Challenges of turning COVID-19 vaccines into vaccinations

The COVID-19 pandemic is unlikely to end until there is the global roll-out of vaccines that protect against the severe disease and preferably drives herd immunity. In this report by Sade Oguntola, experts speak on some challenges to roll-out if the vaccine in Nigeria and its implication on the pandemic.

The COVID-19 pandemic is unlikely to end until there is global roll-out of vaccines that protect against severe disease and preferably drives herd immunity. Regulators in numerous countries have authorised or approved COVID-19 vaccines for human use, with more expected to be licensed in 2021.

‘Herd immunity’, also known as ‘population immunity’, is the indirect protection from an infectious disease that happens when a population is immune either through vaccination or immunity developed through previous infection.

In 2020, COVID-19 disrupted the lives of people across the globe. In Nigeria alone, there have been an estimated 1,761 deaths, 146,928 positive COVID-19 cases and 1,441,013 million tests conducted as of February 16, 2021.

Vaccines save millions of lives each year. They work by training and preparing the body’s natural defences — the immune system— to recognise and fight off the viruses and bacteria they target. If the body is exposed to those disease-causing germs later, the body is immediately ready to destroy them, preventing illness.

Already, at least 89 preclinical vaccines are under active investigations; three vaccines are already approved for full use, while four were abandoned after trials. Yet having licensed vaccines is not enough to achieve a global control of COVID-19: they also need to be produced at scale, priced affordably and allocated globally so that they are available where needed, and widely deployed in local communities.

The National Primary Health Care Development Agency (NPHCDA), recently, said Nigeria hoped to get 42 million doses of the Covid-19 vaccines to cover one-fifth of the nation’s population through the global COVAX scheme. The initial vaccines are to come as part of the country’s plan to inoculate 40 per cent of the population this year and another 30 per cent in 2022.

COVAX, a coalition for epidemic preparedness innovations and the World Health Organisation (WHO) scheme, aims at ensuring all countries, especially the low and middle-income countries have access to safe, effective vaccine.

Unfortunately, President, Africa COVID-19 Vaccine Manufacturing Initiative, Dr Simon Agwale, speaking at a COVID-19 vaccine webinar organised by the Nigerian Healthcare Professionals, USA, said despite its willingness and resources to ensure that Nigeria achieves the vaccination of at least 70 million people, getting enough dose of the most efficacious COVID-19 vaccine is a challenge.

Agwale, a former researcher at the National Institute for Pharmaceutical Research and Development (NIPRD), Abuja, said depending on its manufacture abroad will not solve the problem as such, African countries are trying to ensure that manufacturing capabilities are built throughout the continent to produce the vaccines to make them easily accessible to those that need them.

The vaccinologist, however, said that recent clinical trials in South Africa showed that the AstraZeneca vaccine efficacy in the country was about 26 per cent, far below the threshold that WHO approved for COVID-19 vaccines, making South Africa stick to Pfizer and Modena vaccines for use.

He said this is a pointer that Nigeria also needed clinical trials to assess the vaccines it will be rolling out for use, and to ensure that the decision on what vaccine to use is evidence-based.

He added: “The African Centre for Disease Control (CDC), a few days ago, said that countries that have not reported the South Africa strain should go ahead and roll out the existing vaccines. And then countries that have reported the South African strain should use other vaccines apart from the AstraZeneca vaccines. They recommended that there should be clinical trials in those countries so that the roll-out of the products will be evidence-based.

“Without South Africa participating in those clinical trials, we would have blindingly gone to start implementing vaccines that will probably not work against our population. So, we are working hard to make sure that clinical trial setups are established throughout Africa so that countries that report the South African strain will do minimal clinical trials like bridging studies to show that these vaccines work for them.”

He, however, declared that Nigeria needed to tread cautiously on using AstraZeneca vaccines because there is limited genomic surveillance done in Nigeria.

“We have the UK strain, which is covered by the current vaccine; we have not seen the South African strain based on pieces of isolates that are taken national wide. Again, we have to interpret that cautiously because we don’t have a surveillance system,” Agwale stated.

He pointed out that even if AstraZeneca vaccine will be deployed, it must be aggressively implemented to stop the circulation of the virus because the longer the virus is allowed in circulation, the more it can mutate and cause more problems.

Agwale, President and Chief Executive Officer, Innovative Biotech Nigeria, however, stress the importance of Nigeria also investing in strengthening its clinical trial capacities, saying this had helped South Africa to make COVID-19 rollout evidence-based.

According to experts, no vaccine protects against viruses 100 per cent of the cases. Dr  Gertie Anyanwoke, an infectious disease expert said for how long the vaccine will be able to confer protection against COVID-19 is not known, but assured that all approved ones for use are able to protect an individual from developing the severe form of the disease and even the possibility of dying.

She said there was really no need for vaccine hesitancy because “what we know is that not taking the shot is worse than taking the vaccine. It is better to take the vaccine and protect yourself rather than getting exposed and dying.”

Moreover, she declared that alongside the vaccination, individuals still need to continue to wear face masks, practice social distancing and washing of hands to slow down the transmission of the virus and ensure herd immunity is attained.

According to her, the percentage that needs to be vaccinated to get herd immunity varies from community to community and from country to country, as well as the virulence of the circulating virus.

“So, the message is that everybody that is qualified to take the vaccine should go-ahead to take it because we don’t know the percentage that is required to achieve herd immunity as far as COVID-19 is concerned,” she declared.

The infectious expert said individuals that recovered from COVID-19 also should take the vaccine and especially health care professional, who, because of their work, stand a higher risk of getting exposed to the infection.

Meanwhile, the WHO has warned that the longer it takes to vaccinate those most at risk everywhere, the more likely the virus will mutate and evade vaccines.

In its weekly epidemiological update in early February, the organisation said once countries with vaccines have vaccinated their health workers and older people, the best way to protect the rest of the population is to share vaccines to other countries.

Also, the body said that there is a huge risk of losing vaccines due to cold chain failures and non-functional freezers, as per previous experience. And in the opinion of experts, losing millions of doses of COVID-19 vaccines could be disastrous for getting a handle on the pandemic.

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