Insight

COVID-19 vaccine: Rural dwellers’ fate hangs in the balance (1)

The peculiarity of the COVID-19 vaccine and concerns about its efficacy when not properly stored becomes a cause of concern for Nigerians. In this investigation that covers different states, JULIANA FRANCIS tries to find out challenges of health workers with the cold chain in randomly selected rural communities

On June 3, 2021, our reporter undertook a journey to Oriba village, a rustic community sitting dejectedly in the heart of Epe Local Government Area of Lagos State. The visit was mainly to see its Primary Health Centre (PHC) and to check out health workers’ preparation towards the vaccination process and cold storage system. Naturally, because Lagos State is the Centre of Excellence, all arrangements were expected to be top notch. Oriba village was one of the randomly selected communities for this investigation. One cannot access the village without a motorcycle, on a journey which is between 45 minutes and one hour.

The cyclist must wait to take the visitor back, or the visitor will be stranded. The road to the village is rough and bumpy. The PHC at Oriba has been renovated, but there are no health workers there. The building is surrounded by weeds and reptiles.

The PHC also has a dilapidated detached dispensary, but goats and other animals have turned it to their abode. Yet, there are about 40 towns under the Oriba community. If there are no health workers in this centre, how are the villagers going to be vaccinated? The Baale of Oriba, Nurudeen Olowolayemo, lamented that the state government has abandoned and forgotten the village. He noted that the village doesn’t have toilet facilities, pipe borne water or a borehole, and owing to these lacks, villagers defecate in the river and also drink from it.

Furthermore, when pregnant women go into labour or villagers become critically ill, they have to use canoes to ferry the persons to the next village called Itoikin. The canoe journey takes approximately an hour, leading to high maternal and infant mortality. Sometimes, the women deliver their babies in the canoes. Olowolayemo said the community has lost many pregnant women and villagers to death during such journeys.

He said: “On days when water hyacinth takes over the surface of the river, riding canoes for medical emergencies becomes an ordeal. We voted for the government in power and supported them, yet they have abandoned and forgot our community. People have died due to the lack of a functioning health centre in our village.”

The baale complained that electrical cables and poles sighted in the community were mere window dressing. According to him, the village was wired in 2015, but the residents have neither seen nor used electricity. Another motorcycle ride was to Arapagi village, also in Epe Local Government Area. The story here is the same as at Oriba. There is no functioning health centre and the villagers have to take canoes to Itoikin for medical attention. According to a 2017 report by Frontiers in Public Health, there are about 30,000 PHC facilities across Nigeria.

But how many are functional? PHCs are built, equipped and operated by states and local governments. Most of these PHCs, aside from being located in remote rural communities, just like Oriba and Aparagi, have no electricity for storage of the COVID-19 vaccines and have no accessible roads. Indeed, Nigerians have become hopeful of defeating the coronavirus, following the donation of nearly four million doses of the AstraZeneca vaccine from Covax Consortium, a global scheme, aimed at providing free inoculations.

However, prior to the arrival of this vaccine, some of those who contracted the virus in Nigeria had died, while more are still dying. As of June 16, 2021, at least 2,117 people have died, as stated by Nigeria Centre for Disease Control (NCDC). In the midst of the arrival of the vaccine in Nigeria, are the realities of its peculiarities of cold chain transportation and storage, and the realisation that many things can go wrong.

It is more so, when the vaccine will be taken to rural communities in a country fraught with challenges of insecurity, lack of electricity, inaccessible roads, and unavailability of sufficient numbers of primary health workers, among others. The vaccine demands a certain temperature range or else it becomes useless. Also, for it to be moved to the rural communities, it has to follow that strict cold chain movement mode. The President of the Pharmaceutical Society of Nigeria (PSN), Mazi Sam Ohuabunwa, even before the arrival of the vaccine, had expressed his fears.

“Even if the vaccines arrive, how does the government plan to smoothly distribute them across the country in a timely manner? Our bad roads will certainly slow down travel time and delay the smooth distribution of the coronavirus medicine to far-flung areas of the country,” Ohuabunwa told SciDev.Net.

