Kaduna state Commissioner of Health, Dr AMINA MOHAMMED BALONI, spoke on a wide range of issues surrounding the COVID-19 vaccine which was delivered to the country last week, in the interview belo.
Last Tuesday, the nation took delivery of 3.92 million doses of Covid-19 vaccines and the federal government promised that frontline health workers will be the first to get the jab. Have the vaccines been certified safe by NAFDAC?
The vaccines were received via the COVAX facility, which a global alliance for vaccines, like the WHO, GAVI and other entities that are supporting middle and low-income countries to gain access to free vaccines. The vaccines Nigeria received are from Astra Zeneca and before they were even brought into the country, they have been certified by NAFDAC and given the all clear for emergency use. In addition, NAFDAC had obtained samples from different batches of the vaccines and subjected them to tests to confirm their efficacy.
From available reports, these vaccines require very cold temperatures for storage. Does our healthcare system have such cold chain facilities that will maintain their efficacy?
There are different types of vaccines. It is true that some of them require very low temperatures. These include the ones that are manufactured by Pfizer and Moderna and others that require -80 degrees Celsius. But what we have is Astra Zeneca and it requires between+ 2 and +8 degrees, which is normal refrigeration temperature. We have cold chain facilities that can store them. The vaccine requires the same storage temperatures as routine vaccines that we administer to children. The infrastructure that we have for providing routine immunisation is adequate to protect those Astra Zeneca vaccines.
Has the federal government designed a sharing template for these vaccines? Will it be shared on the basis of equality of states or population?
The strategy for Nigeria is to immunize 70% of its citizens to reach herd immunity. As you know, most of the manufacturers are overwhelmed with orders from developing countries. So, we are going to get the vaccines as they are being manufactured. So, that is why the immunisation will start with frontline workers, then essential workers like the military, the police, personnel that are at the nation's points of entry like airports. Basically, essential workers that will keep the country going are going to be immunised first. Then strategic leaders, leaders of communities that build confidence in the safety of the vaccines, the elderly and those with co-morbidities will be immunised next. So, the sharing formula is based on that population. But as you know, the federal government doesn't have citizens; it is states and local governments that have. So, it will be on a pro rata basis and the population of these group of people that I mentioned will determine how many doses a state can get. So, already we have sent the nominal roll of our health workers. The military and the police and other security agencies are also collating their own. All these will be stored in a data bank and that will guide how the vaccines will be distributed.
Do you mean that a state that has more health personnel will have more of these vaccines than a state that has a higher population?
The initial target now is for all health workers and essential workers to be immunized wherever they may be, they will be vaccinated because they are the ones that are going to manage the cases when they arise. Once these categories of people and those who are considered as essential workers are vaccinated, then we go onto the other priority groups and then the general population over the age of 18 years. So, if you have 50,000 eligible people in your state, you will get 50,000 doses and if a state has 20,000, it will get 20,000 doses of the vaccine. So, the first tranche that will go out will be based on total number of health workers and other priority groups, but all states will eventually get enough to vaccinate 70% of their populations.
The federal Ministry of Health has opened a portal for people to register for the vaccine. Is it open to everybody? What are the criteria that will make people eligible for the vaccine?
The portal is open for everybody to register. There was a pre-registration for health workers that was done through the nominal roll that we had earlier sent. So, that has already been uploaded; so that even if you want to register again, it will filter you out. I don't know if you have looked at the portal?
You should have (general laughter). It has your vital information like your name, your age, your occupation. You will be asked whether you have co-morbidities like diabetes or hypertension. You will list them. The people that have these underlying ailments will be given more priority than the general public. So, the portal is a planning tool and a tracking tool. Even if you are not able to register, for example people that don't have android phones to register they can be assisted to register. There is also registration at the point of vaccination. A code is generated as you register. That will help us to track every dose. As you know, the supply worldwide is very tight. We don't want to waste any dose and we don't want to duplicate any dose. When someone is vaccinated, the batch number of the vaccine will be recorded so that we will know how many of the vaccines have been used and how many are outstanding. If you are pencilled down for vaccination and you don't turn up, we have your address and details; some use phone numbers, some put their email addresses to register. So that they can be reached in that way. So, it is a way of tracking and seeing that everyone is covered.
Just a clarification, is the vaccine administered with just one jab or two?
Astra Zeneca vaccine is two jabs. Only Johnson and Johnson has one jab and it has just been approved in the United States. It is now that it will be allowed to be manufactured in large quantities. May be in a few months, through the African Union facility which is negotiating for vaccines for African continent, we will get it. It is about 300 million doses or thereabouts. And each African country can obtain from there. So, we hope to get the Johnson and Johnson vaccine when it becomes available or possibly through COVAX.
Recently, the federal government gave N10 billion in order to start producing the Covid-19 vaccine locally. Has the production started or is Nigeria waiting for approval?
