Towards an Inclusive Roadmap for Vaccine distribution in Nigeria
By Olufunmilayo Habibat Obadofin
Four months after the World Health Organisation declared the Coronavirus a global pandemic, the world recorded the release of the first vaccine against the virus when China approved the CanSino vaccine for limited use in the military, and two inactivated virus vaccines for emergency use in high-risk occupations
on 24 June 2020.
Eight months later, Ghana and Côte d’Ivoire became the first African countries to receive the vaccine. Soon after, the COVAX Facility, a collaboration between CEPI, Gavi, UNICEF, and WHO, delivered the first batch of COVID-19 vaccine doses to the Nigerian government. CEPI, Gavi, UNICEF, and the World Health Organization (WHO).
Globally there has been a concern about the equitable distribution of vaccines, and more so in Nigeria given the large population of the country and the limited number of vaccines as against the population.
So far the country has only received 6.7 million doses, fully vaccinated 1.94 million which totals 0.9% of its total population.
When the country was preparing for the arrival of the first dose, the government announced through the president’s special assistant on digital and new media, Tolu Ogunlesi, that Nigeria’s vaccination doses would be sent out in four parts.
Front-line health professionals and strategic leadership will be the first to benefit, followed by people aged 50 and up. Individuals aged 18 to 49 with significant medical issues would be covered in the final phase.
While this looks to be a well-thought-out approach, it neglects to account for a full rollout and distribution to underserved and vulnerable groups, notably in rural and IDP areas in the north of the country.
According to the United Nations High Commissioner for Refugees UNHCR, there are over 2.1 million internally displaced Nigerians since 2009.
Prior to the COVID-19 pandemic, the Northern area, which is home to the majority of the IDP populations, had a history of immunization records deficits when compared to its counterpart location in the country. For example, in a 2013 Nigeria Demographic and Health Survey, on DPT3 Coverage and Distribution of Other Antigens; the ten states with the least coverage were Northern states and this included two of the BAY (Benue, Adamawa, Yobe) states and other regions which are presently affected by the insurgency.
Several factors have been linked to this under-coverage and they include lack of awareness, mistrust and fear, service delivery issues and socioeconomic status of the recipient families.
To address the issue of under-coverage in these regions, it is essential to fix these underlying factors, more so is the need to understand and address the causes of these factors.
Additional obstacles exist in IDP camps/communities, such as the absence of information on immunization officers’ visits to the camps and the distance between immunization centres and the camps.
Vaccine hesitancy stemming from mistrust of political players has been identified as a cut-through explanation for vaccine undercover in Nigeria’s low-coverage zones. A community member in Benue state, one of the insurgency-hit states, was reported in a Mercy Corp study report as saying the following.
“If COVID-19 vaccines were available for me and my family, we will not take it because COVID-19 is a scam. I mean since this pandemic began, I have not
seen any patients that truly die as a result of COVID-19″
Similarly, in 2003 five northern Nigerian states boycotted the oral polio vaccine due to fears that it was unsafe.
Worthy of mention is the Nigerian government’s cocktail of efforts such as the ‘Jakadan Lafiya’ initiative, Preventive Mass Vaccination Campaign (PMVC) in Katsina state towards eradicating yellow fever which started before the pandemic.
The ‘Jakadan Lafiya’ initiative which translates to “The Health Ambassadors” in Hausa was supported by the World Health Organization (WHO) supported Government to leverage on health ambassadors as part of the Community Engagement and Routine Immunization Intensification (CERII) project designed to get the local population more actively involved in improving their health.
Nonetheless, in the distribution of the COVID-19 vaccine, it’s still observed that there is a lower coverage of distribution in the Northern states compared to the Southern’s.
Specifically for the Covid-19 vaccine, there seems to be a doused attention in top conflict regions as the unrest continues to rise in these regions.
According to a humanitarian worker in Borno state, Adeola Adegunju (not his real name).
” There are no plans by CSOs working indigenously in these regions for the distribution of COVID-19 vaccines. There are government agencies under the primary health care umbrella that are already administering the vaccine. However, the vaccine is not the top priority for a conflicted affected area as they are more pressing issues like armed gunmen.”
He also went further to say that the people living in conflict-affected regions equally bear the brunt of universal challenges which are vaccine availability and hesitancy.
He mentioned that there are efforts in vaccine availability by state-level primary health care agencies and some research has also been done by some INGOs and other actors to understand issues around vaccine hesitancy. But generally, he describes the push around vaccine use and availability as weak at present.
The weak push on the part of political and non-political actors may also be as a result of other pressing diseases in these regions such as meningitis, malaria, malnutrition, diarrhoea which impact are most instantly visible to the locals.
WHO estimates that more than half of the deaths recorded in Borno State are due to malaria, more than all the other causes of death combined.
The United Nations Office for the Coordination of Humanitarian Affairs reported this record to be caused by the inadequate distribution coverage of (LLIN) and a scarcity of anti-malarial medications.
There is equally a deficit of infrastructure in some of the IDP communities, and this has not allowed for ideal WASH (Water, Sanitation and Hygiene) conditions, hence the rise in diseases associated with poor sanitation. In 2017, over 4,800 cases of cholera and 61 resulting deaths were recorded.
Another camp official who had attempted to interact with the people living in the camps said many are not interested in having the conversation, “they don’t see the need for it because they are more interested in getting the basic needs they lack”
In a 2020 report by Relief Web, the humanitarian needs continue to increase as 1,642,069 people need shelter and non-food items. Most of them have had to resort to makeshift shelters that are either partially or totally damaged.
Considering the peculiar challenges of the COVID-19 vaccine, such as shortage of the vaccine, misinformation, novelty, existing leadership gaps and the resulting widespread doubt about the existence of the virus; it is important to develop more strategic solutions to address the challenges
Mr Adeola Adegunju says “the most prominent and powerful thing to do is to provide information regarding prevention and use of the COVID vaccines. The more information people have about the vaccine the more they are likely to take the vaccine. Another thing is making the vaccine available for all those willing to take the vaccine”
From his interactions so far with the IDPs, several of them are more open to receiving vaccines for other infections especially meningitis.
Since one of the prominent reasons for the region’s reticence is a prioritization of their fundamental material necessities and safety. It is critical that these requirements are met in order to pique local interest in other requirements, such as the COVID-19 vaccination.
A collaborative effort between government and NGOs will also be beneficial in any campaign to address the issues that deter acceptance and availability of the vaccine in this region especially as most of the NGOs have built trust with the locals over time.
“This OUTBREAK story was supported by Code for Africa’s WanaData program as part of the Data4COVID19 Africa Challenge hosted by l’Agence française de développement (AFD), Expertise France, and The GovLab