Sunday Magazine

COVID-19: When health workers refuse vaccination

In this global pandemic era, health workers, as the apex frontline workers, are supposed to be first vaccinated with the AstraZeneca vaccine against COVID-19. JULIANA FRANCIS, in this report, discovered that some health workers, who are expected to vaccinate others, are hesitant to be vaccinated. There is anxiety that this hesitancy may affect the target of nationwide vaccination in Nigeria

 

• I have fertility problem, can’t take it –Nurse

• It’s not compulsory but important –Abia official

• Proper counseling needed for health workers –Kaduna NMA

• We don’t know what vaccine looks like –Bayelsa health workers

 

A volunteer staff with a Primary healthcare centre, located in Azuba Bashiyi, Shabu Development Area of Lafia Local government, Goselle Manya, 31, became ill after being vaccinated with the AstraZeneca Vaccine on March 22. Manya is believed to be among the first set of health workers to have taken the vaccine.

 

The vaccine arrived in Nigeria on March 2 and the Nigerian government announced that frontline workers, especially health workers, who were at high risk of exposure, should be prioritised for vaccination.

“After I took the vaccine, I felt dizzy and I thought it was the normal sign that comes with the vaccine.

However, when I got home, I began to have a headache and chest pain. I was not sick before I took the vaccine,” she said, while sharing her experience with a national Newspaper. Feeling seriously bothered, she went to report her ordeal at the PHC where she works but was told that it was Malaria. She took Malaria drugs but her situation worsened. She said: “I had rashes all over my body and the headache continued.

 

The situation was not abating which made one of our church members, working with the National Agency for Food and Drug Administration and Control (NAFDAC), ask me to come to their office for further examination.”

 

At NAFDAC, she was asked a series of questions and taken to Dalhatu Arafat Specialist Hospital, where she was admitted for three days. She was further asked to go for a series of tests but she couldn’t due to financial challenges. Fearful she could die, Manya started begging for financial support to cover for the medical tests but it was a futile effort.

 

However, a close friend to Manya, who spoke with the New Telegraph this year, said that she survived but after much suffering. Manya was not the only one that suffered after taking the vaccine. Many Nigerians experienced similar side effects. Although they lived, the fear spread by those affected caught up with many and health workers were not left out.

 

Thus, many Nigerians, including health workers have become hesitant in submitting themselves to be vaccinated.

 

Similarly, a man in Lagos State is presently battling to stay alive after taking his second jab. According to his friend, Rachel Omoniyi, that he was still alive was a miracle. She said: “He started feeling funny 24 hours after taking the second jab. He was stooling. His tongue began to protrude and he appeared lifeless.

 

We were all scared and feared the worst. We had to start forcing water, salt and sugar solution into his mouth. He went into a coma for three days. Even as I’m speaking, he’s still weak and not his usual self.” Aside from the side effects fuelling health workers’ refusal to take the vaccine, another issue is the conspiracy theory that had trailed the arrival of the vaccine, with Nigerians and clerics alleging it could cause health problems and even death.

 

The National Bureau of Statistics (NBS) revealed in its report titled, ‘COVID-19 impact monitoring February 2021,’ that the number of people willing to be vaccinated fell from 86 per cent in October 2020 to 83 per cent in February, 2021. According to NBS, for those not willing to get vaccinated, seeing their religious leaders, family, friends, doctors, nurses and community leaders get vaccinated would increase their likelihood of taking the vaccine.

 

The Nigerian government in the first dose of the COVID-19 vaccination said it was targeting one million health workers in the first phase of the vaccination. It is doubtful if it has hit that mark yet.

 

Many health experts worry that this hesitancy on the part of the health workers would affect receptiveness of the vaccine. Ironically, health workers are at the increased risk of contracting and transmitting the virus and their decisions can influence their patients’ decisions to be vaccinated or not.

A heated debate has been ongoing, on whether health workers should be mandated to take the vaccine. Some argued that it was an encroachment on their fundamental human rights. However, governments in some countries are beginning to make the vaccination mandatory as the COVID-19 infection rate continues to spiral, with new variants emerging.

A health worker in a rural community in Delta State, who didn’t want her name mentioned since she’s not supposed to speak with journalists, said: “People are scared of taking the vaccine, including health workers. You have to realise that we’re human beings first before being health workers. Most PHCs workers that I know said they wouldn’t take the vaccine.

