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What is the objective of COVID-19 vaccination in Nigeria? 07 Apr 2021

It is improbable that Nigeria would achieve herd immunity against COVID-19 by 2023. Herd immunity, or population immunity, against a disease is achieved when the pathogen cannot spread because it keeps encountering people who are protected against it. The protection can be from vaccination or previous infection.
    
The World Health Organisation (WHO) said last December that it was uncertain what percentage of the population needed to be immune in order to achieve herd immunity against COVID-19. However, the European Centre for Disease Prevention and Control (ECDC) used 67 per cent for its herd immunity modelling, while Amesh Adalja, a Senior Scholar at the Johns Hopkins Center for Health Security, said over 70 per cent is a good threshold for the United States if the new COVID-19 vaccines are not less effective.

According to data by the Nigeria Centre for Disease Control (NCDC), 160,657 cases of COVID-19 have been recorded in Nigeria as of March 14, 2021. Approximately two million full doses of the AstraZeneca vaccine have been delivered to the country. These translate to immunity for a maxi-mum of 2.16 million people, representing 1.6 per cent of an estimated 130 million Nigerians that must have natural or vaccine inoculations for the country to achieve herd immunity.

There are demand and supply obstacles to vaccinating a majority of Nigerians. The demand-side constraints include fiscal constraint by the government in purchasing the more efficacious but pricey Pfizer and Moderna vaccines, and the absence of cold chain infrastructure for their storage and distribution. More fundamentally, it would be a miracle for a country that made a hash of the distribution of limited COVID-19 palliatives to vulnerable citizens to be able to administer two shots of vaccines to 130 million Nigerians. Even with the single-dose Johnson & Johnson vaccine, the target only appears less daunting.    

On the supply side, the so-called vaccine nationalism means that the countries that developed the vaccines, and those involved in their production, have put themselves at the top of the pecking order. When the rich countries and emerging market power-houses have fully vaccinated their adult populations later this year, they are likely to maintain stockpiles of the vaccines, nevertheless. It remains dubitable if only one full dose of vaccine would provide lasting protection against the novel coronavirus. Booster shots may be required at intervals.

New variants of the virus are also emerging. The new mutations may become resistant to the current vaccines, sending scientists back to the laboratories for the development of altogether new vaccines.

In the meantime, some current and past Nigerian government officials have provided themselves priority access to the limited doses of the AstraZeneca vaccines delivered to the country. This is being choreographed as fighting vaccine hesitancy. But once the privileged class has been covered, the rest of the people can wish themselves good luck with access to the vaccination.

However, against lack of effective demand and gross supply shortfall, the government needs to define the objective of the administration of the limited vaccines it has received and any additional future supplies. Such an objective should serve to forestall community spread of the disease. In other words, the vaccine administration should be aimed at maintaining “R” number (the number of people that an infected person can pass the infection to) close to zero, but definitely below one. Lockdowns are aimed to achieve this but with acute economic disruption, which the vaccination strategy is devoid of.

The country needs to identify population segments to allocate available vaccines to in order to achieve near-zero R number. Health workers should be a topmost priority. But next would not necessarily be “people with underlining conditions.” Such people are too many to be covered in the next few years. For instance, over 38 per cent of Nigerian adult population are hypertensive. To protect this demographic and other co-morbidities more effectively is to create a firewall to prevent the people from getting infected, bearing in mind that the vaccines don’t provide fool-proof protection against the disease.

Part of the firewall against the spread of the infection is to vaccinate aviation workers. The spikes of COVID-19 infections in Nigeria have followed the surges in the Western countries, indicating a strong link between international travels and infections in the country.

COVID-19 vaccination in the country could be somewhat elitist and beneficial. Government officials who engage in regular international travels and receive foreigners in the country should be part of the backstop. Their counterparts in the private sector should also be among the early beneficiaries.

To achieve credibility and the desired outcome of the strategic objective of creating a defence against the spread of COVID-19 – as opposed to achieving herd immunity, policymakers – would have to be transparent with their targeting and effectively communicate progress with the public.