Despite the newest Federal Government directive on COVID-19, the availability of the vaccine seems to still top the citizens’ concerns, JUDE IDU writes

Nigerians a few days ago woke up to a fresher directive on how to lead their lives in order to stave off the third phase of COVID-19 that has consumed millions of persons across the world. As of last count, no fewer than 3.35 million persons have lost their lives just as over 161 million persons have contracted the disease that left many families and countries in the lurch. For instance, India has recorded no fewer than 200,000 contracted cases daily, surpassing the United States and Brazil on the “ugly list” in recent time.

But even as the Presidential Steering Committee (PSC) on COVID-19 rolled out this directive in Nigeria, many stakeholders are looking at the issues surrounding the virus from different perspectives. While many Nigerians are buying into the precautions canvassed by the government and adjusting their lifestyles, some others are worried about the continued availability or otherwise of the vaccine in the country.

COVID-19 Vaccine: Presidency dismisses fear of side effects on Buhari, Osinbajo

For the later school of thought, the authorities should more than anything else inundate the citizens with the arrangement that is place to make the vaccine available in the country. For these persons, their worry bothers on whether the country is continuing with AstraZeneca vaccine or is embracing the Johnson & Johnson drug.

Indeed, many Nigerians are expressing worry over reports that the authorities might be changing strategy with the importation of Johnson & Johnson vaccine, despite the fact that some others are waiting to receive their second jab of AstraZeneca vaccine.

The Federal Government might also have bought into these concerns by ‘quietly contemplating’ a combination of jabs, AstraZeneca and Johnson &Johnson vaccines.

Recall that Oxford-AstraZeneca faced initial challenge arising from the blood clothing complications that prompted some European countries to withhold its use temporally. But the World Health Organisation has since after further verifications given the vaccine a clean bill of health.
Meanwhile, ThisNigeria’s finding has revealed that there is great worry among the authorities handling the importation of the Covid-19 vaccines over the inability of AstraZeneca to assure prompt supply of the second batch of its vaccines.

In fact, they say the supply was not even guaranteed in the initial agreement, which portends danger to the country.

According to Dr. Ozioma Brown, a medical consultant with the Gwagwalada Specialist Hospital, Abuja, although there has been a possible shortage of vaccines across the world, and many countries courting controversy over the possible efficacy of combination of the vaccines from different countries, especially in African countries.

According to Brown, Nigeria is particularly prone to medical issues and the National Agency for Food Drug Administration and Control (NAFDAC) and other regulatory agencies could have carried out laboratory examinations on the AstraZeneca vaccine before vaccinations.
“Just take a look at the whole scenario; I am aware that countries like America did her clinical test on over three to four vaccines, counting from Pfizer, Johnson and Johnson, AstraZeneca and others, and are ready to import any of these items based on the clinical test they have carried out before.
“But in our own case, who knows we may start all over, while other countries are running faster. “But let me also comment on the issue of the cold chain which made Nigeria go for AstraZeneca. “It was because Nigeria saw that the vaccine does not require lower temperature for storage before vaccination like other vaccines from Pfizer and Johnson & Johnson and others.

“Are you now telling me that we are ready for these cold facilities? “Another reason is the fact that AstraZeneca requires two shots to make a complete dose, while others require just one shot. “Should Nigeria go for the other vaccines that require only one shot, what then happens to those Nigerians who have taken one round of shots from AstraZeneca?

“I am aware that so many of them are waiting for the second dose, which may not come because of what is going on now.

“The point is this; should Nigeria go for Johnson & Johnson? What happens to those who took a single shot from AstraZeneca? “How do they complete the dose, or is it to be left the Nigerian way? There are lots to talk about that medically.”

Dr. Jamiu Orgah, director, Clinical Services at Blessed Hospital, Wuse Abuja, spoke about the ‘failure’ of the Federal Government to make possible choices of the vaccines based on convenience, efficacy and availability. “I must tell you one thing. It is even confusing when I heard that the Federal Government doled out billions for the purchase of the vaccine, and at the same time it was also televised live when the World Health Organisation came in with the first phase of the vaccine donated to Nigeria as well as other nations.

“So, when are we going to see the vaccine that the National Assembly and FEC (Federal Executive Council) approved for its purchase? “This shows that there was no concrete plan on which vaccine Nigeria is going for, while hoping on Bill Gates Foundation, WHO and other international bodies.
“And now that Johnson & Johnson is coming, the question remains that the vaccine has a different approach in vaccination process, and it means that the entire process will change, including the provision of cold storage chain, the vaccination approach, as well as training of vaccinators and so on.”

