Democratising the COVID-19 Vaccine Roll Out in Nigeria.
The National Primary Health Care Development Agency (NPHCDA) has stated that Nigeria is set to receive 16million AstraZeneca Vaccines. Though a very small number in a country with an estimated population of 206 million, this is comparatively better than the 320,000 Pfizer vaccines the country is going to receive in February 2021. As Nigeria prepares to roll out the COVID-19 vaccines, the question we must ask the relevant authorities is how they intend to ensure the equitable distribution of the vaccine.
Access to medicine for key populations and access to health care for rural communities remains a challenge in Nigeria, the distribution of the vaccine may be no different. Access to the vaccine becomes a human rights and social justice issue when hard-to-reach communities and low-income members of the population do not gain immediate access. Even if they do, many primary health centres and cottage clinics do not have ultra-low temperature freezers, reliable electricity nor the physical infrastructure for transportation and storage. I wrote about this here. A study I led on access to energy in Nigerian Primary health centres revealed that Nigeria’s energy problems provide a huge impediment to equitable access to health care. Primary Health Centres (PHCs) in several communities in the Federal Capital Territory (FCT) had no access to a steady power supply. Even PHCs with solar infrastructure had no arrangement to maintain the solar systems and several of their solar freezers were non-functional. These gaps meant that some PHCs could not store vaccines. Mothers have to travel miles to vaccinate their children in bigger centres that may have better storage and energy facilities. This problem lingers.
Access to energy continues to be a major bane to basic healthcare in both urban and rural communities in Nigeria. Regular power cuts, inadequate budgets to power health facilities, and a lack of alternative energy sources add to the problems which overwhelm Nigeria’s health sector.
Sadly, there is no political will to fix the central challenges that becloud the health sector, but somehow the government believes that they are capable of urgently distributing the vaccine to its population. How do we ensure that the challenges which the country has faced in the past will be surmounted and there will be an equitable distribution of the vaccine to all citizens? While it is paramount to prioritise hotspots and frontline workers, it is necessary to consider domestic workers, store attendants, teachers, and persons who, by nature of their work, are in constant contact with people.
The National Primary Health Care Development Agency NPHCDA has stated that they will be seeking vaccines that are less dependent on ultralow temperatures for cooling. However, the Pfizer vaccine expected this month must be at temperatures of around -70 degrees Celsius (-112°F) before being sent to distribution centres in specially designed cool boxes filled with dry ice. Once out of ultra-low temperature storage, it must be kept at 2C to 8C to remain effective for up to five days. With the current state of our energy facilities and general infrastructure, Nigeria cannot store and transport the vaccine at such low temperatures. Note that the AZ vaccines do not require this kind of low temperature.
Before we get excited and say that Nigeria successfully eradicated the poliovirus, let us bear in mind that Nigeria was the last country to eradicate the poliovirus on the African continent. So while we like to depend on God and miracles to help us get through inadequate preparation, at some point we must apply innovation and find out of the box ways to ensure the equitable distribution of a COVID vaccine for every Nigerian citizen. I have combed through different government websites for a distinct distribution plan and I have not seen any. (I pray to be corrected, please). I wonder if the average Nigerian understands how the NPHCDA intends to ensure the impartial distribution of the vaccine. I doubt that they understand anything about the government’s rollout plans. That is if a concise rollout plan exists and is accessible in the public space.
In a country where basic health care is very expensive and the elite can access medical trips abroad to address major health problems, low-income citizens do not have access to the simplest treatments like malaria. Now, we must ask ourselves and our government representatives if they are ready to be creative in their distribution of the COVID-19 vaccine. Who are the first recipients of the vaccines, frontline workers, people with immune-compromised health situations, then who? Does the government have the data to execute its rollout plan, are they going to access citizens’ medical records to identify persons with the greatest health risks? There are too many questions with no answers.
Will private hospitals be selling the vaccines to the high-class clients who can afford to pay top naira or will every Nigerian gain access to the vaccine in a way that is equitable and just?
Countries that have begun vaccine distribution are leveraging on partnerships with state, local and private organisations for a truly national vaccine plan. Some points to note:
· Can the government establish temporary vaccination centres and mobile vaccination units in hard-to-reach communities?
· Is Nigeria making efforts to boost the manufacture and supply of vaccines in the country?
· How does the NPHCDA intend to vaccinate 206 million citizens, will they hire a larger public health workforce to help deploy the vaccine country-wide? How are they going to conduct the appropriate pieces of training for the health volunteers?
· What intergovernmental collaborations exist for the launch of a national public health campaign to convince people to get vaccinated?
· What are the means of distribution, what kind of partnership has NPHCDA and the National Orientation Agency established to convince Nigerians to take the vaccine?
· Is Nigeria engaging with universities, institutions, and the private sector on the manufacture of COVID-19 vaccines?
At the moment, Nigeria does not have the structure and transparency to equitably distribute the vaccine.
The Minister for Health announced that Nigeria had written to the African Union requesting for 10 million vaccine doses and allocated $26 million for licensed vaccine production. See the Reuters report here. To digress a little, it is rather unfortunate that a country with such vast human capital can be poor at creating solutions. This is because the government consistently fails to engage its citizens and invest in the population. Hence, our steady dependence on other countries.
We are yet to explore the idea that there may be a treatment here in Nigeria. So I wonder, why do we not look within ourselves for solutions rather than depend on other countries to supply us with a vaccine that will target the disease in a way that protects us as Africans and as Nigerians, or am I overthinking this thing? With some countries sparking the vaccine nationalism (a topic for another article) debate, it has become more imperative for us as Nigerians and Africans to leverage on collaborations that will tilt the scales in ways that will benefit us as a continent. The Nigerian government is not leveraging partnerships enough. Nigeria has awesome experts and even resources to find solutions but our government is not utilising its assets. The government needs to be creative in engaging the innovators, the youth, the private sector, the academia, and research institutes on the fair distribution of the vaccine. To ensure the unbiased distribution of COVID-19 vaccines, all hands must be on deck, with the government taking the lead.
I end with a reminder that Nigeria ranks a poor 161 out of 189 countries in the Human Development Index. As a country, we currently struggle with providing access to justice, access to medicine, access to livelihood, and access to basic health care to our citizens. We cannot afford to add inadequate access to vaccines during a pandemic to our list of problems. Here is an important thought, my sister Niniola Williams, the founder of DRASA Health Trust shared with me — “People are so focused on whether the vaccine works or not and the science of it but we have not taken the time to think about how easily accessible it will be for our people, especially the poorest and most vulnerable among us”