This question should really be addressed to the federal government. But what I know is that Nigeria used to manufacture some vaccines in Vom, Plateau state. But it hasn't done so in a long time. So, the effort is to revitalise the places that we have. There are also some local companies whose parent companies are manufacturing Covid-19vaccines and we want to see if we can key into that. For example, South Africa is manufacturing some of these vaccines because they have the facilities. India is doing the same and we believe that Nigeria should be able to do the same because we have the market. And we have the expertise; Nigerians are some of the most educated people in this world. But the N10 billion is towards revitalising the facilities and possibly putting up new facilities where these vaccines can be produced. But there is usually a gestation period. You can't just get N10 billion and start manufacturing vaccines tomorrow. You have to make sure that everything is in place, including the Quality Assurance. You need to do re-training for the personnel. This preparedness that we are doing is not just for this pandemic; it is to make sure that our facilities and systems are resilient for any other pandemic that will come. And the whole world doesn't expect to be vaccinated in one year. We are looking at two years, may be three. So, we hope that before that time, some of these vaccines can be manufactured in Nigeria. We won't have to start asking people to do it on our behalf.
With the arrival of these vaccines, is there the danger that people may start lowering their guards regarding observing the Covid-19 prevention protocols?
There is a chance but we have been trying to communicate to people on the need to still observe these protocols. First of all, there are two vaccines to be taken. You will take the first one and after 12 weeks, you will get the second one. Between the first and second jabs, you have better immunity, but you may still contract the virus and even transmit it. So, it is when you take the two that you are fully protected. Two, because people will not be immunised at the same time, we still have vulnerable populations. That is why we have categorisation of people. So, we will start with the health workers who will deal with the disease and essential workers who will keep the country going. Then we go on to the vulnerable which are the elderly people. You see from our statistics that most of the people who died from the virus are people who are the elderly and those with co-morbidities. Then we move to strategic leaders. There are some people who will inspire confidence in the vaccine, for example people may feel more comfortable if they see me take the vaccine or the Governor. Some will say that the Sultan took it or the President of the Christian Association of Nigeria (CAN) took it, so it must be safe. Or our paramount ruler took it. So, that is the idea. You have seen it on TV, the presidents of countries take it, so that people will know that it is not anything harmful. You have seen the Pope take it, you have seen the president of the United States take it. Our president is taking his tomorrow (Saturday); we need to build confidence to get everybody on the fold.
Governor Nasir El-Rufai had promised that apart from the vaccines that the federal government will give to the states, Kaduna state will go ahead and procure its own vaccines. How far has the governor gone in that direction?
We are making enquiries on obtaining vaccines. Like I told you in the beginning, it is a tight global market. Before the vaccines were even approved, more than a billion doses have been bought by the western countries. So, the companies cannot manufacture the vaccines as fast as the world needs it. First, we must contend with that, and we have to wait in a queue. And you know, we are only 10 million people in Kaduna state. Countries are buying 200 million doses; the manufacturer wants to recoup his money. So, he will give priorities to those countries. But like I said we are making enquiries and efforts to supplement the efforts being made by the federal government.
-A candidate vaccine goes through several stages before it can be given to people;
-The process begins from the exploratory science, to the pre-clinical testing (often on animals), then clinical development (which includes three phases of human trials), and finally regulatory review and approval, manufacturing and quality control;
-In pre-clinical studies, a vaccine is tested to see whether it is toxic and how it reacts with the body - this is to identify a safe dose before testing it on people.
-Human trials are designed to spot side effects - these are not the same as temporary short-term reactions such as a headache, sore arms, fatigue, chills and fever;
-These reactions are not uncommon in other vaccines or injections, and are usually not harmful in the long term. Genuine side effects mean anything that is long-lasting and potentially dangerous;
-Two of the new vaccines developed by Pfizer-BioNTech and Moderna use mRNA technology. mRNA vaccines are fast to develop, cheaper and easier to manufacture than more traditional vaccines and safe;
-During clinical trials, the Pfizer-BioNTech vaccine was given to half of a total of 43,500 people, and the Moderna vaccine to around 15,000 of 30,000 people;
-Throughout the phase 1, 2 and 3 trials assessing safety, no major side-effects have been reported so far;
-The Task Force for Global Health's Brighton Collaboration is a group of more than 750 vaccine experts working on vaccine safety, including for COVID-19 vaccines;
-Rumours circulating on the internet and on social media platforms claim that the new vaccines can affect fertility. There is no evidence of this claim;
-More importantly, there is no biological possibility that COVID-19 vaccines could affect fertility, or can the vaccines actually give you COVID-19;
There have been anecdotal reports of people appearing to get COVID-19 after the first dose of the vaccine, most likely these patients already had the virus incubating before their shot.
Adapted from www.gavi.org/covid-19/vaccines