How Will a COVID-19 Vaccine be Rolled Out in Nigeria?
First published on Helium Health here
Two companies, Pfizer and Morderna have announced breakthroughs in the quest for a COVID-19 vaccine with respective efficacy rates of 90% and 94.5%. However, Nigeria has only tested about 0.32% of the population. How will it implement a strategy that gets a COVID-19 vaccine across to the majority of the population in a short period of time?
There are currently 66 vaccines in development for the coronavirus globally, according to the New York Times Coronavirus Vaccine Tracker. Only 11 vaccines are in Phase 3 clinical trials, including vaccines from established manufacturers like Pfizer and AstraZeneca. Even though Moderna and Pfizer’s vaccines are very close, none has been approved by regulatory agencies as at the writing of this article. Regardless, the anticipation for a vaccine that could quell the pandemic is immense.
Governments are heavily invested in the development of a successful vaccine given the human toll of the pandemic and the impact on economies worldwide. For example, the U.S. government’s Operation WARP Speed initiative pledged $10 billion to develop and deliver 300 million doses by January 2021, while the WHO is coordinating global efforts to develop and deliver 2 billion doses by the end of 2021.
Amidst global clamour for a vaccine, the Nigerian government is not far behind. Dr. Osagie Ehanire, the Nigerian Health Minister, noted that Nigeria is planning to get 2 billion vaccines by working with the WHO’s Access to COVID-19 Tools Accelerator (ACT), a global mechanism tracking and sponsoring global organizations working on COVID-19 vaccine development. The Nigerian Ministry of Health is also working to secure additional vaccines through the COVAX Facility, a Gavi-sponsored initiative to ensure equitable access to vaccines as soon as they are available, especially for lower-income countries.
As such, it appears that securing vaccines may not pose the biggest challenge for a COVID-19 vaccination roll-out in Nigeria. However, once vaccines are secured, several hurdles exist in the delivery and distribution of the vaccine to contain the pandemic.
The first hurdle is the existing infrastructure for vaccine distribution in Nigeria. Chikwe Ihekweazu, the Director General of the Nigeria Center for Disease Control (NCDC) indicated that the National Primary Health Care Development Agency (NPHCDA) would lead the distribution and planning of a COVID-19 vaccine in Nigeria. The NPHCDA is significantly involved in the repairing of Nigeria’s Primary Healthcare System, receiving approximately 45% of the Basic Health Care Provision Fund (BHCF) to procure essential drugs, maintain primary health care facilities, equipment and transportation and improve human resource capacity. However, the BHCF is funded using only 1% of federal revenue, and poor data management and accountability may hinder the impact of this initiative.
Chikwe Ihekweazu, the Director General of the Nigeria Center for Disease Control (NCDC)
Ihekweazu is confident that Nigeria’s vaccine distribution mechanism is one of the most efficient parts of the public sector. Nigeria’s eventual success with eradicating polio and other diseases was achieved using a sophisticated vaccine distribution infrastructure with strategic emergency operations centres located across the country. While leveraging existing infrastructure is an efficient strategy, there are unique attributes of the coronavirus that call into question the replication of existing strategies or infrastructure. Firstly, the poliovirus is spread primarily through contaminated water and stool, whereas the coronavirus involves air transmission, making it highly contagious. Secondly, the poliovirus mainly affects children under 5 years of age, while the coronavirus has shown a deadly impact across all ages, particularly the elderly and those with high-risk comorbid conditions. Both of these differences translate to a much larger scale vaccination program for the coronavirus pandemic that poses a significant challenge for which more sophisticated data collection and surveillance would be required.
Another hurdle is the complicated delivery of vaccines expected in Nigeria. In April 2020, the NCDC DG announced that Nigeria plans to increase testing to 2 million Nigerian over the next 3 months. According to the NCDC’s COVID tracker, 620,758 samples have been tested as of October 2020, which is approximately 0.32% of the Nigerian population. If the coronavirus testing capacity in Nigeria is any indication of the anticipated vaccination capacity, a robust strategy needs to be developed before the COVID-19 vaccines are available. The DG indicated that the low testing capacity was attributable to external factors beyond the NCDC’s capacity such as organizing and transporting test samples and sending results back to Nigerians. If the delivery of samples was a hurdle for coronavirus testing, how can the Nigerian government overcome these delivery hurdles for a successful vaccination strategy especially if a vaccine like Pfizer’s that requires -70º storage and two doses becomes the most available?
The Nigerian economy took a significant hit as a result of the impact of the coronavirus pandemic; as such, securing the funds to efficiently acquire, distribute and deliver enough vaccines to Nigeria’s ~196 million population is bound to be an uphill battle. Additionally, when COVID-19 vaccines become available, initial supplies are likely to be limited across the globe. As a result, a cost-effective approach to the vaccination strategy needs to be developed. Several experts have been advocating for targeted initial vaccination campaigns, with healthcare workers and ‘high risk’ populations prioritized in the first phase of vaccinations.
Given the limited census and data collection infrastructure in Nigeria and the time sensitivity of vaccinating enough people once vaccines are available, electronic medical records (EMR) pose a significant opportunity to support a targeted vaccination campaign. As the number of health care centers adopting EMR increases across the nation, particularly in public centers, this is becoming an increasingly viable opportunity. The BHCF and other primary health care revitalization programs in Nigeria are also in a unique position to leverage additional funding for improved EMR collection at primary health centers, further supporting the targeted distribution of vaccines coordinated by the NPHCDA.
The Nigerian government’s efforts to secure enough coronavirus vaccines for the population and plans for a national vaccination delivery strategy can be optimized using EMR data. This data can be used to cross reference patients with high risk conditions, as well as identify centers treating a high proportion of COVID-19 patients, in order to target the most vulnerable healthcare workers.
In order to effectively control the coronavirus pandemic, public and private health centers in Nigeria should embrace technology solutions that can leverage EMR data to support a cost-effective vaccination strategy.
