Africa's dependence on imported vaccines was starkly illustrated by the Covid pandemic. But faced with recurrent outbreaks of diseases ranging from yellow fever and diphtheria to cholera and mpox, Nigeria still relies on other countries for vaccines.
In this explainer, we look at existing vaccine gaps and consider how Nigeria can overcome shortages.
A vaccine is a biological preparation that helps the body's immune system recognise and fight viruses and bacteria.
Between 1940 and 1991, Nigeria produced smallpox, yellow fever and some rabies vaccines at the Federal Vaccine Production Laboratory in Yaba, Lagos and even exported vaccines to other African countries.
The laboratory made yellow fever vaccines in the 1970s and 1980s, producing 316,000 doses of the vaccine in 1978, and reaching a peak of more than 500,000 doses in 1987.
But today the laboratory is dilapidated, and occupied by homeless people. Plans to upgrade the facility were abandoned, virologist Prof Oyewale Tomori told Africa Check.
Without vaccine production capacity, Nigeria has had to rely on countries such as the United States, France and Spain during disease outbreaks.
Mpox is a viral disease that causes a distinctive rash and can be fatal.
As of 30 September 2024, the Nigeria Centre for Diseases Control (NCDC) reported that there were 78 confirmed cases of mpox in Nigeria. The most affected group has been children below the age of five. No deaths have been reported.
In August, Nigeria received 10,000 doses of the Jynneos mpox vaccine. The vaccines, developed by the Danish pharmaceutical company Bavarian Nordic, were donated by the US government.
Dr Eniola Erinosho, a public health physician and former director of the Lagos State Ministry of Health told Africa Check: "The World Health Organization stated that only 500,000 doses of the mpox vaccine were available at the moment and that more will be available in December, about 2.4 million."
Nigeria could get more doses then, she said.
"Don't forget that Nigeria is not the epicentre of the current outbreak. So it's understandable that the country got 10,000 doses."
But given that the vaccines are mainly for the "at-risk population, especially children and those with sexual risk behaviours", Erinosho said that the amount was not enough for the whole population.
Five states - Bayelsa, Edo, Cross River and Lagos - have been identified for priority vaccination.
Cholera:
Cholera is an acute diarrhoeal disease that can kill within hours if left untreated. It is spread by food and water contaminated with the bacterium Vibrio cholerae.
Nigeria is using three World Health Organization-qualified oral cholera vaccines, from UK vaccine company Valneva, India's Sanofi and Korea's biopharmaceutical company EuBiologics.
"A prequalified vaccine is a vaccine that has been certified as okay for quality, safety, and efficacy by the WHO and that such vaccine meets with global standards and can therefore be used by countries," Tanimola Akande, a professor of public health at the University of Ilorin, told Africa Check.
In 2021, more than 3.5 million doses of the oral cholera vaccine were approved by the WHO for Nigeria. In 2022, the health agency approved the use of a further 9 million doses.
All three vaccines require two doses for full protection and are only given to people at high risk of contracting the disease.
Diphtheria:
Diphtheria is a highly contagious disease caused by the bacterium Corynebacterium diphtheriae. Humans are its only natural host.
The diphtheria, tetanus and pertussis (DTP)-containing vaccine is provided by Gavi, a global health partnership that improves access to immunisation in poor countries. Nigeria has received 11.7 million doses of the pentavalent vaccine.
Children under the age of five are particularly vulnerable to diphtheria. The graph below shows that millions of children aged 12 to 23 months have yet to receive all three doses of the DTP vaccine.
Human papillomavirus:
Human papillomavirus (HPV) is a viral infection that commonly causes warts. Some types of genital HPV can cause cervical cancer.
In October 2023, Nigeria secured 6 million doses of Gavi's current HPV vaccine for girls aged 9 to 14 years. The vaccine protects against genital warts and most cases of cervical cancer.
About 13.9 million of Nigeria's estimated population of 223.8 million are girls aged 10 to 14.
"Vaccine rates in the country are very low," Akande told Africa Check. This was due to "poor awareness of the benefits of vaccination, ignorance, religious reasons, poor access to health facilities, negative perception and attitude of caregivers and, in some parts of Nigeria, fathers' opposition to vaccination".
"In some parts of Nigeria with conflicts or war, health workers are unable to reach the children. Vaccination coverage is also low among migrant populations," Akande said.
"You remain at the mercy and mood of the donor. You work with whatever they give you and sometimes the donor, who is the piper, not only dictates the tune, but also how you dance to the tune," said virologist Tomori, who was a member of the WHO Covid-19 Technical Advisory Group.
"Ultimately, you are the beggar who has no choice about what you get, when you get it, how you use what you get or if you will even get anything at all."
Tomori said reliance on foreign donors undermined Nigeria's ability and commitment to developing local vaccines for diseases that were a significant burden.
Nigeria had the resources to do so, Tomori said, including human, natural and material resources. "The issue is the misuse of these resources."
"We are not resource-limited, we are resource-wasting. We are not resource-constrained, we are resource-squandering. We must realise that you do not bring tears to the equity table, you bring what you must negotiate for equity. When you bring nothing to the equity table, you get nothing, you bring your raw material, you get a raw deal."
Tomori said that all that was needed was a national commitment that went far beyond political will, backed by financial commitment and a dose of national pride.
"The implementation of the plan for local vaccine production must be driven by national interest. Ability and opportunity to direct and implement our health plans with minimal dependence on external forces that we cannot control. Reduction in foreign exchange spending. Creation of jobs for our citizens, and of course more taxes, corporate and individual, for the government. This is all it takes."
But billionaire Microsoft co-founder Bill Gates disagrees. During a visit to Nigeria in September 2024, he said Nigeria should focus on developing health products that had more immediate benefits, rather than local vaccines. Gates said there were challenges to local vaccine production in Nigeria.
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"Regulatory complexity and economic scale as significant barriers" were the challenges, he said.
(Disclosure: The Bill and Melinda Gates Foundation provides funding support to Africa Check.)
Dr Rotimi Adesanya, director of medical services at the Federal College of Education (Technical), Lagos, southwest Nigeria, supports Gates's view.
"I buy his opinion, the resources are limited, we need to prioritise our resources," Adesanya told Africa Check.
He said Nigeria could easily get vaccine supplies from donors with waivers across borders.
"If there are waivers across borders, vaccines will be very affordable as there will be no taxes on duty on such and many countries will find it easier instead of going for local productions," he said.
Erinosho told Africa Check: "There are many health commodities and consumables that are not mass produced and therefore not easily available and not affordable in the county."
Nigeria could focus on producing these, he said, especially to benefit the needy. Examples included life-saving drugs, antibiotics and contraceptives.
On the issue of vaccine equity, Erinosho said it was the way forward for effective and efficient prevention and control of vaccine-preventable diseases.
"It means prioritising needs in vaccine allocation. For instance, recently the WHO prioritised the Democratic Republic of Congo and Nigeria in the allocation of the available mpox vaccine based on needs. That's vaccine equity."