Take for instance in this Delta State, the vaccine is available but it’s only fear that’s making health workers not to take it.” Asked if the government can force health workers to take it, she replied: “Yes, the government can force us to take it, unless, we don’t want the job anymore. If we lose our job, there are many people queuing to grab it. And these people will be ready to take the vaccine.”

 

A nurse in Philadelphia United States of America, Ogechi Orji, said that health workers in the state were not mandated to take the vaccine but they were given conditions. She explained: “As a health worker, if you’re working in a hospital or a nursing home, you must do a COVID-19 test at the beginning of every week, usually on Mondays. When it comes to private agencies, which provide home services to patients at home, we were told that it was mandatory and you have to submit a copy of your Centers for Disease Control (CDC) vaccination card.”

The National Primary Health Care Development Agency (NPHCDA), the Federal Government agency in charge of the distribution of the vaccine and the vaccination, is optimistic that more health workers will decide, without coercion, to be vaccinated.

NPHCDA added: “We’re expected to reach about 2.01million persons and we have so far reached about 1.959 million Nigerians out of which 26 per cent are health workers, while about 62 per cent are other frontline workers, who also interact daily with members of the public, and are exposed to people.” The agency said these other frontline workers include, the military, paramilitary, bankers, teachers, lecturers and others.

 

The agency also noted: “We have about 12 per cent elderly and above 50 years. On health workers specifically, from available statistics, both public and private, there are about 974,000 nationwide, and we have so far reached about 484,000 of the health workers, which is about 47.8 per cent of health workers reached in this first batch. “When compared to other countries, Nigeria has done very well. Some of the advanced countries never got 20 per cent of the health workers when they introduced the vaccination.”

The agency further noted that as it begins to wind up the first batch of the vaccination, more health workers had been stepping forward, desirous of being vaccinated, having noticed that those administered with the vaccine, had no serious consequences. “There shouldn’t be any worry. There is advancement in Science and Technology; so even in the vaccine world, science and technology has helped in getting vaccines produced faster,” explained NPHCDA.

 

On March 11, 2021, Abia State joined other 35 states across Nigeria to flag-off the first phase of the COVID-19 vaccination; with focus on capturing the health workers. One month after the flag off, precisely in April 2021, NPHCDA listed Abia State as among states with lowest number of vaccinated people in the country with just 1,874 persons captured.

 

Two months after that information, our reporter visited the Abia State Primary Health Development Agency, Umuahia, to verify the level of vaccination so far and there were about 24,000 vaccinated in two months.

According to the information made avail-    able by the Abia State Immunization Officer (SIO), Mrs. Happiness Akpulonu and Mr. Nwabuisi Augustine, Abia State Cold Chain Officer (CCO), the state vaccinated 26, 635 persons in the first dose and has been able to vaccinate over 8,000 persons as at June 13, 2021.

 

Almost all the health workers that spoke with our reporter, in three selected LGAs of Ukwa East, Ikwuano and Bende, which fell within Abia South, Abia Central and Abia North Senatorial Zones, claimed they had been vaccinated with the first and second jab. While some of them said they took it because they knew how important it was, others said the Primary Health Authority in the state made it mandatory for them.

However, when asked if the vaccination exercise was mandatory for health workers, Akpulonu said it was not, adding that the State PHDA only encouraged all health workers to take it for their own good.

She added: “There are a lot of conspiracy theories everywhere, especially in the social media, which is causing misinformation. Even some doctors are skeptical about taking the vaccination. However, the best way to encourage people to get vaccinated is for us, who are health workers to get vaccinated first. Health workers have the freedom to decide to be vaccinated or not. For us in Abia State, it was not made mandatory but I heard that some states made it compulsory for their health workers.”

Abia State has been recording the low vaccination rate, not just because of its health workers’ hesitancy in being vaccinated but also because the citizenry are not convinced that they should take the vaccine.

 

Augustine said: “The hesitancy of people, not just health workers, is a big problem. You must capture the person’s data and upload into the system and most times, the network makes it difficult. You must make sure you do it to enable the person capture his or her information to be available whenever needed.

 

And we’re now at the point of using their data to search for them. These are people that took the first dose and we’re looking for them. It may not be easy. It will be easier if they’ve not traveled, and if some have not died as well. These things are challenges because people move about and can’t stay at a place.” Our reporter also gathered that health workers at the Amaoba PHC, Ikwuano LGA, had not been vaccinated as of June 9.

