Feature

COVID-19 vaccines: Medical experts disagree on modalities, arrival of second batch

The arrival of vaccines for COVID-19 in Nigeria was greeted with enthusiasm. And immediately, discussions followed about the ethical challenges of how to ensure fair access to it across states and which groups should be prioritised. In this report, ISIOMA MADIKE and REGINA OTOKPA, look at the fears of analysts regarding the four million doses available to the country and suggested they should be given to only two million people so they can get two jabs and retain their efficacy

zz Political cronies are prioritised above others -GMD
zz A responsible government should take health of citizens seriously –NARD
zz Leaders struggle for vaccine doses for their countries –Odubanjo
zz All nations may not achieve required level, says Ezeibe

There are fears that the World Health Organisation (WHO) initiative under which Nigeria got the first batch of four million COVID-19 vaccines may not be in a position to provide the country another round of the vaccine doses in a long time. With such fears, some analysts are suggesting that the first batch, already being given to individuals, should be made available to only two million people so they can get the necessary two jabs for the vaccine efficacy to be meaningful.
They are worried that at the rate people are rushing to get the vaccine, the country may likely exhaust the available four million doses on four million people soon. If this happens, they said, how would those who already got their first jab be able to take the second dose within the specified period required. Already, about 500,000 jabs have been given out across states within just a few weeks.

For now, the United States of America, Europe and the European Union (EU) are still battling with the pandemic, and may rightly need to take care of their citizens first before making provisions for others. Similarly, India, where the AstraZeneca vaccine largest producing company is situated, was recently hit by an upsurge of the disease and was reported to have opened up immunisation to more people, which eventually will reduce vaccine exports.

India has reported more than 12 million infections, including a big surge last month with deaths at more than 162,400. To many, these situations portend danger for countries expecting to get immediate shipment of the vaccine, especially the African countries. While evaluating the situation, the president of the Guild of Medical Directors (GMD), Professor Olufemi Babalola, noted that the rollout of the vaccination programme in Nigeria has been rather chaotic. While the priority, according to him, should be the vaccination of all health workers both in the private and public sector before any other group (as is the case in other decent countries), “we see in Nigeria that political cronies are prioritised above all others. “We have made representations to the National Primary Health Care Development Agency (NPHCDA) to no avail.

There is as yet no clear cut approach to the vaccination of frontline healthcare workers nationwide. As of now, just over 500,000 Nigerians have been vaccinated. If we are to achieve herd immunity, we need to vaccinate over 100 million or at least 50 million if we target hyper endemic areas only.

“We do not see a rush because there is so much skepticism in the general population; skepticism, which is best addressed by health workers, who should have themselves been vaccinated,” Babalola said. However, a Professor of Veterinary Medicine and Clinical Virology at Michael Okpara University of Agriculture in Umudike, Abia State, Prof. Maduike Ezeibe, decided to look at the issue of vaccines differently.

Ezeibe told one of our reporters on the telephone that he had always feared that vaccines may not solve the problem of COVIDd-19. He said: “All nations may not achieve the required level and yet nobody is sure how long those fully vaccinated would remain protected.

We have a medicine that has cured HIV/AIDS despite the severe immune deficiency it causes and it works by targeting electrical charges. Every scientist knows that such medicine would cure more rapidly diseases caused by electrically charged agents that do not cause immune deficiency including COVID-19.

“My appeal is that everybody in the world should insist that WHO investigates our claims and certify the Antivirt so that anybody infected will be treated quickly. Already two confirmed cases treated with it recovered within a few days.” Reviewing the suggestion by analysts on the possibilities of not getting a second consignment of the COVID-19 vaccine soon, the Chairman, Ministerial Expert Advisory Committee on COVID-19, Professor Oyewale Tomori, said he would rather support the use of available vaccine to vaccinate more people since the first dose confers a protective level of immunity. “This means we have four million instead of two million with some level of protection until we get the next batch of vaccines. Remember we are aiming for herd immunity as fast as we can get it.