A UNICEF Nigeria health specialist, Dr. Ijeoma Agbo, explained that the cold chain system is for storing, managing and transporting vaccines in a good, safe and potent condition. She added: “This is done within recommended temperature ranges from the point of manufacturing of the vaccines to the point of administration. Delivering vaccines to all corners of the world is quite a complex task, based on the variations in the storage temperature requirements of the different COVID-19 vaccines.”

Agbo emphasised that the cold chain must be uninterrupted in order not to reduce the potency of the vaccine. According to her, UNICEF is currently working with national and state governments in Nigeria, along with other partners in ensuring, “our cold chain continues to work efficiently, effectively and that we deliver the COVID- 19 vaccines to all eligible persons”.

The Specialist Pharmacy Service (SPS), which main purpose is help to improve the use of medicines so people live longer, said that the AstraZeneca vaccine’s maximum shelf life is six months, when stored in a refrigerator between 2°C and 8°C. Once removed from the fridge, it may be stored between 2°C and 25°C for up to six hours.

“Once punctured, the vial must be used within six hours. It must not be frozen, and during storage, vials should be kept in an outer carton to protect it from light,” SPS added. To find out the challenges involved with maintaining the cold chain and its movement to rural communities, our reporters decided to randomly visit other rural communities aside from Lagos State. Other states visited are Abia, Bayelsa, Ogun and Kaduna states.

Lamentations of insecurity, inaccessible roads and lack of power supply were recurring decimals. The National Primary Health Care Development Agency (NPHCDA) is the agency directly responsible for distributing the vaccine around the country, while PHC workers in different villages are the vaccinators. According to our findings, just to ensure that the vaccination programme is successful and reaches the remotest of rural communities, the Coalition Against COVID-19 (CACOVID) in Nigeria took care of the logistics.

The CACOVID funds, among other things, will ensure door-to-door vaccination, buying of solar-powered systems and ice packs for PHCs in different villages. NPHCDA also disclosed that funds for the vaccination programme are donations from different quarters.

“It’s not a question of how much, but how much donated and by who? This is because the Presidential Task Force (PTF) has a separate account they are running, CACOVID has an account managed by the Central Bank of Nigeria (CBN), and the Ministry of Health has an account they are running. Donations from UNICEF are mostly in conjunction with the European Union (EU) contributions. In fact, the money can’t be traced to any particular ministry,” it said. Citing CACOVID as an example, the agency stated it is responsible for transportation of the vaccines and provides a cargo plane which delivers the vaccines to states.

“For those without what we can call a functional airport, there is a delivery van that transports the vaccine. So you can see what we mean when we say the contributions are majorly in kind, not cash,” said NPHCDA. The Ministry of Health, on its part, insisted it has never collected money, and that everything comes in the form of donations.

The Chief Executive Officer at Vaccine Network for Disease Control, Mrs. Chika Offor, who is currently working with the Anambra State government to ensure the vaccine gets to rural communities, said the fact that most PHCs do not have power supply has been factored in and taken care of. Offor explained that communities without electricity and generators, but have PHCs, wouldn’t receive vaccines. Health workers will not keep vaccines where there is no electricity or refrigerators, stressed Offor. But on vaccination days, health workers from such PHCs will have to go to the central storage and collect vials necessary for that period’s vaccination.

She added: “After the health workers are through for that day, whatever is left is returned to the centre that has the storage facility for auditing. Everything is monitored; not just by Nigerians, but also by countries that donated the vaccine. These organisations also helped some of these states to renovate their cold stores and made sure they had the necessary equipment to keep the store in the condition required.”

On vaccination, she said vaccines are collected in cold or frozen boxes and moved to PHCs that have no electricity. She further revealed that if 50 vials are collected from the cold storage and only 30 used in the rural communities, both the used and unused vials will be returned for accountability. Offor noted that going to rural communities where there are insurgents, is usually problematic. According to her, in everything, safety of the personnel and the vaccine is paramount. “Vaccination cannot take place in places where they are fighting or have other insecurity problems. It doesn’t make sense for the health workers to start running for their lives and in the process the vaccine will pour away. Vaccines are expensive,” she added.

