New Telegraph

December 1, 2023

COVID-19 vaccines: AstraZeneca, Moderna scarcity lingers

Officials asked us to call at intervals to check for availability –those seeking second jab
There is no scarcity, we have over 36 million combinations of those doses, says NPHCDA
If there’s break, the anticipated efficacy’ll be compromised –Odo

For over three weeks now, many Nigerians, especially those needing the second jab have been finding it difficult to access both the AstraZeneca and Moderna brands of the COVID-19 vaccines in many of the primary health centres across the country, particularly in Lagos State.

These Nigerians alleged that each time they go to the centres the officials would instruct them to go back and call the number in their vaccines cards to check when the vaccines would be available because they had none to give at the time for the second jab. But reacting to the seeming scarcity of the vaccines in the country, Director, Planning, Research and Statistics of the National Primary Health Care Development Agency (NPHCDA), Dr. Abdullahi Garba Bulama, has said it’s misinformation.

Those talking, according to him, either do not know exactly what is happening, or talking out of mischief. He said the Agency is aware that the claim of scarcity has been trending on social media, and the other platforms, but insisted that the country has more than enough doses for now.

He said: “As I am talking to you, we have 36 million combinations of those doses and these vaccines are not just kept in Abuja, they are meant for the people. So, we distribute the vaccines. If there is any claim or any report of shortage of vaccines, it must be misinformation.

Probably because the person talking does not know exactly what is happening, or it is a mischief. “Nationally, we started with only four million doses of vaccines in March 2021. So, because at that time, we were not sure of the continuous flow of the vaccines, we had to even control the number of the centres that were to give vaccinations. I could remember, nationwide, we created only 3,632 centres, that amounts to just three to five centres by the local government.

Again, at that time, we had to choose the interval between the first dose and second dose to be almost 12 weeks, so that when somebody takes the first dose within those 12 weeks at least vaccines will arrive because there are two doses. That was why we went for the longest interval at that time.

“But from October through November, counties started donating vaccines to us. It was under pressure not under crisis to ensure that we utilise the vaccines. So, every day, every evening, we do reviews, we prioritise or we apply what we call the first in, first out.

We look at the vaccines that have the shortest or the nearest expiry date. For example, now we’re in February, we have a few vaccines that are going to expire. So, ordinarily, you know, our attention should go towards utilising those vaccines and then looking at the remaining trenches of vaccine supply.

“We also took some vaccines from Lagos to Nasarawa based on utilisation and that was how we survived 2021 without much wastage of the vaccines, except the little that we experienced in November because the vaccines were just four weeks shelf life and then even the four weeks shelf life one week was already gone. “Now we are very careful. We’re looking at the data. So, any states that request we’ll give them vaccines.

But now what we’re doing is not even giving them vaccines for one dose to wait for a second, we are thinking of the entire dose. From Wednesday, states will be receiving in excess of 500,000 doses for any vaccine that they’re supposed to get. “The issue now is uptake of the vaccine, and that is why we are appealing to the states, local governments, nonstate actors and all the gatekeepers like religious leaders and traditional leaders to make sure that we mobilise the people so as to increase the vaccine uptake, so that at least we can do away with this coronavirus and address other primary health care challenges.”

Bulama noted that they are dealing with human beings with attitudes, and said that they have realised some of this misinformation to be intentional. “Some people take the vaccines just because it has become compulsory for Hajj travels, for travelling to US, UK and other countries. This is what really forced many people to take the vaccines not because they want to take it. “In our agency we usually send a reminder to alert people to take their second dose when it’s time but for their personal reason people don’t even though the vaccines are there.

That is another area that requires a lot of work, we need to mobilise people to take the second jab of the vaccines because unless you take a full course of the vaccination, you cannot be fully protected. “If you take the first and second jab of Pfizer the booster should be Pfizer, and if you take first and second jabs of Moderna the booster should be Moderna, while those who take J&J, the booster should be J&J. But if you take AstraZeneca first, and second jab, the booster should be Pfizer or Moderna not AstraZeneca.

“Science has indicated that the additional dose of AstraZeneca may not add immunity that is required but Pfizer can be used to build on AstraZeneca. Pfizer starts where Astra- Zeneca stops. You may not get the full protection if you don’t take the second jab within the stipulated time. “It is even better not to have taken the first jab at all.

Remember the vaccines do not give you protection from contracting the virus; it only helps to make the disease not strong enough for you to require hospitalisation or to be placed on oxygen supports and other critical treatment. “So, definitely it is unlikely for somebody to die from COVID-19 complications if fully protected through vaccination, but taking just one jab only offers half protection,” he added.

