Since the Spanish flu pandemic of 1918, otherwise known as the great influenza, the world has never witnessed a pandemic as threatening and devastating as COVID-19. The scale of mortality and morbidity, and quantum of economic loss that trail COVID-19 pandemic is a sad reminder to us that we are not too far away from the age of pestilence. Up to 133 million people were infected with COVID-19, with about 3 million deaths and 107 million recoveries. Hence, emerging and reemerging infectious diseases have proven again to be a threat to the global security agenda, and they should not be ignored.
In sub-Saharan Africa where Nigeria is the largest and most influential nation, the impact of the pandemic has not been accurately quantified. This may be related to inadequate testing capacity for case detection, and poor contact tracing to capture the very young population that may get only asymptomatic or subclinical infections. Previous exposure to endemic infections that could have conferred cross-immunity against SARS-CoV2, and an environment that thrives more in outdoor engagements with relatively reduced chances of transmissions, perhaps compound the challenges of accurate quantification of the impact of the pandemic.
Again, the usual seasonal outbreaks of malaria, typhoid, and meningitis that present with similar protracted fever as well as morbidity and mortality, could have lessened the perceived impact of COVID-19 in Africa. Due to high baseline mortality and morbidity rates in sub-Saharan Africa, death is often perceived strangely differently. Deaths of elderly and very sick persons are not considered as an unusual phenomenon in sub-Africa- unlike in other climes where mortality even at the age of 75 is seen as unusual.
Indeed, what makes COVID-19 pandemic unique is that the causative organism is novel with no prior knowledge of its type among the existing Coronavirus family, and no preexisting effective treatment as of the time it emerged in Wuhan, Republic of China. However, advancement in the science of molecular biology provides an unprecedented vaccine development option that made it possible to have effective vaccines approved within a year from onset of the pandemic. There are currently no less than six COVID-19 vaccines approved for general use: Pfizer/BioNTech, Moderna, AstraZeneca/Oxford, Russia’s Sputnic, China’s Sinovac, and Johnson & Johnson. So far, the scale of vaccine rollout has been impressive in some high-income countries but less impressive in several low-income countries as predicted.
Nigeria is privileged to have received about 4 million doses donated through a global initiative called COVAX, for a projected population of over 200 million people. The available doses are, however, inadequate considering that 4 million doses are good enough to vaccinate only 2 million people, when each is expected to receive recommended 2 doses within 3 weeks apart. Worse still, there is a pervasive issue of vaccine hesitancy that is fueled by the conspiracy theories built around the pandemic. Reports of adverse effects, especially for AstraZeneca vaccine as a cause of blood clots in places such as the brain serve as primers for vaccine hesitancy. According to the European Medicines Agency, out of 25 million people vaccinated with AstraZeneca’s, 64 and 24 cases of cerebral sinus and splanchnic blood clots have been reported—resulting into 18 deaths.
Unfortunately, the only vaccines that can be used for wide scale distribution in most sub-Saharan African countries are AstraZeneca’s, Sinovac, Sputnik and Johnson and Johnson, because their cold chain requires only standard refrigerator, unlike the others with subzero temperature (-70 degree) requirement. Latest data have shown that Sinovac is not very effective, while there are also concerns over the rigor with which the data showing efficacy of Sputnik vaccine was collected. This has put Nigeria and sub-Saharan Africa in a fix due to lack of many options.
It is imperative to know that all vertical programs often suffer from some form of rejections at the local level due to conflict between perceived needs and felt needs. Hence, the government of Nigeria must work hard to earn public confidence and improve awareness on the multifaceted preventive measures to combat the pandemic, including vaccines and their effectiveness. It, therefore, must be made clear to the public that since the groundbreaking discovery by Edward Jenner, vaccines have featured prominently among the top 10 most impactful medical innovations that shaped public health. Thanks to vaccines, the world has eradicated smallpox and poliomyelitis.
Interestingly, the same messenger RNA novel technology used to develop COVID-19 vaccine to prime the body defense system for effective protection against the disease, is inspiring hope for curing hitherto incurable diseases like HIV. Science is very clear that the benefit of AstraZeneca vaccine far outweighs its risk of blood clots. Data from countries with impressive vaccine coverage have shown that those vaccinated have reported zero COVID-19 related deaths, hospitalizations, and severe disease.
Hopefully, COVID-19 will soon be over with more deployment of vaccines. But when there is growing skepticism, changing to a much safer option will restore public confidence and give the authority the much-desired empathetic touch. It is, therefore, pertinent that all hands must be on deck to ensure availability, affordability, and acceptability of safe and effective COVID-19 vaccines in Nigerian and other low-income countries.