Coronavirus: Dealing with vaccines distribution politics

The federal government recently announced that it was expecting 100,000 doses of Pfizer/BioNTech coronavirus vaccine to arrive the country before the end of January. Although the time frame for the procurement of the vaccines may not be realisable as latest development has indicated, modalities for its deployment have started generating controversy in the country.

The group to first raise concern over the sharing formula was the elitist governors’ forum. Some of the governors had questioned the rationale behind the lopsided allocation in favour of some states, where covid-19 infection rate is low and which evidently are at lower risk of spread of the virus.

The news of the development of a vaccine regiment for covid-19 came as a big relief to countries of world that saw it as saving grace from the ravaging disease that has tormented humanity since its outbreak late 2019. For Nigeria, also, the development of vaccines has given a ray of hope for a possible victory over the disease.

Particularly, for the federal government, it is a huge relief to curb the impact of the second wave of covid-19 since other preventive measures of non-pharmaceutical protocols have been utterly violated and disregarded by a majority of Nigerians.

Modalities for Distribution

The federal government said it has put in place a technical working group for covid-19 vaccine headed by the Executive Director of the National Primary Health Care Development Agency (NPHCDA), Dr. Faisal Shuaib. The team is to coordinate the implementation of the covid-19 vaccination in the country. The technical group is made up of all relevant ministries, parastatals and partners. Already, the Minister of Health, Dr. Osagie Ehanire, said the federal government had concluded arrangements with suppliers of the vaccines, COVAX vaccines GAVI.

Shuaib, however, gave the timelines for the procurement of vaccines, earlier in the month at a press conference by the Presidential Task Force on COVID-19. He said the country would receive 42 million free doses of COVID-19 vaccines later in the year.

The NPHCDA boss went further to release the sharing formula for 100,000 doses of the Pfizer/BioNTech vaccine at a webinar to interact with the media.
According to the NPHCDA, the distribution breakdown is as follows Kano, 3,557; Lagos, 3,131; Katsina, 2,361; Kaduna, 2,074; Bauchi, 1,900; Oyo, 1,848; Rivers, 1,766; Jigawa, 1,712; Niger, 1,558; Ogun, 1,473; Sokoto, 1,468; Benue, 1,423; Borno, 1,416; Anambra, 1,379; Kebbi, 1,268; Zamfara, 1,336; Delta, 1,306; Imo, 1,267; Ondo, 1,228; and Akwa Ibom, 1,161. Others are Adamawa, 1,129; Edo, 1,104; Plateau, 1,089; Enugu, 1,088; Osun, 1,032; Kogi, 1,030; Cross River, 1,023; Abia, 955; Gombe, 908; Yobe, 842; Ekiti, 830; Taraba, 830; Kwara, 815; Ebonyi, 747; Bayelsa, 589; FCT, 695 and Nasarawa, 661.

The Swirling Protests

Since the release of the sharing formula by the agency, a lot of issues have been raised regarding the yardstick adopted in arriving at the figures allotted to the various states. Many stakeholders especially, state governments have misgivings about the allocation formula applied by the NPHCDA.

Governors under the auspices of the Nigeria Governors Forum (NGF) rose from their meeting to demand for a review of the vaccine sharing formula. The chairman of the NGF, Dr. Kayode Fayemi, said the forum had proposed a meeting for Tuesday, to afford the governors an opportunity to interact with relevant agencies in the health sector particularly, NPHCDA on the contentious issue of vaccine distribution in the country.

The Oyo State Government said the vaccine doses allocated to the state were not adequate. Governor Seyi Makinde said he might have to seek alternative means to get additional vaccines for the state.

Chief Press Secretary to the governor, Taiwo Adisa, said, “We don’t have vaccines yet in Nigeria, so, the allocation was made on paper ahead of its availability in the country. The governor said this evening that the number that is projected to be given to Oyo is grossly inadequate and that the state is going to make alternative arrangements.

“The state would talk to alternative manufacturers of vaccines and make direct procurement, where possible. With 1,800 vaccines, if a person is injected with two dozes, only 900 people would get. When you look at this in consideration of the population of Oyo State, what percentage would that be? That is why the state needs to open discussion with other manufacturers of certified vaccines.”

In the same vein, Cross River State Commissioner for Health, Dr. Betta Edu, reportedly said the doses of COVID-19 vaccine allocated to the state would not be enough for its over 5,000 health workers.

She said: “The sharing was done based on places considered to be hot spots. More concentration was on Lagos, Abuja and other hot spots in the country.

“Cross River has very few cases. However, the vaccine that would be sent is definitely not enough. It cannot even go round our health workers. We will be seeking more”.

On its part, the Lagos State Government said it was making efforts to get COVID-19 vaccine doses for residents aside from the arrangement being made for the country by the federal government.

The state Commissioner for Information and Strategy, Mr. Gbenga Omotoso, was quoted as describing the sharing formula released by the NPHCDA as a surprise.

He said: “Nobody has involved us in what the national vaccine strategy would be. So, all these are new to us. We have not heard anything from the federal government; there has been no directive. But whatever they give us”.

An Official Explanation

Interestingly, the NPHCDA has come up with an explanation, saying the federal government took a decision to prioritize the deployment of the vaccines to take care of those at severe risk of covid-19 infection such as the frontline health workers.

