The recent yellow fever outbreak in the country has claimed 76 lives, with as much as 222 reported cases in many states. Amidst rising death rates and spike in infections are revelations that yellow cards can be obtained through back doors.
The yellow card is a card showing proof of vaccination against yellow fever, a requirement for international travellers. The card is issued at the Federal Ministry of Health and Port Health Services unit of international airports in the country.
Yellow fever is caused by a virus spread through the bite of infected Aedes aegypti mosquitos. Some of those infected develop serious symptoms, including high fever, loss of appetite, nausea, muscle pains, headache and jaundice (yellowing of the skin and eyes). Some die from the complications of internal bleeding and organ failure.
Infection with yellow fever virus is easily prevented by a vaccine that provides immunity for life. Inspite of this , Nigeria has continued to witness annual outbreaks of yellow fever.
Our findings however, also revealed that the practice of getting yellow cards without vaccination is not as widespread as it was before the launch of the e-card.
In the last few weeks, there have been reported cases of strange illnesses killing people across some states of the country. The Nigeria Centre for Disease Control (NCDC) this week confirmed that the cases and deaths from a strange illness in Delta, Enugu, and Bauchi states is indeed another outbreak of yellow fever in the country. Investigations are still ongoing in some other states over the reported strange illnesses.
The NCDC in its situation report on yellow fever published on Friday night said between the 1st and 11th of this month, a total of 222 suspected cases, 19 confirmed cases and 76 deaths have been reported from three states – Delta, Enugu and Bauchi. The centre said it was currently responding to the yellow fever outbreaks in the three states.
Speaking on the resurgence of yellow fever in the country, Prof. Oyewale Tomori, a renowned virologist, said the situation is expected for a country that plays lip service to disease control.
Tomori, who said Nigeria has no business experiencing annual outbreaks of vaccine preventable diseases, and that it was a national disgrace, noted that the country knows what to do, what to expect and has the resources to do what is needed but has refused to do so.
“When an outbreak occurs, we start running from pillar to post, begging everybody to come to our aid, while we pretend as if what happened came on us unexpectedly. The sad part is that we are playing with people’s lives. We should stop blaming external forces. That we are still having yellow fever since the first available reports in 1910/1911 is our fault and we should be thoroughly ashamed. I understand that the index cases of the outbreak we are now reporting occurred as far back as July this year. We should hang our heads in shame!” he lamented.
Situation across the three states
Delta State Governor, Dr Ifeanyi Okowa, Wednesday announced that two additional casualties were recorded in the affected communities of Ika North East.
The latest deaths bring the official number to 24. However, Daily Trust on Sunday investigations revealed that over 30 persons had died in the three affected neighbouring communities of Ute-Okpu, Ute-Erumu and Idumuesah in Ika North East Local Government Area of the state.
Enugu State government said it has commenced immediate mass vaccination for yellow fever in Ette and Umuopu communities in Igbo-Eze North Local Government Area of the state, after confirmation of the outbreak of the disease in the areas.
Daily Trust on Sunday gathered that so far, the disease has claimed over 50 lives in the affected communities within the Igbo-Eze North LGA which is said to share boundary with Kogi State.
A medical team from the state Ministry of Health led by the Health Commissioner, Dr. Emmanuel Obi, and officers of the Enugu State Fire Service, led by the Chief Fire Officer, Engr. Okwudiri Ohaa, were in the affected communities, on Wednesday, to commence vaccination and fumigation exercises, respectively.
Meanwhile, the Bauchi State Ministry of Health confirmed the death of eight persons from yellow fever and has also taken the samples of 41 suspected yellow fever patients from Miya ward, Ganjuwa Local Government Area for confirmation at the National Centre for Disease Control (NCDC) Abuja.
The ministry is planning massive vaccination across the 19 local government areas.
The State Commissioner for Health, Dr Aliyu Mohammed Maigoro, said “What we are doing now is active search to isolate people with symptoms such as joint pain, fever, yellowness of the eyes, urine and the body.
NCDC said that the National Yellow fever Emergency Operations Centre (EOC) was activated to coordinate response activities across all affected states on November 7 and that the State Epidemiology Team in the affected states is leading the response with support from NCDC, National Primary Health Care Development Agency (NPHCDA) and WHO.
Dr Walter Kazadi Mulombo, WHO country representative, said Nigeria is one of the countries implementing Eliminate Yellow Fever Epidemics (EYE) strategy. This strategy is being steered by WHO, Gavi the Vaccine Alliance and United Nations Children’s Fund (UNICEF), to protect at-risk populations, prevent international spread and contain outbreaks rapidly.
How Nigerians get yellow card without vaccination
“Do you want to get a yellow fever card without vaccination? If you want it, it is possible,” was the question our correspondent got when she asked an official of the Nigeria Immigration Service about issuance of the yellow card.
The man who simply identified himself as Ade told our correspondent that some people prefer to get the card without vaccination because of the stress involved in the procedures for vaccination to get the cards.
He said someone who does not want to be vaccinated could pay N3000 and get a yellow card. “But, for someone who want to get the vaccination, the person will apply for it online with N2,000 and it takes a whole lot of stress before the card can be gotten eventually. So, since the money involved is not so much, people prefer to save themselves the stress and get their card through the back door,” he added.
Meanwhile, the Permanent Secretary, Ministry of Health Lagos, Dr. Olusegun Ogboye, said, “It is not possible to get a card without vaccination.”
