Opinion
The Choice and the science of deploying COVID-19 vaccines in Nigeria
By Peter Ikhianosimhe Imoesi
Recently I read in the news how Nigeria is preparing to procure the COVID-19 vaccine for her citizenry. Is anything wrong in procuring a COVID-19 vaccine? Certainly not, but is there a need for a rush? No. In this piece of write-up, I will address why Nigeria shouldn’t be in a rush in getting the COVID-19 Vaccine, the type of COVID-19 vaccine we should be aiming to procure, and the need for a robust nation-wide seroprevalence study before contemplating on a vaccine.
The current COVID-19 pandemic hasn’t had a devastating effect on the African continent as initially predicted due to the poor healthcare system, poor social amenities and a high population density. Apart from South Africa, the abysmal testing on the continent is completely insignificant in spite of many African countries flouting the COVID-19 non-pharmaceutical interventions. This is equally applicable in Nigeria a country of over 200 million people, and since the start of the pandemic, Nigeria is yet to test 1% of her population.
Despite the slow testing pace, nonadherence to COVID-19 guidelines, the total death recorded in the country is less than 1500. Some have doubted the accuracy of reported deaths, but when compared to the average death rate over the same 10-month period of the previous year(s) no surge is apparent. Due to the flouting of precautionary measures aimed at preventing the spread of the COVID-19 disease, one could deduce, a possibility of widespread infection rate in the population. But for reasons yet to be established scientifically, many of the cases in the country are mild or asymptomatic.
Chances are that many Nigerians may have already contracted the virus, recovered without knowing, and by extension acquired a certain level of immunity. Since many of the precautionary measures are completely flouted, there is the possibility of continuous exposure to the virus and depending on the level of immunity based on previous exposure, there could be a risk for continuous reinfection.
In recent preprint paper from Imperial College, London, it was reported health workers with continuous exposure to the virus had no changes in the rate of antibodies positivity. Also, in a recent study conducted 16 – 18 weeks after the first lockdown in the United Kingdom, and published in Science Immunology, it was reported individual with mild or asymptomatic SARS-CoV-2 infection had neutralising antibodies and complemented by multi-specific T-cell responses at 16 – 18 weeks after infection.
However, it is unclear how long this level of immunity could last, and the same goes for the current vaccines. Before deploying a COVID-19 vaccine in Nigeria, it is highly necessary to conduct a large scale seroprevalence study in densely populated cities and towns across the country. This robust study will help establish the true representation of Nigerians with the antibody against SARS-CoV-2 virus.
The situation of COVID-19 in Nigeria is not high burden compared to countries such as South Africa, Brazil, United States of America or the United Kingdom etc. Therefore, the need for hastened mass vaccination may not be so urgent. Also, the current COVID-19 vaccine is yet to undergo a clinical trial in a black dominant population.
And in terms of case fatality rate, cases in Nigeria or Africa are far less compared to western countries, and the average median age of the country is 18.1 and life expectancy 55.8. Based on these peculiarities and the behavioural pattern of the virus in our clime, it is highly essential a clinical trial of the vaccines be carried out.
For instance, the Oxford AstraZeneca is currently under clinical trial in India under the name COVIShield in line with the Indian Central Drugs Standard Control Organisation. There have been instances where a few vaccines such as polio and typhoid vaccines proven to be effective in a western population failed to stimulate immunogenic reaction in an Indian population. Also, since the Oxford AstraZeneca vaccine is currently under clinical trial in Kenya, it is imperative Nigeria and many other Africa countries wait for the final clinical data.
When we finally decide to procure a vaccine, a number of factors should be considered: one, is the vaccine tested on a black dominant population? As the vaccine undergone thorough clinical trial of Phase I, II, and III? Are the clinical findings published in a reputable peer-review journal? Do we have the right mode for storage? For emphasise, no vaccine is licenced against COVID-19, the current vaccines are authorised for emergency use only. This implies if a COVID-19 vaccine is to be use in Nigeria, such vaccines should undergo thorough clinical trial.
For instance, the Pfizer/BioNTech, Moderna, and Oxford AstraZeneca vaccine recently published their data in The New England Journal of Medicine and Lancet Journal respectively. In contrast, there is the COVaxin (India), SputnikV (Russia) and SinoPharm (China), these vaccines have been greeted with several controversies within the science community due to lack of transparency. If we must procure a vaccine in Nigeria, we should be considering the Pfizer/BioNTech, Moderna or Oxford AstraZeneca vaccine.
However, since the logistics to deploy the Pfizer/BioNTech requires -70 degree and the Moderna -20 degree; the Oxford AstraZeneca stored at 2 – 8 degrees seems to be the best suitable option for our clime. In terms of cost, the Oxford AstraZeneca cost about £3.00 compared to the Moderna £15.00 and £25.00 for the Pfizer respectively.
I will recommend first, the Oxford AstraZeneca, next Moderna (-20 degree) and finally, Pfizer/BioNTech if we have the -70 degree storage capacity. My recommendation is premise on the thoroughness of the development of these vaccines and the transparency; also, the clinical trial data are published already in peer-review journals. The government of Nigeria should be critical in picking a vaccine backed with reasonable efficacy data in a black dominant population. It is clear the virus as behaved differently in Africa and this should be put into context before procuring any form of COVID-19 vaccine.
Dr Peter Ikhianosimhe Imoesi, is a Research Fellow at the University of Aberdeen, Scotland, United Kingdom. I hold a BSc degree in Biochemistry – Nigeria, MSc degree Molecular Biology – England and a PhD degree Translational Neuroscience – Scotland.
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