaccine rollout, according to Professor Muhammed Adeboye, a consultant pediatrician at University of Ilorin Teaching Hospital. “Part of the health workers that are administering the vaccine are resident doctors who are on strike. We have some of these doctors playing vital roles,” he said.

Nigerian healthcare workers at the frontline of the pandemic are currently being paid 5000 naira ($13.1) monthly as hazard allowance. The strain of managing a health care system which is incapable of addressing a pandemic has proven to be too much for the country’s healthcare workers.

The first known case of coronavirus in Nigeria was an Italian businessman working in Ogun state who tested positive on February 27, 2020, after traveling from Milan three days earlier. The virus spread steadily across the country, necessitating a series of lockdowns. Over 160,000 people have been infected with Covid-19 in Nigeria, leading to more than 2000 deaths.

“It is big injustice from the politicians and a disservice to the county,” Professor Adeboye said. “The government promised a special allowance [when the cases were overwhelming] but it was stopped after three months, and even some health care workers have not received payment for those three months as we speak.”

At present, the NPHCDA remains the sole agency distributing the vaccine across the 36 states of the country. The vaccines are administered at primary health care centers in coordination with the local government. But the process has been dogged with hitches.

Alao Abiodun, a reporter with a national daily in Nigeria, received the vaccine in Lagos on the 20th of March. Arriving there in morning, it took him up to six hours to finally get his shot. “The e-capturing process was quite slow, because the server was down at different points,” he told Sahelien.com.

Abiodun is not the only one who found the process difficult to navigate. Temitayo Olofinlua, a writer who resides in Ibadan, said the registration system is opaque. “I know vaccines are here but how is it being given? I have no clue, just pictures of people who have collected it, sparsely on Twitter,” she said. “If me, with my information privilege and willingness to receive the vaccine has no clue, what about the market woman who only cares for survival?” she asked.

Bakarey sees problems with the sole administration of the vaccine by the government. Pointing to previous vaccination programs like polio and measles, he said the involvement of private institutions and NGOs was crucial to achieving success.

“The government is just trying to be monopolistic about it because of what they are trying to gain financially for it. I don’t see why NGOs and private institutions cannot be involved in this,” Bakarey said. “If you look at polio, measles and all that, you can go to private institution and children will be vaccinated. If you look at the hierarchy of the health system you would see that there is no way to reach the grassroots if the government is the only one handling the distribution.”