Before now, there were fears that the COVID vaccines, the World Health Organisation (WHO) initiative under which Nigeria got the first batch may not be in a position to provide the country another round of the vaccine doses in a long time. There were worries also at the rate people were rushing to get the first jab. Many, at the time, had fears that the country may likely exhaust the available doses.

If this happens, they said, how would those who already got their first jab be able to take the second dose within the specified peri-d required. These fears have become potent now as many primary health centres are currently grappling with the problem of shortage of vaccines, particularly the AstraZeneca and Moderna brands. Even though NPHCDA is refuting the claim of scarcity, Saturday Telegraph investigations have proven the scarcity claim to be through in many centres, particularly in Lagos State.

In the last three weeks, the paper, which has been monitoring the trend can attest to the fact that many, who had gone for the second dose at some of the centres visited, are sending back people who are turning up for the second jab. At the moment, the United States of America, Europe and the European Union (EU) countries where Nigeria gets its vaccine doses from, largely on donation, are still battling with the fourth wave of the pandemic, and may rightly need to take care of their citizens first before making provisions for others.

Similarly, India, where the Astra- Zeneca vaccine largest producing company is situated, was recently hit by an upsurge of the disease and was reported to have opened up immunisation to more people, which eventually will reduce vaccine exports. “Two weeks ago, I was at the Sango Primary Health centre, at Pen Cinema for my second dose but was turned back. The officials simply told me there were no AstraZeneca to give at the moment and that I should call the number in the card anytime I intend to come back to check if there are supplies.

I was not the only one as many others were told the same thing. “The unfortunate thing about this is that we were not told in specific terms when the AstraZeneca vaccine would be available even as they said they could not give the Moderna brand said to be available at the time except those who came around for their first jab. “However, we are afraid that if not taken at the approved window period, the first jab becomes useless as it will lose its potency. “When I enquired if I could take the Moderna said to be available, I was told it’s unethical to mix two different brands. They said the Moderna is for those who had come for their first jab.

The dilemma now is that nobody seems sure if the same Moderna will be available by the time people start coming back for the second dose. “There is also this fear that the first dose already taken might have expired before giving it to us. Or how else could one explain this dilemma?” asked one anonymous client, who appeared frustrated with the situation. Nigeria, she said, is in a mess as far as this vaccine issue is concerned. It’s even worse, according to her, because the country does not buy but depends on donations from Western countries.

The case of the client above is not an isolated one. Another went for her second dose of the Moderna brand and got a similar treatment. It was the same dilemma at the other centres visited as many lament their frustrations to this paper. However, a Public Health Physician and the immediate past president of the Guild of Medical Doctors (GMD), Prof. Olufemi Babalola, attempts to allay the fears of people when he said that the gap between first and second doses can be extended to three months and that that does not necessarily mean that the vaccine will lose its potency.

He said: “The second dose of most of the vaccines available (AstraZeneca, Pfizer and Moderna) should be given within 3-4 weeks of the first dose, but it can be extended to three months. “For logistic reasons it may not always be possible to give the second dose within that window period. Any additional doses are called a booster dose, and the whole idea is to increase the level of antibodies in the system to fight infection. Too many repeat doses may not however be advisable to avoid hypersensitisation of the immune system.”

But, Dr. Doyin Odubanjo, another public health physician, has modified this position slightly by saying that it depends on how long after the person ends up getting the second dose. “It’s known though that at least two doses are required for appropriate immunity to develop,” Odubanjo added. Dr. Abiodun Kuti, President, Guild of Medical Directors, has also said that the first dose taken is to agitate the antibodies, which he called the soldiers that are supposed to fight the virus.

While, according to him, the second jab is to ginger the antibodies to be more active. “Once the first dose has been given, the soldiers that are supposed to fight the virus have been deposited in your body, they have been activated. The second jab is just a backup. The time lag doesn’t have any effect on the antibodies.

“The most important thing is for the body to stimulate the soldiers to be ready for the virus. The second jab is like getting another group of soldiers from another garrison to come and help in the fight. “It will still give the same goal,which is to make sure that your body can resist the virus once it gets into the body.

The vaccine is just to quicken the action so that you do not get overwhelmed by the virus when it attacks you. “We have different variants now so like it or not, different soldiers in the body will have to be fighting different viruses of the same origin. But you will need the vaccine to boost your ability to fight the virus.” To the National President of the Association of General And Private Medical Practitioners of Nigeria (AGPMPN), Ambassador Dr. Ugwu Iyke Odo, it’s just like giving somebody regular medication for ailment. “For example, somebody is having fever or pain and you give him paracetamol. You tell him to take the paracetamol every eight hours.