There is really no ‘appointed’ time for receiving a second jab. Conventionally you receive the second jab after your body must have developed some measure of immunity from the first jab. “For many vaccines, it’s anything from 10 to 14 days. Thereafter any time you get a second jab the ‘memory’ antibody cells from the first jab come rapidly to develop more immunity in what is called anamnestic reaction.

So, really it does not matter much when you get the second jab. What is important is how much immunity you develop from the first jab. Remember the J & J vaccine requires only one dose,” he said. Dr. Doyin Odubanjo, a public health physician, aligned with Tomori, when he said that Nigeria taking its chances would be the best as, according to him, the whole world is struggling to ensure adequate vaccine doses for their countries. In this circumstance, he said, the saying that half a loaf is better than none, applies.

“A single dose protects to some degree and will protect some people for a while. So, it’s okay to not reserve the doses to be given to the same people who got the first doses. Also, the government expects that more donations will arrive before the 12 weeks period given to those vaccinated now to get their second doses.

Otherwise, the second dose would have been planned for three to four weeks after the first,” Odubanjo said. Dispelling the fears that the country may not get the second batch of the vaccine any time soon, the Nigerian Institute of Medical Research (NIMR) DG, Prof. Babatunde Salako, believes the government will receive more doses from the African Union (AU). Though there was nothing tangible to support this assertion, Salako said with confidence that many more people will be vaccinated by June when the second jab is due.

A family physician, Dr. Rotimi Adesanya, also told one of our reporters that the government has booked the vaccine for the second phase already. He said: This will be kick-started as soon as possible. The first four million was donated; the second dose is expected in three months. The one we paid for will land sooner than later.

“The citizens will need to calm down, let’s believe the government for a moment. If there is anything they got right, it is this COVID-19 vaccination programme.” Also, National Chairman, National Association of Nigeria Nurses and Midwives, Federal Health Institutions Sector, (NANNM-FHI Sector), Wale Olatunde, said if the information at his disposal is anything to go by, the second batch of the vaccine has been factored in by the Nigeria Centre for Disease Control (NCDC). Olatunde said: “That is why the immunisation itself has not been generalised.

For now it has been restricted for those at the frontline and those at higher risk. So, they must have factored in the first and second doses. “For example, if we have 10 million doses, it means you are going to pick five million because if you give the first dose and you don’t give the second dose at the appointed time it becomes a waste and that is why for now, it is restricted to front liners and those highly exposed.

There’s no cause to fear. Government I want to believe is working hard to get more doses.” Dr. Aminu Magashi, National Coordinator, Africa Health Budget Network, was more emphatic when he said that the four million doses of vaccine already being given to people was meant for two million people. He said: “Once NPHCDA reaches two million vaccinations and is not getting additional doses, my guess is they will stop adding new people.” President, National Association of Resident Doctors of Nigeria (NARD), Dr. Uyilawa Okhuaihesuyi, told our reporter that the country’s population is over 200 million and that the schedule for the vaccine was first for frontline health workers and the elderly. The vaccines will be gotten for all Nigerians, he added.

“When you try to get herd immunity that means virtually everybody in that environment should be vaccinated to achieve herd immunity. So, we should be able to call on the government to provide more vaccines for Nigerians. The second dose of the vaccine should be taken at least three months after the initial vaccine.

“The first dose is about 50 to about 87 per cent immunity while the other one is about 90. Depending on the vaccines, there are different types; Pfizer, Moderna and Astra- Zeneca and others. It’s taken twice three months apart but all Nigerians should be vaccinated.

“Delivery of another vaccine is scheduled for August; we are in April that means we have about four months to go. We encourage everybody to go for the vaccines and to the government, get more vaccines for Nigerians so at least we can keep Nigeria safe.

A responsible government should take the health of her citizens more seriously,” Okhuaihesuyi said. Nigeria received four million doses of the COVID-19 vaccine on March 2, shipped through the COVAX Facility, a partnership between CEPI, Gavi, UNICEF and the World Health Organisation (WHO). The arrival marked a historic step towards the goal to ensure equitable distribution of COVID-19 vaccines globally, in what will be the largest vaccine procurement and supply operation in history.

