Unscrupulous business people are selling vaccines in controvesial circumstances and without complying with NAFDAC guidelines.
In the second and concluding part of this report, Ebuka Onyeji investigates why the scarcity of Yellow fever vaccines occurred in the areas where they were most needed in Nigeria and how business persons cashed in on the situation, neglecting health and ethical concerns. Read the first part here.
The report of strange deaths from an 'unknown' ailment later confirmed as Yellow fever in some communities in Enugu State led to a rush for vaccines in the state late last year.
After the Nigeria infectious disease outfit, NCDC, confirmed that the strange deaths, put above 50 by residents and below 40 by officials, were from Yellow fever, the Enugu State Government on November 19, 2020, began 'mass vaccination' in the three most affected local government areas.
According to the executive secretary of the Enugu State Primary Health Care Development Agency (ENS-PHCDA), George Ugwu, the exercise was targetted at almost a million residents in Igboeze North, Nsukka and Isi-Uzo local government areas.
Amid the panic over the strange deaths, residents of neighbouring towns also sought to get immunised.
On December 3, 2020, an Enugu resident alerted PREMIUM TIMES of likely collusion between government health officials and 'vaccine hawkers' in the sale and administration of jabs to desperate Nigerians at N1,000.
"They hoard it and redirect it to private hospitals where they sell it at N1,000 per jab," the resident said. He added that a government hospital directed him to a private vaccine dealer.
Two months of investigation by PREMIUM TIMES confirmed that private vaccine dealers connived with government health officials to sell the jabs to desperate citizens.
When news of the strange deaths broke, Nnabuife Ezeani was in desperate need of vaccines for himself and his family. He is an indigene of Opi in Nsukka North Local Government Area (LGA) of the state - one of the affected communities.
"When we found out that this disease is caused by mosquitoes, we knew nobody was safe no matter where you are and that brought a lot of panic among those of us living in Enugu," he told PREMIUM TIMES.
"Enugu town is dominated by Nsukka people. At least 6 out of 10 people living in Enugu are from that area and we love travelling home almost every weekend. My community, Opi, is just a few minutes' drive from' Enugu; it is a border town known for good palm wine that is why we frequent home."
Mr Ezeani said when the government announced the Yellow fever vaccination campaign, he was warned by his people not to return home until he gets himself and his family vaccinated.
"I had also calculated the risks," he said.
"Sometimes if I travel home, I come back and find mosquitoes from the village in my car."
Unfortunately, Mr Ezeani did not find vaccines at any of the government health facilities he visited last November.
"Most of the government hospitals we visited said they don't have the Yellow fever vaccines," he said.
Mr Ezeani said it was the same situation at the Enugu State University Teaching hospital, also called 'Park lane'. But something strange happened there.
"On our way out, a nurse called my wife and gave her a piece of paper saying, 'call that number, she will give you the vaccines at N1, 000 per person'."
The lawyer said he called the number and a lady directed him to Methodist Cathedral at Uwani to get vaccinated.
The address given to Mr Ezeani was different from the one on the piece of paper, indicating that the dealers are vaccine hawkers.
"She said we should come fast because people were booking the vaccines. When we got there, she vaccinated me and my family, all six of us and we paid N6,000."
Mr Ezeani said his wife asked the woman why she is getting her vaccines and if she is a licensed dealer.
"Lawyers like you have come to ask me similar questions and I told them that I run a private business. I bring my vaccines from Abuja and when it finishes, I bring another batch," Mr Ezeani quoted her as saying.
After hearing Mr Ezeani's account, this reporter went in search of Yellow fever vaccines in health facilities in Enugu. There were no vaccines at primary health centres (PHCs) in Ogui, Uwani, Trans Ekulu, and Abakpa.
After he was told there were no vaccines at 'Park Lane' hospital, the reporter just like Mr Ezeani was cornered by a staff who gave him the same paper card. "Call the number on the card, they will give you the vaccines," the official said.
Contacted the following morning, a lady who identified herself as Victoria directed the reporter to her home at RCC Estate in Trans Ekulu.