Julius Ogbodo, a journalist, took a shot of the AstraZeneca vaccine with the intention to have the second one by the month of June. He is afraid that he may not be able to have access to it since Nigeria claims shortage of the vaccine and is already in agreement with Johnson & Johnson for continued vaccination.

He is currently in fear as to whether a failure to complete the dose renders the former jab irrelevant and so makes him more prone to the virus.

Ogbodo insists that what made the whole thing more complicated is the fact that he had already taken AstraZeneca and does not know if a combination portends health hazards.
Documents from the Nigerian Primary Healthcare Development Agency (NPHCDA) obtained by Health Policy Watch show that the agency intends to begin rolling out the J&J vaccine to almost 30 million people as soon as it can obtain the vaccine supplies.

The agency, while denying that safety concerns are an issue, said the Nigerian government’s intentions also comes amid growing global concerns about AstraZeneca’s efficacy against the SARS-CoV2 virus variant first identified in South Africa, as well as safety concerns that have led to the suspension of AstraZeneca vaccines for people under the age of 60 in Germany, and other few European countries.
Nigeria had already commenced the rollout of the AstraZeneca vaccine, with vaccines supplied by the WHO co-sponsored COVAX initiative.

The country was meant to get more AstraZeneca supplies though the African Medical Supplies Platform (AMSP) –having already placed the largest order on the continent through the AMSP, as previously confirmed by the Africa Centres for Disease Control (CDC).
However, according to the documents, the AstraZeneca vaccine doses reserved through the AMSP would be replaced with Johnson & Johnson vaccines.

“Based on this, Nigeria’s total allocation is now 29,850,000 of Johnson & Johnson (Janssen) COVID-19 vaccine, which is one dose short to cover 29,850,000 eligible Nigerians as originally planned,” the agency stated.

That would be enough to cover about 15 per cent of Nigeria’s population of 200 million people. ‘No worries over Johnson & Johnson ‘one jab’ vaccines’
But amid concerns across the board, government officials in Nigeria have attributed the shift to J&J’s to the vaccine’s single jab technology which will make it much easier to administer as compared to AstraZeneca’s two-dose shot as well as ensuring the vaccine coverage stretches even further.

They deny that it was linked to issues of safety and efficacy. Another quality, according to NPHCDA, is the J&J vaccine’s ‘documented efficacy’ against the B.1351 virus variant identified in South Africa – and now spread to some 16 other countries on the continent, including nearby Ghana.
The agency said South Africa recently announced that it had secured 30 million J&J vaccines, after a small clinical trial and genomic surveillance showed the AstraZeneca vaccine was not strongly effective against that variant.

In an earlier advisory, the Africa CDC stated that African countries where the B.1351 variant is the predominant, SARS-CoV-2 strain should consider swapping the AstraZeneca vaccine for others that have shown more efficacies.

Neither the AMSP nor the Africa CDC could confirm when the J&J doses will become available.
A recently announced J&J commitment to supply some 400 million vaccines to Africa is only scheduled to get into motion in the third quarter of 2021. Meanwhile, the continent continues to call for vaccine equality, fair distribution and local vaccine production.

Assurance
In order to douse the tension on the efficacy of AstraZeneca and the combination of the vaccines, government officials have continued to assure citizens of the safety of the vaccine despite global concerns – as they continue to roll-out the available AstraZeneca doses while awaiting the J&J vaccines. On February 18, just a few days after Nigeria received its first shipment of the AstraZeneca vaccine, the country’s drug regulator, NAFDAC approved the vaccine for emergency use. “The recommendation for Emergency Use Authorisation was based on rigorous scientific considerations,” NAFDAC stated.

Addressing a recent webinar on COVID-19 Vaccines, Dr. Faisal Shuaib, Executive Director/CEO of NPHCDA, acknowledged the controversy around the vaccine’s safety, but urged countries in Europe and globally to continue vaccine administration as it is safe and effective.
NAFDAC’s Director-General, Prof. Mojisola Adeyeye, added that safety of the vaccine is primary to the agency, and that the agency would be using its Med Safety App for Active Pharmacovigilance of the vaccine.

ThisNigeria learnt that Oxford scientists are expanding efforts to test whether two different Covid-19 vaccines can be combined, after some European countries worried by rare side effects with the Oxford/AstraZeneca jab started offering other vaccines as a second shot.