The Director of Communicable Diseases and Immunization, Dr. Bassey Okposen, who disclosed this at an interactive meeting with journalists also said some key government leaders were being considered as priority beneficiaries of the vaccines as a matter of national security.

However, since prioritizing frontline health workers regarded as being at high risk of infection is logical. There’s another slant to it and it is that they should be allowed to guide the application of the vaccines to areas with higher risks of covid-19 Infection in the country.

In this case, many are at a loss on why states like Lagos and the Federal Capital Territory (FCT), Abuja, which had consistently recorded high numbers of new infections were not given the highest vaccine doses.

But Okposen further gave details of the timelines for the introduction of the vaccines. He said as soon as the vaccines arrive the country, there is going to be some kind of prioritisation in order to optimize the limited resources available.

He explained that the arrangement would be based on global best practices, adding that the frontline health workers, airport workers, immigration, security men, who are on essential duties, would be prioritised too.

He noted that the segment of the society with high burden risk, that would be prioritized include the elderly – those above ages of 50 and those that have comorbid conditions like asthma, diabetes, heart disease and hypertension.

Okposen said the agency was targeting to vaccinate 70% Nigerians between this year and next year.

While explaining the handling and distribution mechanism for the covid-19 vaccines, he said immediately the vaccines arrive Abuja, they would be taken to the National Strategic Cold Store, where there are ultracold chain freezers for storage.

Before being loaded to the freezers, a sample of the vaccines would be taken by officials of NAFDAC for analysis and eventual certification in line extant laws, adding that the agency would not release the vaccines to anyone until they were sure that the states were ready to implement.

“As soon as each state is ready to implement the vaccination, NPHCDA will transport supply to them within 24 hours,” he said.

One of the key drivers of the current intervention to contain the spread of covid-19, the Nigeria Centre for Disease Control (NCDC), has maintained a steady hold on the efforts and processes being undertaken to stem the tide of spread of the covid-19 pandemic in the country.

The agency has ensured some watertight data on real time record of the virus infection rate across the country. However, the expectation is that such data on infection rate would serve as a guide for the deployment and distribution of covid-19 vaccines when it eventually arrives the country.

Speaking against the background of the brewing controversy over the distribution pattern, the Director General of NCDC, Dr. Chikwe Ihekweazu, who participated in an online press conference organised by the World Health Organisation on Wednesday said, “In Nigeria, everyone is working very hard at the moment and the effort at delivering the vaccines are led by the NPHCDA, which is responsible for the distribution and management of vaccines.

“Fortunately, we have a lot of experience in vaccination campaign, and given the intensity of the work we have done on polio, the vaccine campaign against Yellow Fever, yet the target population might be a little different but we understand very well the steps required, the micro planning, logistics, the coordination among the states.

“So we are going to leverage on all of that experience. So, right now, NPHCDA is leading the way in defining our priority population. Healthcare workers are the obvious ones. The next ones are the elderly, and those with health burden.”

He said due the non-availability of accurate population data, the country would be utilising different methods and mechanisms in order to identify, who the priority population are and where they are.

Beyond the Controversies

Meanwhile, the present clamour for covid-19 vaccines might be premature going by the update by the World Health Organisation (WHO) on the timelines for the arrival of the COVAX and GAVI procured vaccines in Africa. It said recently that vaccines would not get to Africa until March.

In the same vein, the world health body has also said it would roll out guidelines for national vaccine deployment plan.

Speaking at the first online press conference in the year, the Regional Director of the WHO in Africa, Dr. Matshidiso Moretig, said the global facility being coordinated by COVAX and GAVI plans to provide about 600 million doses of covid-19 vaccines to Africa in 2021.

She said WHO expected the first batch to arrive in March with a larger Roll-outs in June, adding that apart from the vaccines procurement by WHO and partners, African Union was also making plans to source additional 70 million doses of vaccines by the end of 2021.

She said: “Together, we will deliver nearly 900 million doses of vaccines this year.”

According to Moreti, WHO has developed guidance for national vaccine deployment plan for countries and also carrying training for them on key aspects of vaccines deployment! Moreti also said the findings of WHO has shown that there are still significant gaps in preparedness among countries in Africa.

One of things that should be properly addressed as part preparations for the arrival of the vaccines in Nigeria is the issue of developing an acceptable framework for equitable distribution of vaccines. The vaccines, as experts claimed, have limitations in terms of storage adaptation.

What this means is that it could not be kept beyond certain length of time except at places with the requisite refrigerating capacity.

So, while politicians and other ethnic bigots might be seeking to politicise the vaccines meant for people desperately in need of medication, they should be mindful that the vaccines are not another kind of palliatives to be stored away for selfish use. It is time bound and would most likely boomerang.

Perhaps, there might be some positive impacts to be derived from the present controversy. First, it is well-known fact that vaccine introduction in the country usually comes with some kind of apathy or resistance to its use. Additional funds and energy are usually dissipated on advocacy and public awareness campaigns in many parts of the country especially, in the north.

Some states are even reluctant to commit to help encourage their people to cooperate with health officials carrying out vaccination. But with the current scramble by the states for the acquisition of covid-19 vaccines, the challenge of public acceptance may no longer be stiff.