Getting there, the reporter posed as a businessman that just returned to the country to meet his fiancé.
"I am already vaccinated but I need one for my fiancé. I am from Opi town and I was told both of us should get the vaccines before returning home to avoid infection," he told Victoria, a plump light-skinned woman.
She hesitated when she discovered the reporter did not come with any flask or cold chain to preserve the vaccine but opted to sell nonetheless, in breach of the law and guidelines put in place by Nigeria's food and drugs agency, NAFDAC, on vaccine distribution.
Section 12 of the NAFDAC Act 2004 provides guidelines for good distribution of food and drug-related products and frowns at distributors or their agents who sell or supply vaccines in flagrant abuse of the law.
"Go and ask them to give you cold pure water so we can put it (the vaccine) in it. Make sure you keep it refrigerated once you get home until you are ready to inject her," she said.
After getting the cold water, the reporter paid N1,000 and was given a form to fill. The form contains hundreds of names of people that had already paid for a jab.
"She should inject it all, it's 7.5 mil. Put it in between your bag. You have luck, the next set of people might not see anywhere to buy," Victoria said, handing a card over to the reporter.
Asked how they get their stockpile, Victoria said, "When you look at the card I gave you, you will see the name of the company we are working with. It is located in Abuja. My boss gets our supplies from China and India - all kinds of vaccines, not just Yellow fever."
Asked if she's duly registered and authorised to sell and administer vaccines, Victoria avoided the question and rather said, "Our company is well known in Abuja."
Most of the conversation was held in Igbo language.
'Optimum Vaccine and Preventive Health Services LTD', is the name on the card Victoria gave the reporter. The address is No 38 Nyerere Close Opp. Asokoro District Hospital, Asokoro Abuja.
The search for the said company turned a wild goose chase as there is no such address in the entire area. The phone numbers on the card were switched off each time it was dialled.
But further checks on the company's Facebook page showed a different address and phone number.
Contacted on phone, a man who identified himself as Mr Phillip and an official of the company agreed to sell Yellow fever vaccines to our reporter who disguised as a pharmacy owner based in Enugu.
On the day of the transaction, instead of taking the reporter to the company's office as earlier agreed, Mr Phillip insisted the transaction should take place on an open road close to Mr Biggs junction in Jabi area of Abuja.
Mr Phillip who appeared to be in a haste sold two to the reporter at N4,000. He did not ask the reporter to show his identification as an authorised pharmacy owner or care to know if the reporter was authorised to buy and administer vaccines as stipulated by the NAFDAC guidelines.
Even though the reporter did not come with any cold flask to shelter the jabs, Mr Phillips sold them nonetheless. He told the reporter to call him later in the evening for any other questions as he was in a haste to deliver vaccines to some hospitals.
Posing as a newbie in the business, the reporter contacted Mr Phillip to request a proper orientation on the nitty-gritty of the vaccine trade.
"Many people will come and tell you that they heard vaccine is free. Don't listen to them because they will still come back and ask you to sell to them," the vaccine dealer explained on a Thursday evening over the phone.
Mr Phillip said the vaccine trade is a big business and the government cannot handle it alone. He said his company is registered and has the required licences for the importation, distribution, and supply of the vaccines.
"We are in partnership with the government, public health facilities and the health ministry.
"We buy from India where there is an open vaccine market. If you have the licence you can import. The government is aware of this. Optimum vaccine is registered with the C.A.C and that's the first when it comes to this business.
"We supply over 30 different vaccines, including that of cervical cancer. Over 30 different vaccines. Here in Abuja, we supply many hospitals, including Garki General Hospital."
When PREMIUM TIMES later contacted Mr Phillip officially, he denied ever selling or distributing vaccines on the roadside or to any unauthorised dealer.
He claimed his company is duly registered and only deals with licensed vaccine buyers such as hospitals.
Breaching NAFDAC's guidelines
The NAFDAC Act 2004, Section 12, contains the Good Distribution Practice (GDP) guidelines of the agency which apply to all persons and companies involved in any aspect of the distribution of pharmaceutical products, such as vaccines, from the manufacturing site to the point of use.