At the Port Health Service (PHS) headquarters at the Murtala Murtala International Airport (MMIA) yesterday, few passengers were seen at the office waiting to get their e-yellow card which was launched in July last year.
However, Daily Trust reports that with the introduction of the e-yellow card last year, the Federal Government said it would reduce fake cards as some agents were accused of selling fake cards to prospective passengers just to aid their trip.
One of the passengers who spoke to Daily Trust yesterday on condition of anonymity however confirmed being vaccinated by officials of the Port Health Service after completing the registration process online.
He however described the process as tedious, saying there should have been a faster way of issuing the yellow card.
“Yes, I actually got vaccinated. I did the registration online and printed out the form which I brought to this place. I was taken to a small room where I was vaccinated,” he said.
Officials of the Port Health Service however refused to talk to our correspondent, directing us to the spokesperson of the Federal Ministry of Health.
However, one of them who was told of the alleged compromise of the vaccination process by issuing the yellow fever form without the beneficiaries being vaccinated, said that is no longer possible with the e-yellow card.
Speaking with our correspondent, the General Manager, Aero Medical Standards of the Nigeria Civil Aviation Authority (NCAA), Dr. Wilfred Haggai, said the allegations that people are getting yellow cards without vaccination are “spurious.”
He said there is a tracking system to fish out anyone who fails to get vaccinated once there is evidence showing the details of the person.
Our correspondent had previously witnessed situations at the airport where travellers just pay the stipulated fee and get the yellow card without vaccination. But current checks at the airport shows that such practice has ended.
One of the airport workers at the Abuja airport who spoke on condition of anonymity said the procedure now is that you will have to run the whole process.
“You are no longer given yellow fever cards without test anymore. It’s either you do your yellow fever vaccination at the Federal Ministry of Health or at the airport through the Port Health,” he said.
According to him, “the procedure is that you pay online I guess through Remita. You complete the forms online and pay directly to the Federal Ministry of Health. After paying and completing the form with your passport, you take your print out to the clinic at the airport and do your test first. If you are negative, you are vaccinated,” he explained.
Recounting his personal experience, he said “Early this year, we were to go to Ghana for a meeting, and we followed the same process. Even as airport staff, they didn’t listen to us. There was no concession.”
He also said the process is now strict because countries fine airlines if they discover a passenger with a fake yellow card.
Our reporter was also at the Federal Ministry of Health to observe the process involved in getting the Yellow Card. The reporter was told to bring a photocopy of his international passport and make an online payment of N2,500 to generate a code before he could be attended to.
A man who does not want his name in print said even though the practice of collecting yellow cards without vaccination is not as widespread as before, people still do it secretly. He said an individual who doesn’t want to be vaccinated could claim to have one health challenge or the other, or feign pregnancy if a woman.
“Women can also say they are pregnant and use that as an excuse and they can be given. But it is not an open thing,” he said.
Mrs. David not real name also said since the yellow card is a criterion for one to travel to some countries especially South Africa, people do whatever they can to get it without being vaccinated.
She said people part with tokens to get the yellow card even though many are now getting vaccinated before getting the card unlike before.
Expert’s view
On the implication of getting yellow cards without vaccination, Prof Tomori said such practices contribute to the burden of the disease in the country. He said doing so was fraudulent, deceitful and corruption.
“It is an aspect of corruption far more dangerous and harmful than the corruption of our political leaders, because the repercussion of the yellow fever corruption is directly on your life. You are exposing yourself to death and also endangering your loved ones by being the source of infection to them. The yellow card does not protect you; it is the vaccine that does. By not vaccinating, you are living on false hope, you are hanging your life on a piece of spider thread. The yellow card without the vaccine is a worthless and useless piece of trash!”
How to address the burden of yellow fever in Nigeria – Expert
Prof Oyewale Tomori said the country needs to do six things to address the burden of yellow fever.
He said firstly, the country needs to complete the mass vaccination exercise started since 2012 in which it was planned to vaccinate all persons in Nigeria from nine months to 45 years of age. “The plan was to have completed the exercise by 2016 or thereabouts. Our failure to do so is responsible for the continuous and unabated yellow fever outbreaks in different parts of the country,” he said.
He said the country also needs to improve on disease surveillance to enhance its capacity to prevent, detect and respond to emerging diseases like COVID-19 and re-emerging diseases like yellow fever.
Tomori also advised the 36 states and the Federal Capital Territory (FCT) to take up responsibility of strengthening and funding the epidemiology divisions of their ministries of health.
The expert said fourthly, at least one laboratory in Nigeria must be upgraded to the level of a WHO accredited lab to save precious time by not having to confirm laboratory results in faraway Dakar, Senegal. “We lose between 10-21 days waiting for confirmation of lab results in Dakar, without which no yellow fever vaccine will be approved for responding to any outbreak that our labs detect,” he said.
“Nigeria must go back to the days of producing vaccines locally. We are making progress, but it is really slow, and the sixth thing is that at the individual level, we need to realise that getting yellow card without vaccination is like getting fake WAEC certificate without sitting for the exams; like obtaining driver’s license without a driving test.
“We therefore need to educate our citizens on the dangers of not vaccinating against yellow fever. Get a yellow card certificate only after you get your vaccine.
We have no moral right to condemn our thieving leaders if we cannot be honest with simple things like obtaining authentic yellow cards. A person who cheats on such a small matter is likely to steal the nation dry when he or she holds political office,” he advised.