 

The Executive Secretary, Ogun State PHCDB, Dr. Elijah Ogunsola, said about 13,489 health workers in the state had been vaccinated so far. Giving the breakdown of those that have been vaccinated, Ogunsola said, 5,225 male health workers and 8,264 females received their first jabs of the vaccine. Ogunsola revealed that the government had tackled vaccine hesitancy among residents by vaccinating strategic leaders in the state, who in turn allayed fears of the residents.

 

According to him, the strategies deployed by the government have also helped create awareness about the safety of the vaccine. Our reporter visited one of the PHCs in Owode-Egba in Obafemi Owode LGA of the State. A female health worker there said: “We were encouraged to take the vaccine, and my staff here have all been vaccinated. Some have even started receiving their second jabs.” A nurse, Mrs. Rhoda Adefioye, in one of the PHCs in Imeko Afon LGA of the state, said that when her centre took delivery of the vaccines, they were mandated to take their jabs first before anyone else.

 

Adefioye said that although there was vaccine hesitancy at first, especially among health workers and other residents of the area, however, with continued sensitisation, a good number of people turned up for vaccination. She added: “I have taken the vaccine and some of my colleagues that I know have also taken, and so far, we have recorded an impressive number of people who have taken the vaccine.

 

At first, residents, including some of us didn’t want to take the vaccine because of the rumour being spread on the social media on the negative effects of the vaccine but the Commissioner for Health, Dr. Tomi Coker, allayed our fear and even took the vaccine to prove to us that it was safe.” The Chairman of the State chapter of the Nigerian Medical Association (NMA), Dr. Oladapo Ogunlaja, lamented that the State has not been able to vaccinate as many people as possible but was still optimistic the situation will soon turn around.

 

Ogunlaja noted that some members of the association had refused to take the vaccine due to personal reasons which he said were best known to them. He, however, added that the association would continue to encourage and sensitise its members who were yet to take the vaccine to do so and not expose themselves to danger.

 

His words: “Vaccine hesitancy among health workers in Ogun State is not as much as people are saying it is. I know a lot of doctors who have taken it. I have also taken the vaccine and I have encouraged my members to take the vaccine.

 

There may be very few doctors who have not taken it. Maybe, due to personal reasons but a lot of doctors that I know have enrolled and they have taken the vaccine. We just have to try as much as possible to encourage those that have not taken it to get vaccinated because we are one of the people that are most exposed to the virus.

 

So, they should get vaccinated and protect themselves.” Another health worker in Yewa South Local Government Area of the state, who spoke under the condition of anonymity, said she did not take the vaccine because she was not sure of what the effect would be on her. She expressed the fear that, according to reports of possible side effects, she preferred not to take the vaccine than risk being affected by it. She also noted: “How do I know if what they are giving people is truly what they say it is?

 

For all I know, the vaccine they claim they are giving people may not be the same thing people from other countries are receiving. I have heard people complaining of headache and body pains after taking the vaccine, and I don’t think I want to go through that experience. It’s better for me not to take the vaccine at all than to take it and have reactions.

 

I’m not discouraging anyone from taking the vaccine and as far as I’m concerned, anyone who wants to take it is free to do so. My reason for not taking the vaccine is personal and I’m entitled to my freedom of choice.”

 

Asked if she wasn’t compelled to take the vaccine, she replied: “When my boss insisted that I must take the vaccine, I told her that I had been advised not to take it because of my condition. I have fertility challenges and that was how I was left alone.” At a community in Kaduna State called Gwagwada, neither the people in the community nor the health workers had been vaccinated.

 

According to the villagers, aside from what they heard on the news, they had no idea what the vaccine looks like, let alone to have been vaccinated. The only PHC in the community does not even have a signpost, and only attend to minor ailments and pregnant women. When our correspondent visited, a nurse was seen attending to pregnant women and lactating mothers.

 

 

This was as the nurse on duty declined to comment on any issue. Our reporter visited Akaba community, in Yenagoa Local Government Area of Bayelsa State and spoke with health officer, Mr. Frank Sikpi, who is in charge of the facility. He said that he didn’t even know what the vaccine looked like and thus, had not been vaccinated.

 

Sikpi added: “We have not taken the vaccine but it is still going round. It will definitely reach here. We are not afraid, but the stories about the vaccine are very scary. We heard that those who took it wouldn’t live long. If it is like that, then nobody should come near me with it.”

 

On June 8, our reporter went to Amarata PHC in Yenagoa LGA. A nurse, who identified herself as Perekosifa, was on duty at the Centre. When asked if she had taken the vaccine, she replied: “I have not taken it. People are afraid of taking it but I heard that the government wants to make it mandatory.”