According to section 1.10 of the regulation, distributors or their agents should supply pharmaceutical products only to persons or entities which are themselves authorised to acquire such products either in terms of an authorisation to act as a distributor or to sell, supply or administer products directly to a patient.
Victoria sold the vaccine to an unauthorised dealer in Enugu. She also broke the cold chain guide by supplying to a buyer who had no means to maintain the vaccine cold chain.
Also, she could not provide any means of identification as a licensed agent or distributor.
Mr Phillip on the other hand sold on a roadside to an unidentified buyer who has no cold chain.
The dealer's claim that his company is registered with the Cooperate Affairs Commission (CAC) did not check out in a search on the commissions' website.
PREMIUM TIMES further wrote an FOI to the CAC. Received and stamped February 16 by the commission's Registrar General's office, the FOI requested for full details of the registration status of the company.
More than a month later, there was no response from the commission.
When notified of the findings of this investigation, the Pharmacovigilance department of NAFDAC said it would commence an independent investigation immediately.
"It's not just about the sanctions", said Fraden Bitrus, the head of the unit said when this reporter asked the type of actions the agency will take on complicit suppliers. "Its' matter of life and death".
Mr Bitrus explained that such shady deals and unsafe distribution of vaccine if allowed to continue will put many lives in danger.
"We need to move in immediately and puncture this kind of arrangement to serve as a deterrent to others in this kind of business," he said.
NAFDAC's Pharmacovigilance department is charged with the function of investigating, monitoring and apprehending drug and vaccine dealers violating the agency's guideline for the sale and distribution of such products.
Also known as the drug safety unit, this department is also responsible for the assessment and prevention of effects in drugs.
The first part of this investigation detailed how superstition leading to vaccine resistance, poor vaccine storage and irregular power supply in PHCs contributed to why Yellow fever, which is vaccine-preventable, has remained endemic in Nigeria.
Sharp practices in the sale and distribution of the vaccines also contribute largely to why Yellow fever vaccine rollouts in Nigeria do not achieve the desired results, health experts say.
These breaches in distribution guidelines can make the vaccines ineffective and can also be hazardous to health, according to Iyabo Daradara, Director of Logistics and Health Commodities at the NPHCDA.
"When you look at the chain of distribution from the Enugu vaccine rollout to the involvement of private dealers, there are a lot of gaps," Emmanuel Egbroko, the C.O.O of Inocul8, a Nigerian vaccination provider, said.
"Vaccine cold-chains were broken. Again, why is a big hospital like Park Lane not able to provide vaccines and its staff are referring patients to unknown vaccine sellers?
"There is evidence of collusion and gaps that government is not making much efforts to address," he explained.
This report builds on previous investigations that showed how government officials collude with desperate travellers to beat the Yellow fever card requirement for travelling in and out of the country.
Yellow cards are issued after immunisation at a government hospital and are validated with a signature and stamp from the port health authority.
But desperate travellers are using fake Yellow cards obtained from corrupt airport officials to bypass the travel requirement, according to a check by Devex, thereby increasing the risk of the epidemic-prone disease spreading to other countries.
Another report by the ICIR revealed how not less than 80,000 Yellow cards are now being sold in the markets and streets.
Yellow fever vaccination
Yellow fever is an acute viral haemorrhagic disease that can kill within 10 days if symptoms become severe.
The Yellow fever vaccination was introduced in Nigeria in 2004 as one of the vaccines expected to be given to children free during routine immunisation. In spite of this, the country is still witnessing recurrent outbreaks of the disease.
The increasingly regular outbreaks are large because many people are not immunised, according to the NCDC. The NPHCDA said the vaccines procured by the government could not cover the entire country, hence the low immunisation rate.
"The Yellow fever vaccines are free only for children under 5. The only time vaccines are free for the general public is when there is an outbreak and a campaign is flagged off," an NPHCDA official said.
"Once the campaign is over, anybody that needs the vaccine will have to source it."