Abia State

Since the #EndSARS protest in 2020, the South-East has been gripped by violence while its people are enveloped in fear. This year alone, many security agents and civilians have been killed, and government infrastructure burnt, as elements termed “unknown gunmen” hold the region by the jugular. The violence has spread to the five states that make up the South-East.

It’s in the midst of this escalating violence and tense atmosphere that Abia State began its vaccination programme. Health workers in the state said vehicles have been provided for remote and nearby villages and thus, the programme will not be derailed.

The state Cold Chain Officer, Mr. Nwabuisi Augustine, said the state’s cold storage is at the required standard and explained that all the PHCs selected as sites for COVID-19 vaccination have been equipped with solar-powered refrigerators aimed at keeping the vaccine at the right temperature. Augustine claimed that the government has made movement of the vaccination teams easy by providing buses for remote areas. The majority of Abia State local government areas, aside those within Aba and Umuahia, have electricity problems.

However, the Local Immunisation Officer (LIO) in Ukwa East Local Government Area, Mrs. Onyinyechi Ekeagba, while confirming that lack of electricity is their initial worry, said the problem has been sorted out. She said: “It was handled efficiently with the help of the NPHCDA, which provided us with enough solarpowered fridges to ensure the storage of the vaccine at the required temperature.” Ekeagba explained that they also have a standby generator, which enables them to produce ice packs.

She added: “The ice packs are an important storage and movement tool in COVID-19 vaccination exercise. This is because they help the vaccine to retain its efficacy during movement after it has been removed from the fridge.” Ekeagba further stated that there are solar refrigerators supplied by donor agencies and NPHCDA.

“We have generators for ice packs’ production, but the vaccine storage is mainly in the direct drive solar refrigerators. We have about 10 satellite cold chain centres in this place. We have two COVID-19 vaccination centres; Akwete and the Azumini PHCs. We will go to Umuahia using our vehicles and cold boxes to procure the vaccine so that its potency will not be reduced,” she said.

The Health Authority Secretary of Ikwuano Local Government Area, Abia State, Sir Akpara Godwin, explained that some PHCs serve as mini-cold chains. Godwin said that the mini-cold chain makes it easier for health workers to go back to headquarters in Oboro to collect the vaccine. He said: “It’s true, some of these communities have bad roads and we need transportation. Also, there are some areas we have to use motorcycles to cover because vehicles cannot go there. Those are hard to reach areas. We have also discovered that most villagers are not aware of the exercise, notwithstanding all our messages through local town criers and other information dissemination channels. Also, those that are aware do not have means of coming to Umugbalu and Ariam for vaccination, which is why we’ve decided to move from community to community.“

A community leader in Uzuakoli, Bende Local Government Area, Elder Clement Uchenna, opined that the state government is not partnering with NPHCDA in the fight against COVID-19. He said: “I took it upon myself to go for the vaccination. Nobody convinced me. I’m, however, shocked that till date, the Abia State government has not demonstrated any seriousness in this fight. How many of the vaccination equipment came from the state government as their input? The state government is treating this COVID-19 like it is the Federal Government disease and that is dangerous!

I go round PHCs and I see the frustration of the health workers. They can’t even go round to vaccinate here in Bende because they don’t have enough vehicles. The health workers are scared of speaking the truth. How many buses or motorcycles do they have at Igbere, Uzuabam and Uzuakoli PHCs? Bende is the largest local government area in the South-East. If the Federal Government, through the NPHCDA, has provided solar-powered fridges, as I have been made to understand, what has the state government done to make vaccination easy?” A former chairman of Akwete Joint Traditional Council of Chiefs and Village Head of Umunwaibari village, Akwete, Chief Onyema Olujie, said awareness about the COVID-19 vaccination has not been created in the villages. He said: “How would health workers get to our community which is already cut off from the rest of the state due to terrible roads? I urge the government to be serious because if the second wave becomes serious, I don’t think we will survive it!”

Additional reports by Regina Otokpa and Emmanuel Ifeanyi To be continued

This report was facilitated by the Wole Soyinka Centre for Investigative Journalism (WSCIJ) under its Free to share project

 

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