It suggests that the paracetamol that you gave now, the effect of it will last for about seven hours and as it is telling off, you boost it by taking another. “If you fail to boost your dose at the time you should, the pain will come back almost in full force. But if you are able to continuously fill in that gap, you may stay without pain for days and the pain may disappear from there. “Certainly vaccines are supposed to be boosted to have their full impact or effect. If they are not, it means that the anticipated efficacy or potency will be compromised and that could lead to what we call resistance.

“It’s just like treating someone for malaria and you are supposed to give that person a certain dose of the anti- malaria drug daily for three days and you give it for only two days. We know that it is only when you have completed the full course that the parasite will be finally subdued.

“If you stop midway, what do you end up doing? You will make the parasite weak; they too will become sick and hibernate. They go on holiday and recover. When they recover, they become more dangerous. Similar things can happen with the vaccine. “The way out is that while we are thanking the government for the efforts that they are making to protect Nigerians by acquiring the vaccines, they should do their best to make sure that what they are doing is done the right way, because if you do the right thing the wrong way, you achieve the wrong results.

“They should do their best to make the vaccines available so that people can follow the prescribed protocol, meet the timing of the dosing to have the highest efficacy. The first time when they started this, they made sure that they stopped at half of what they had so that they would be able to give the second dose to the same person, which was good control,” Odo said. However, The WHO recommends an interval of 3–4 weeks between the first and second dose of vaccination. According to the World body, if the second dose is administered less than three weeks after the first, the dose does not need to be repeated.

But if administration of the second dose is delayed beyond four weeks, it should be given at the earliest possible opportunity, it said. “We know that having the second dose is essential to ensure the best effect of the vaccine, and to maximise protection against new variants. So, it’s important to get your second dose as soon as you are offered it. “Generally the second dose of the COVID vaccine, whether Pfizer/BioNTech, Oxford AstraZeneca, or Moderna, will be effective after two weeks.

This can vary slightly from person to person, depending on your immune response. Most studies of the vaccines have measured effectiveness 21 days after the first dose and 14 days after the second dose, and have found significant increases in effectiveness after the second dose.

“However, if you had the Oxford/ AstraZeneca vaccine for your first dose, you should have the same for your second. Very rarely, someone might have had a serious reaction to their first dose of the vaccine. This is extremely rare but if this does apply to you, speak to a healthcare professional about whether your second dose should be a different vaccine.” Dispelling the fears that the country may not get the second batch of the vaccine any time soon, the Nigerian Institute of Medical Research (NIMR) DG, Prof. Babatunde Salako, believes the government will receive more doses to effectively continue the vaccination.

Though there was nothing tangible to support this assertion, Salako said with confidence that many more people will be vaccinated when their second jab is due. Professor Maduike Ezeibe, a Veterinary Medicine and Clinical Virology at Michael Okpara University of Agriculture in Umudike, Abia State, in his summation decided to look at the issue of vaccines differently. Ezeibe told one of our reporters on the telephone that he had always feared that vaccines may not solve the problem of COVIDd-19. He thinks that vaccination is not the correct method of control for COVID -19. He said that WHO should approve medicines that can achieve quick cure as a method of control for the pandemic. With such medicines, the professor said, fear of the disease will vanish and infected people will be quickly treated to reduce spread.

He said: “Once a virus experiences a drug or antibody from a vaccine and still survives, it changes (mutates) to a different form (variant). It means that COVID-19 requires vaccination being repeated every two months otherwise vaccination as a method of control will continue to cause the rapid evolution of new variants already being experienced. “But can the world afford vaccination of all persons and all susceptible animals every two months under the present condition of lack of vaccines and hesitancy? “I think vaccination is not the correct method of control for COVID-19.

The current claim that vaccination makes the disease less severe is unscientific. Vaccine is supposed to prevent infection, not to reduce severity of disease. Those vaccinated people who get infected have become medium for mutation and new variants that emerge from them would be resistant to the vaccines used to vaccinate them.

“WHO should approve medicines that can achieve quick cure as a method of control for the pandemic? With such medicines fear of the disease will vanish and infected people will be quickly treated to reduce spread. Nigeria should take the lead to call WHO to reason scientifically. “It is wrong to use vaccines that protect for such a very short period (three months against ten years of Yellow fever vaccines) to attempt controlling a virus that changes and spreads so fast.”

Additional report from Appolonia Adeyemi

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