Public health experts say poor power supply, especially in the rural areas, may hinder Nigerians at the grassroots from gaining access to COVID-19 vaccine.
According to the experts, while the cold chain storage has not been a problem in the developed countries where vaccination has taken off full blast, lack of power supply infrastructure in Nigeria, particularly in the rural areas, could be a big challenge to ensuring proper storage of the COVID-19 vaccines at the appropriate temperature.
They noted that while the power supply is a general problem in the country, the challenge may be worse in the rural areas where irregular power supply is very rampant.
Speaking with PUNCH HealthWise in separate interviews, the public health experts, Consultant Clinical Pharmacist, Dr. Kingsley Amibor; and Clinical Pharmacist (Cardiology Specialist), Adebola Lawal, warned that if the cold chain storage was not properly handled, the vaccine could become useless by the time it is being administered
Recall that the Executive Director of the National Primary Healthcare Development Agency, Dr. Faisal Shuaib, had, last week, said Nigeria now has the ultra-cold chain to store vaccines expected in the country.
The NPHCDA boss, while giving an update on COVID-19 vaccine introduction in Nigeria, said the Federal Government had invested in cold chain equipment and that the focus was to get vaccines that the storage facility could effectively manage.
However, speaking with our correspondent, Dr. Amibor, who is also the national chairman of the Nigerian Association of Hospital and Administrative Pharmacists, said storing and distribution of the vaccine could still be a big challenge in Nigeria.
“Storing and distribution of the vaccines in our part of the world might pose some challenges, quite unlike what might be the case in the UK and other leading countries.
“For one, the Pfizer vaccine needs to be kept extremely cold. It is supposed to be at minus 70 degrees Celsius, which is colder than winter in the Antarctica.
“Moderna has said that its vaccine needs to be frozen, too, but only at minus 20 degrees Celsius, more like a regular freezer.
“Now, you and I know the challenges we are experiencing locally with regular electricity. How possible will it be to maintain the Pfizer vaccine at minus 70 degrees Celsius? So, maintaining the cold chain will present some challenges, no doubt.
“For the Moderna vaccine that is supposed to be stored at minus 20 degrees Celsius, that might be easier to sort out than the Pfizer vaccine. These challenges may be worse off in the rural areas where irregular electricity supply is very rampant.
“So, we have to address these daunting challenges. We have to ensure appropriate storage of the vaccines to maintain the cold chain because if those vaccines are exposed to high temperatures, they become denatured and useless to anybody.
“So, this issue of maintaining the cold chain will need to be looked into by the government,” Amibor said.
On which of the vaccines so far approved for use would be more appropriate for Nigeria, Dr. Amibor said the Oxford University vaccine may be better for the country because it is easier to store.
“The large trial showed that the coronavirus vaccine developed by the University of Oxford is highly effective at stopping people from developing COVID-19 symptoms.
“Interim data suggests 70 per cent protection, but the researchers say the figure may be as high as 90 per cent by tweaking the dose.
“The results, though very encouraging, come after Pfizer and Moderna vaccines which showed 95 per cent protection.
“However, the Oxford vaccine is far cheaper and is easier to store and so could be better for us,” he said.
Amibor, while praising the government for making the vaccination of health workers a priority, also expressed reservation about the lack of long-term clinical studies to determine the safety of the vaccines approved so far.
“There is no doubt that frontline healthcare workers are at serious risk of contracting the coronavirus in the course of rendering care to our teeming patients.
“To that extent, it would be natural to expect that frontline healthcare workers should be a priority when it comes to vaccination of the population. So, the government is justified in positioning healthcare workers as a priority to receive the vaccines.
“However, there has been a lot of controversies with the currently approved vaccines for COVID-19. One of such is the fact that long-term studies were not carried out on the vaccines before approval for use.
“We cannot say with certainty how safe these vaccines will be in the long term.
“The fact that some may appear safe for use now does not automatically translate to a guarantee that the vaccines will not cause problems in the population in future.
“Remember the case of Thalidomide, which was used in the 1960s as a sedative, and was initially thought to be safe but years later, it produced birth defects in pregnant women who took it during pregnancy.
“Subsequently, the FDA and other regulatory agencies worldwide came up with stringent regulations on testing for long-term safety of new medications before approval for mass use in the population.
“In the case of the Pfizer vaccine and others that have been approved for use for prophylaxis of COVID-19, I cannot say I am looking forward with much enthusiasm to receive the vaccine for reasons I have just stated.
“I will rather observe the safety protocols put in place by government and wait for results of long-term studies that will confirm the safety of the vaccines over time,” he said.
On concerns over the effectiveness of vaccines on the new COVID-19 variants, the clinical pharmacist said while he is hopeful the vaccines will still be effective on the new variants, there is the need for more studies.
“The new variant of the Coronavirus that is surging across South Africa may make the existing COVID-19 vaccines less effective, but is unlikely to be resistant to the shots. It is extremely unlikely that the mutations would render vaccines useless.
“Also, Dr. Anthony Fauci, the top United States infectious disease expert, said data coming from Britain indicate the vaccines will still block the UK variant virus. Fauci, however, said the US also will do tests to be sure that the vaccines will also be effective. That is to tell you there is need for caution.
“The South African variant carries a mutation called E484K, among others. This is different from the UK variant. Both variants appear to be more contagious, which could be a problem because of possible tougher control measures to check their spread.
“While changes in the new UK variant are unlikely to harm the effectiveness of current vaccines, there is a chance the South African variant may do so to some extent, from research findings by scientists.
“Scientists have tested the Pfizer COVID-19 vaccine against one of the mutations found in the South African variant, called N501Y, using blood samples from 20 people.
“In that preliminary study, vaccination appeared to work against the mutated virus. More studies are needed before we can conclude with certainty,” he said.
Also speaking with our correspondent, Lawal who is a clinical pharmacist specialising in cardiology care, said he was unsure of the nation’s preparedness for a COVID-19 vaccination campaign.
Lawal, who is a member of America College of Clinical Pharmacists, said personnel that will handle the storage of the vaccines should be properly trained.
“We are not prepared. Pharmacists who will handle the cold chain storage of this molecule have not been trained,” he said.
Lawal, who is also the public relations officer of the Pharmaceutical Society of Nigeria, Ondo State chapter, also shared the same view with Amibor on safety concern of the COVID-19 vaccine.
“While I am looking forward to the vaccination, I am, however, being fearful of the vaccine because there is no absolute scientific documentation on the side effects and adverse effect of this vaccine, so its safety is an issue for me.
“I also remember that the phases of the clinical trial were crashed because of the pressure to get the vaccine ready.
“As a drug expert that knows how cumbersome the process of drug development is, that is a big issue for me.
“I strongly advocate serious validation by regulatory body here before injecting any of the vaccines on any healthcare provider or patients who are Nigerians.
“We also need to conduct our local studies here to be able to give conclusive preference on which of the vaccines is better.
“However, going by science and antecedent of the pharmaceutical companies involved in the vaccines so far, the Oxford-Astrazeneca vaccine may be preferable because they didn’t crash their phases of the clinical trial,” Lawal said.
According to the World Health Organisation, cold chain management is a very important factor for ensuring vaccine safety and effectiveness.
Cold chain management, WHO stated, requires the maintenance of necessary refrigeration levels for temperature-sensitive coronavirus vaccines across manufacturing, storage, transportation and distribution processes.
While urging nations to take vaccine storage seriously, the global health agency stressed that proper vaccine cold chain management will require varying degrees of cooperation and coordination among multiple stakeholders.
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