COVID-19: Tackling vaccine hesitancy and a burdened health system

The coronavirus (Covid-19), which originated from Wuhan in China, has been a subject of controversy. The subsequent development of vaccines unlocked even more controversies and conspiracy theories. SADE OGUNTOLA examines concerns on the pandemic, vaccines and the implication on Nigeria’s already burdened health system.

AMIDST the second wave of the coronavirus pandemic and new variants ravaging some parts of the world, many countries have queued to access vaccines for its citizens. Already at least 89 preclinical vaccines are under active investigations; three vaccines are already approved for full use while four were abandoned after trials.

Public health experts say that at least 70 per cent of any community must get vaccinated with a COVID-19 vaccine to achieve an acceptable level of immunity to protect its members. But the success of the vaccination hinges on the availability of efficacious and appropriate vaccines, including tackling issues such as stigmatisation, vaccine cold chain maintenance and consumer distrust for the COVID-19 vaccines.

Vaccine hesitancy is not peculiar to Nigeria, but it may get aggravated by misinformation on the social media about vaccination, history of the failed Pfizer drug trial to treat meningitis in northern Nigeria and general distrust for public authorities.

But, Mr Babatunde Irukera, chief executive, Federal Competition and Consumer Protection Commission (FCCPC), Abuja said the refusal of the vaccine should not be based on the past failed Pfizer drug trial or past recklessness of some researchers early in the pandemic that said Africans can be used for the vaccine clinical trials.

Mr Irukera who spoke during a public webinar by Opinion Forum on the theme “COVID pandemic, vaccines and the Nigerian health system,” said the fact that COVID-19 cases are more in the western world and the race to develop an appropriate vaccine for it is more in the same continent should create some level of trust in the vaccine efficacy and safety”.

Mr Irukera, however, said what needed to be prioritised is ensuring that whichever COVID-19 vaccine is deployed for use in Nigeria is safe, storage conditions are adequate to ensure their potency and logistics to ensuring people in hard-to-reach communities also benefit from the vaccines when it gets into the country.

He said that most active platforms for conspiracy theories on the vaccine is more among the elite and professional and trade associations, adding, “I don’t have a problem with people interrogating issues but what is problematic is an absolute baseless publication which does not address anything but confuses the situation.”

Mr Irukera argued that Africans must figure out a way to ensure it gets sufficient vaccines to use for its citizenry, warning that “in the continent, we are still so far behind. If this issue is addressed elsewhere, it will not be receiving the quality and quantity of attention it is getting today.”

He said much as individuals may not be compelled to take the vaccine, COVID-19 vaccination is of public health interest to check the spread of the infection and this supersedes the rights of individuals.

Dr Adamu Onu, a consultant family physician and epidemiologist and medical director, Garki Hospital, Abuja, said COVID-19 has to create a crisis for the Nigerian health system, imposing stress on its different components- leadership and governance; health information systems; health financing; human resources for health; essential medical products and technologies; and service delivery.

According to Dr Onu, “we already know about lack of coordination across the whole country from the different states; we have state governors who are in denial about the reality of COVID-19; we have those who have taken it serious and others that have not taken it seriously.

“Is it true that the true cases of COVID-19 are higher than what is reported? The truth is that we really don’t have any way of answering that question because we really have a weak health information system.

“Of course, not enough resources are been devoted to health care in Nigeria, likewise human resources. In terms of service delivery, COVID-19 itself has imparted on that. We know cases of patients who have been denied care because of fear of COVID-19. We know cases of avoidable deaths. Patients who present in hospitals with breathing difficulty, which might just be an asthmatic attack, are turned away.”

He declared that most of the cases of COVID-19 that are presented in hospitals are symptomatic and are probably those who have probably tried treating themselves at home but because they were not responding to treatment, then decided to go to the hospital with symptoms such as fever, cough, difficulty breathing and reduced respiratory levels.

He added that ensuring COVID-19 treatment has been difficult because test results for COVID-19 take time before it is made available, stigma surrounding coronavirus infection and many patients who come in with symptoms suggestive of COVID-19 cases out rightly reject the test and get discharged from the hospital.

Nonetheless, he stated that COVID-19 itself is an opportunity to invest resources to improve the health system and to ensure that it delivers healthcare to Nigerians.

Dr John Nnadi, an infectious diseases physician, Ochsner Medical Centre, Boston, in an overview on COVID-19 said steroids are the only drugs found to prevent deaths from COVID-19 and not hydroxychloroquine.

He stated that the severity of COVID-19 can be judged by monitoring the oxygen level in the blood and what kills is when the blood oxygen levels start to drop.

Dr Nnadi declared that alongside ivermectin that has been shown to have some benefits in treating COVID-19, the inclusion of vaccines can help the infection control, alongside wearing of facemask, social distance and avoidance of crowded places.

Dr Anu Osinusi, an infectious diseases physician, stated that there will be the need to evaluate all other vaccine options to make up for the deficit to vaccinate Nigeria’s population of 200 million.

She added that there is limited information on the safety of these COVID-19 vaccines during pregnancy and there seems to be extremely low risk, saying it will still require a personal discussion between the physician and the patient taken before the vaccination in pregnancy.

Irrespective of vaccination, Dr Osinusi said there is a possibility of a person contracting the infection after vaccination or even after recovering from COVID-19.

She said a re-infection can occur because the level of immunity every individual has is different.

The expert said no vaccine protects 100 per cent from any disease and studies on the COVID-19 vaccine show that it only protects from having the severe form of the disease and not necessarily that it will prevent an individual from getting the infection.

Dr Osinusi added “that is why we still say that when people are vaccinated, until we know a lot more, we still need to practice safe social distancing, wear a mask, avoid crowds and all other things as preventive measures as well.”

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