For the second stage of its continuing trial, the Oxford Vaccine Group is recruiting more than a thousand participants who have already received an AstraZeneca or BioNTech/Pfizer shot. The group of over-50s will either receive a second dose of the same vaccine or get a dose of the Moderna or Novavax shots, it was further learnt.
Matthew Snape, associate professor in Paediatrics and Vaccinology at Oxford, said the study could mean that people do not become “hostage to fortune” when there are supply shortfalls or changes to recommendations on who should take which vaccine.

The first arm of the study, which gave participants one AstraZeneca shot and one Pfizer shot, will not deliver data until May, so for now, as Kate O’Brien, the WHO’s head of vaccines, warned this week, there is still “no data” on mix-and-match regimens. “It’d be very valuable to have data on how to best to use these vaccines,” she said. “But that really has to be done in a way that provides evidence that can be acted upon both by regulators and the policy advisers and policy makers.”

Vaccine mix?
According to agency reports, France and Germany said last week that they would offer people under 60 the messenger RNA vaccines developed by BioNTech/Pfizer and Moderna as a follow-up dose, after they recommended against this group taking the AstraZeneca jab because of concerns over rare blood clots. China has also floated the idea of using different vaccines together, but for another reason: to boost efficacy amid concerns its home-grown vaccines are not very effective.
Combinations of vaccines have been tried in other diseases, including malaria and HIV, when immunizations were not proving very effective. But given that many of the approved Covid-19 vaccines have been shown to be highly effective, most governments are recommending people stick to regimes tested in clinical trials until more evidence is available.

The UK government has said “every effort” should be made so that people get two of the same vaccine, but has allowed for special circumstances in which vaccines may be mixed, such as a shortage of the required shot at a particular site, or if it is not known which vaccine the person initially received.
All the currently approved vaccines work by teaching the immune system to respond to the virus’s spike protein, and in each case they do it differently.

What evidence is there that it works?
Scientists are not concerned that mixing vaccines could be unsafe, and Snape said there were “no safety signals” so far in the data from the first arm of the trial.
The “main risk” is if the immune system does not respond as well and the vaccine is rendered less effective, Snape said.

Other advantages?
Stephen Evans, a professor in pharmacoepidemiology, said it was important to understand “vaccines are not like drugs”.
“They do not depend on the vaccine remaining in the body to have a continuing benefit. What they do is to ‘train’ the body’s own immune system to be able to repel an invading virus. “It is the body’s own immune system that does the work against the virus,” he said.

FG assures
Against the perplexities among Nigerians, the government is still assuring that the second dose of the Oxford-AstraZeneca COVID-19 vaccines will soon be administered on eligible men and women who received the first shots.

The Executive Director, NPHCDA, Faisal Shuaib, made this known at the Presidential Steering Committee (PSC) on COVID-19 briefing, on Monday.

Shuaib said the commencement of the second dose of the Oxford-Astrazeneca vaccination in all states of the federation and the FCT had been approved by the PSC. “Already, the Presidential Steering Committee has approved the commencement of the second dose of the AstraZeneca vaccination in all states of the federation, including FCT,” he said, adding that, “in both technical and operational terms, the committee has been very supportive of the states.”

Shuaib added that senior supervisors had been redeployed to monitor activities in the states with daily evening review meetings to determine the status of the COVID-19 vaccine implementation across all the states and the FCT.

“These meetings, as I had mentioned during our last briefing, allow us to receive reports from the sub-national level on how the campaigns are proceeding, what challenges they face, and how we can pro-actively anticipate and resolve any impending challenges,” Shuaib said.

The director said the meetings also provide an avenue to troubleshoot and resolve any operational hurdles as they emerge before they become problematic.

Shuaib appealed to the public to continue to cooperate with vaccinators whom, he noted, are providing an incredibly important service to the nation amid this global crisis.
He said the government would ensure that only safe and efficacious vaccines were supplied for all phases of the vaccination campaign in the country.

“In addition to health workers, front-line workers aged 18 years and above and persons aged 50 and above are advised to visit any designated vaccination site to receive the vaccine free of charge. “We also advise that people who have received their first dose should check their vaccination cards for the date of their second dose, and ensure that they receive the second dose to gain full protection against COVID-19,” he said.

“This is in line with the scientific recommendation provided by the World Health Organisation’s (WHO) Strategic Advisory Group of Experts (SAGE on immunization),” he said.
The authority said that, with 1,690,719, representing 84 per cent, having received 3.94 million doses of the Oxford-AstraZeneca vaccines in March, Nigeria commenced vaccination beginning with healthcare workers.

The country has, so far, received about 4.4 million doses of the vaccine. The Nigerian government had said it plans to vaccinate 109 million people against the COVID-19 virus over a period of two years. Health authorities said only the eligible population from 18 years and above will be vaccinated in four phases.