 

Another health worker at the Centre, Steven Kings, thought our reporter came to take the jab and tried to convince her not to have second thoughts. Kings, who introduced himself as a member of the COVID-19 team, said: “I have taken the first jab. I’m supposed to take my second jab today but I forgot my card. The jab will not kill you!

 

The vaccine reacts if you have sickness before taking it.” Kings revealed that it was because frontline workers were hesitant in coming for the vaccination that they had received instruction to vaccinate anyone that comes for it. He said: “Like now, we have shared ourselves.

 

Some people will go to the Navy, others to police stations or the Air Force. These aforementioned people are taking it but not all of them. We are, however, not forcing anybody. If your system starts reacting, you will just take paracetamol.

 

Even now, villagers are refusing to be vaccinated because our pastors have turned the bible upside down. They are the cause of all these suspicions and hesitations.” Also Dr. Neni Awora, in charge of immunization in the Bayelsa State Primary Health Board, said the number of health workers that had been vaccinated couldn’t be ascertained as of now because the exercise was still ongoing.

 

The Chairman of Association of Community Pharmacists of Nigeria (ACPN), Sam Adekola, said that between 2020 and now, some of his members were infected, but survived. He said that only two people died. He said that at least 95 per cent of ACPN members had been vaccinated. Prof Oyewole Tomori, a renowned virologist, said health workers’ hesitancy to take the vaccine could influence their patients.

 

He added: “Certainly such refusals will adversely affect other people’s desire to receive the vaccine; such healthcare workers are not showing good examples.” He also noted that the refusal of some health workers to take the vaccine, would adversely affect other people’s desire to receive the vaccine.

 

“Such healthcare workers are not showing good examples,” said Tomori, who added that to a large extent, awareness had not been created by the government concerning the vaccines.

“However, we started a little bit late and not widespread enough. We have also been too slow in providing facts to correct the fake news and misinformation about COVID- 19.”

 

The former secretary of ACPN, Jonah Okotie, said that he was aware that some health workers had refused to take the vaccine, but that it ultimately meant putting themselves at risk as healthcare providers. He was against the idea of the government making the vaccine mandatory for health workers, “until the air is cleared on some uncertainties about the virus and the vaccine, in addition to guarantees about its effect on people.”

 

The National President of Nigerian Association of Resident Doctors (NARD), Dr. Uyilawa Okhuaihesuyi, said health workers’ hesitancy in being vaccinated was because they had been misinformed.

 

His words: “I think they are misinformed and are not taking their priority of being health workers or health inclined workers. The vaccine helps you to achieve health immunity.

 

Since the person is a health worker, it protects the health worker against infected patients. It means they can deliver more to the society, help people get treatment and at the right time. It’s right for health workers to get the vaccine. So, it won’t lead to a large suicide effect, which has been documented.”

 

Okhuaihesuyi, who said that he had taken his first and second jabs, explained that scientifically, it has been proven that COVID- 19 vaccine protects people from contracting the virus. He said that his advice to hesitant health workers was to go and get vaccinated.

 

He added: “My advice is that health workers should take the vaccine but if a health worker refuses to take it, it’s his or her choice, and this is because there are more advantages in taking it.

 

However, if you’re a health worker, it means you’re at the frontline. Try and take the vaccine, in order to protect yourself, which is part of the oath we took. You have to protect yourself before you can provide treatment to others. Attain immunity first before vaccinating and giving immunity to others.”

 

The Chairman, NMA, Kaduna State, Dr. Aliyu Sokomba, said that the essence of the vaccine to health workers couldn’t be overemphasized. “However, when a health worker declines the vaccine, I want to believe it’s because such a person is not convinced about the benefit of getting the vaccine.

 

At this point, the organisation administering the vaccine should do more of the counselling to the health worker on the need to be vaccinated. I want to believe one of the reasons health workers are declining the vaccines is because of the belief that the virus is mild among Nigerians or Africans.

 

So, there is no added advantage in getting the vaccines, except for the risk,” said Sokomba. He opined that counseling would convince some health workers to get vaccinated, adding: “Instead of forcing people to take the vaccine, counsel and inform them about its importance. If a health worker or anyone declined the vaccine, it means the person doing the convincing had not done enough.

 

Nigeria is a free society. People should be allowed to exercise their rights in making choices they want to make in regards to their health and their well-being. I don’t advocate that vaccines should be made compulsory for health workers.”

 

•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.

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