In this concluding part of the investigation on COVID-19 vaccine and its cold chain movement, JULIANA FRANCIS looks at challenges confronting health workers in the movement of the vaccine to rural communities in Nigeria
There are 93 PHCs in the eight local government areas of Bayelsa State. The state is mostly surrounded by water. Indeed, this is one of the challenges vaccinators will face in the attempt to go to rural communities. According to residents, the most dangerous security threats in the state are sea pirates. The pirates rob, kidnap, kill and terrorise boat or canoe passengers.
They also snatch goods from traders heading to rural communities from Yenagoa. Another prevalent danger, which health workers will face in venturing to rural communities, is the likelihood of boats capsizing. Amarata PHC in Yenagoa Local Government Area is where the vaccine is stored before onward movement to other communities. At the Bayelsa State Ministry of Health, Dr. Jones Stow of the Public Health Department said that after the Federal Government distributed the vaccine to different state governments, Bayelsa’s was flown to Port Harcourt, and then from there to Bayelsa by road.
He said: “We have a cold storage inside the Government House. It has been there for a very long time and it’s very big. We have been using it to store other immunization stuff. We have solar-powered systems in the local government areas because of poor power supply.
But here in Yenagoa, we use electricity and it is from here that the vaccines are moved to different communities. The health workers go with the cold boxes, which have been kept in solar refrigerators in the PHCs, and from there they’ll be distributed to other communities.” Dr. Neni Awora, in charge of immunization, Bayelsa State PHCB, said the concept of vaccination is to reach everyone in the easiest and shortest time.
He said: “The Yenagoa Local Government Area has various sites where vaccines are stored. Some are in rural communities and some close to rural communities. Funds have been made available to get vaccines to rural communities with vaccines currently being used in some rural communities right now. Each vaccine can be used to immunize 10-11 people, and when opened, we try as much as possible to finish it, in order to reduce wastage.” Awora said he was aware that some communities lack power supply, adding that storage facilities for the vaccine were available.
Kidnapping for ransom in Ogun State between 2020 and now, has spiralled out of control, leaving government and security agencies nonplussed. People now fear to walk in the state, but health workers will have to go into remote parts of this state to vaccinate the rural dwellers. Aside from kidnapping, a twin challenge, bedevilling the state is bad roads and electricity.
The Executive Secretary, Ogun State PHCDB, Dr. Elijah Ogunsola, while not talking on the state’s mounting insecurity, disclosed that as at March, over 59,000 residents of the state had been vaccinated with the COVID-19 vaccine. This means the state has achieved 50 per cent vaccination, said Ogunsola.
Investigation revealed that the state administered the first jabs of the vaccine in 106 vaccination centres scattered across the state. All these centres get their supply of vaccines from a central storage facility. Ogunsola said the storage of the vaccine in the state is on different levels. In addition to the vaccination sites, Ogunsola said each local government area has a mobile team that goes to places with difficult terrains, especially rural areas to vaccinate the people. According to him, the state has a central storage facility for storing the vaccine from where it is distributed to the different PHCs and general hospitals.
He said: “We have a cold room and the Governor, Dapo Abiodun, just gave us a 100kva generator to ensure that there is an uninterrupted power supply to maintain the cold chain. We have solar direct-drive refrigerators which are capable of storing the vaccine.
If the vaccine is not in the cold room, it is kept in cold boxes which are used to carry the vaccine around, and there will be ice packs inside to ensure that the vaccine remains potent.” The PHCDB boss explained that at the local government level, there are solarpowered ice landing freezers and deep freezers for storing the vaccine to maintain its potency.
Just like in most rural communities visited, Ogunsola noted that health workers usually move out with cold boxes which have ice packs, which will still keep the temperature of the vaccine until it’s finished. He added: “We have about 520 PHCs in Ogun State. At least each ward has one functional PHC and we have 236 wards in the state, but some wards have more than one PHCs.
The Federal Government gave the state 106 sites for COVID-19 vaccination. The sites are spread across all the local government areas of the state.” A visit to one of the PHCs at Owode-Egba in Obafemi Owode Local Government Area of the state revealed that solar panels were installed for the purpose of powering the storage facility of the vaccine.
During a trip to Gwagwada community off the Abuja-Kaduna Highway in Kaduna State, our correspondent met with the village Head, Mr. Luka Saure. He disclosed that the PHC in the community was not supplied with any vaccine based on his discussion with the health workers. Further investigations, however, revealed that many of the health workers had gone to another community, Dutse, within the Chikun Local Government Area to take the vaccine due to the directive by the state government that all health workers must be vaccinated.
Dutse is between 35 and 40 minutes’ drive from Gwagwada, but those who spoke with our reporter said they usually go on motorcycles which can go in less than 25 minutes because of the state of the road. The New Telegraph moved from Gwagwada to the Giwa PHC and the Giwa General Hospital, but at both centres, our reporter was denied access to the facilities. However, sources in the area said the General Hospital is one of the centres administering the vaccine in the area. A resident in Kaduna State, Mr. Baba Negedu, said the vaccine getting to rural dwellers will be a challenge for health workers because of insecurity in the state.
He said that in Kaduna State travelling from one end to the other is a nightmare. Also, four roads, which link Kaduna State – the Kaduna-Abuja highway, the Kaduna-Birnin Gwari Road, the Kaduna-Zaria Road and the Kaduna-Kachia Road – which travellers ply on a daily basis, are now a source of fear for them. This is because travellers are often attacked. Negudu also complained that villages across the state and those on the outskirts of Kaduna, the state capital, are attacked daily. The man added that in Southern Kaduna houses have been overrun by herdsmen.