The delivery was also part of a first batch of the vaccine arrivals in the country, which the authorities said would continue in a few months from now. It is believed that COVAX shipped 3.94 million doses of the AstraZeneca/ Oxford vaccine, manufactured by the Serum Institute of India (SII), from Mumbai to Abuja. With that, the UN Country Team in Nigeria reiterated its commitment to support the vaccination campaign in the country and help contain the spread of the virus. The United Nations (UN) Resident Coordinator in Nigeria, Edward Kallon, had said: “The arrival of these vaccines in Abuja today marks a milestone for the COVAX Facility in its unprecedented effort to deliver at least two billion doses of COVID-19 vaccines globally by the end of 2021.”

Dr. Walter Kazadi Mulombo, WHO Representative in Nigeria, had also said: “It is heart-warming to witness this epoch-making event and WHO wishes to congratulate the government of Nigeria for its participation in the global vaccine collaboration (COVAX) efforts and its commitment to protecting Nigerians against this pandemic.” According to him, “Vaccines are a critical new tool in the battle against COVID-19; therefore, this is a step in the right direction. These vaccines have undergone rigorous regulatory processes at global and country level and have been deemed safe and effective.”

The COVAX Facility is expected to deliver around 90 million doses of COVID-19 vaccines to the African Region in the first quarter of 2021, and has committed to providing up to 600 million doses to the region by end-2021, to cover 20 per cent of the population. “After a year of disruptions due to the COVID-19 pandemic, today we celebrate the efforts being made in getting the vaccine to Nigeria. With more than 150,000 Nigerians infected with the virus and over 1,800 lives lost, the path to recovery for the people of Nigeria can finally begin,” said Peter Hawkins, UNICEF Nigeria Country Representative.

“This is a very significant occasion – the arrival of the COVID-19 vaccines into Nigeria is critical in curbing the pandemic. The only way out of this crisis is to ensure that vaccinations are available to all.” That was the enthusiasm that greeted the arrival of COVID-19 vaccine in Nigeria. Soon after that, discussions continued about the ethical challenges of ensuring fair access to COVID-19 vaccines within and across states, and which groups should be prioritised. At the global level, there were also concerns about equity in access to COVID-19 vaccines.

Estimates as of December 2, 2020, suggest direct purchase agreements have allowed high-income countries to secure nearly four billion confirmed COVID-19 vaccine doses, compared with 2.7 billion secured by upper and lower middle-income countries. Without such agreements, low-income countries would probably have to rely on COVAX, which would achieve only 20 per cent vaccination coverage. According to The Lancet, a leading world health journal’s report, while COVID-19 vaccines bring potential hope for a return to some kind of normality, vaccine-based protection is contingent on sufficient population coverage.

It also requires effective governance, organisational, and logistical measures, the report said, within a wider COVID-19 control strategy that includes continued surveillance and appropriate countermeasures. However, the America’s Center for Disease Control and Prevention (CDC), said it typically takes a few weeks for the body to build immunity (protection against the virus that causes COVID-19) after vaccination. According to the CDC, it takes time for the body to build protection after any vaccination.

People are considered fully vaccinated two weeks after their second shot of the Pfizer-BioNtech or Moderna COVID-19 vaccine, or two weeks after the single-dose J&J/Janssen COVID-19 vaccine. It was however silent on the Astra- Zeneca/Oxford vaccine.

Though the CDC noted possible side effects after getting a COVID-19 vaccine, which it labelled normal signs, the body, according to it, needs little time to build protection. These side effects, it said, may affect one’s ability to do daily activities, but go away in a few days, while some people may not experience any of it at all. The common side effects on the arm where the shot is given are pain, redness and swelling. And one may experience throughout the rest of the body: tiredness, headache, and muscle pain.

Others are chills, fever and nausea. Plenty of fluids have been advised to reduce discomfort from fever, while it is also advisable to dress lightly within the period. While in most cases, discomfort from pain or fever is a normal sign that the body is building protection, one should contact a doctor or healthcare provider if the redness or tenderness where one got the shot gets worse after 24 hours; if the side effects do not seem to be going away after a few days; if one gets a COVID-19 vaccine and might be having a severe allergic reaction after leaving the vaccination site.

 

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