He said: “Many of the health workers that operate in the villages mainly reside there. Others like partners and NGOs have to travel under heavy security. Recently, two nurses were abducted from a health facility in the southern part of the state. “Some of the roads are motorable, others are in bad shape. Some of the places are better accessed by motorcycles. Many of the villages do not have electricity and as such the PHCs do not have power supply. This is why the state government, sometime back, said the PHCs would be powered by solar energy. But that is not visible at present.”
The National Primary Health Care Development Agency (NPHCDA) told our reporter that the distribution of the vaccine was among states and the Federal Capital Territory (FCT). It also said that it has a Technical Working Group (TWG) chaired by the executive director of the NPHCDA, Dr. Faisal Shuaib, and that the agency has different partners. According to the agency, the TWG meets on a daily basis, and the implementation plan is jointly developed by all their partners to look at what is coming in and how to distribute based on the available information with regards to expected supply. It said: “The COVAX facility gave us 20 per cent of the population vaccine support free, while the rest is to be procured by the government.
The vaccine is already available for purchase in the market for uptake. They gave us the initial dose of 3,924,000 doses. The team looked at the most eligible, and from the eligible, the most susceptible in the epicentre of the pandemic and the vulnerable groups that need to be prioritised.
Thus, Lagos had the highest followed by FCT and others. All the states have received the vaccine.” NPHCDA, while explaining that rural communities have access to the vaccine, added that it created an indigenous innovative strategy to deliver the vaccine nationwide. It added: “After distributing to the states, we had a strategy to deliver to all Nigerians and we used the indigenous innovative TEACH strategy.” The TEACH strategy, among other things, means “to determine where we need to site and how many people will need the vaccination”.
It also entails house-to-house vaccination, which essentially addresses people in rural communities. “It engages graduates to go house-to-house in hard-to-reach areas. We have done the analysis of the first registration and seen the areas where the electronic registration was not effective, so we will use the house-to-house to reach out to more people so that no Nigerian is left out.
“We have storage capacity for routine immunisation for our children in Nigeria, so we don’t have problems storing our vaccines. The country already has enough of that capacity for +22 +80 degrees storage. As at December 2020, the national end has been supported with partners and government funding to provide Solar Direct Drive (SDD) in each of the wards. As at that same December, about 72 per cent of the wards have been provided so that whether there is electricity or not, the health workers will use those SDDs to store their vaccines.” Renowned professor of virology and former Vice Chancellor of the Redeemer’s University Nigeria, Oyewole Tomori, said the cold chain must not be interrupted. He added: “Most proteins are denatured by heat. The colder the storage, the longer the protein.
This time, the vaccine will maintain its integrity. For some vaccines like Pfizer, you need to keep them at ultra-low temperatures as low as minus 80 degrees centigrade. Most other vaccines like Oxford AstraZeneca can be kept in ordinary fridge temperature.” According to him, if the cold chain is interrupted, and the vaccine given to the patient, the person will only be vaccinated, but not immunised, meaning the person remains unprotected. Tomori argued that insecurity, lack of electricity and inaccessible roads to penetrate rural communities are not the greatest challenges facing COVID-19 vaccination in Nigeria.
He said: “Yes, the challenges have always been with us, yet we were able to stop the transmission of polio using the polio vaccines to vaccinate children in the remotest parts of the country. So, we should have no fears about COVID-19 vaccines which are stored at temperatures like the polio vaccine.
But the greatest problem is the non-availability of COVID-19 vaccines! My worry is that the vaccines are not being produced in sufficient quantities while at the same time many western countries have paid for more than they need. Remember India that is the largest producer now has her own problem. So, even if we pay for vaccines now, we’ll have to wait for those who have paid to be satisfied first.” The UNICEF Nigeria health specialist, Dr. Ijeoma Agbo, said that the cold chain begins from the point of the manufacturer, where it will be stored at the required temperature in a warehouse.
The same thing is done when it’s being transported to the airport and by air, to various countries where it is needed. She said: “When it enters Nigeria, it is stored at a national warehouse. For Nigeria, this is at NPHCD national store. From there it is distributed to states and from there to local government areas, where there are storage facilities and then to the health facilities, where they would be used and later administered to the beneficiaries.”
Agbo said that Nigerians, who are not in the medical line, may not be able to detect when the cold chain has been interrupted. She said: “However, if the vaccine is exposed to either temperature that is too high or too low, it loses its potency. Potency is the ability of the vaccines to protect us from diseases, and once a vaccine loses its potency, it can’t be regained.
If at any point the vaccines can’t be kept within safe temperature ranges, the cold chain is disrupted and the vaccines turn from potential life-saver to a threat. Now, there’s something about the vaccine vial, which is the containers of the vaccines.
It’s called the ‘vaccines monitor’ and this is a label or a sticker which contains a sensitive material. It is placed on the vaccine vial. It changes colour if the vaccine is exposed to heat, and this lets the health workers know whether the vaccines can be used for vaccination or not.” Agbo said some consequences in interrupting the cold chain, leading to the vaccine losing its potency, are wastages, which could lead to “stock out.” She added: “This is because we have already quantified the amount of vaccines required when they were sent to health facilities or certain regions. But if exposed to wrong temperatures, they become damaged; this then means we don’t have the right amount for that populace.
If the vaccines are in non-potent form, there can be sepsis which is an infection. However, we always ensure that health workers are trained in order to be able to notice when the vaccine vial monitor has changed colour.” According to her, it is important that health workers receive the vaccination training in order to meet the demands of their roles. These training, she stressed, are always ongoing, because new recommendations will keep evolving as scientists learn more about the vaccines.
Additional reports by Regina Otokpa and Emmanuel Ifeanyi
This report was facilitated by the Wole Soyinka Centre for Investigative Journalism (WSCIJ) under its Free to share project