Dr Faisal Shu’aib, is the Executive Secretary of the National Primary Healthcare Development Agency (NPHCDA). In this interview with Mallam Mannir Dan Ali on Trust TV, he spoke about the efforts being made to combat COVID-19, Lassa Fever, Circulating Mutant Polio Viruses and other health issues. Excerpt
We are right now in the midst of the big challenge of COVID-19 and we are still in the early stage of getting vaccinated. We’ve been told by the WHO and all the health experts that the best way to mitigate the current situation we are faced with is where there are always mutations, new variants of this particular health challenge coming up, we have to be vaccinated. Where exactly are we with the vaccination in Nigeria right now?
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Thank you very much for that question. In terms of vaccinating Nigerians, we’ve seen ups and flaws in terms of the activity. A few months after we started vaccinating Nigerians against COVID-19 in March 2021, we had the challenge of having the vaccines. So, vaccines were not widely available. First, most of the developed countries bought the vaccines and hoarded them in their stores more than two, three times their needs. So, few quantities came to Africa and other developing countries. But in the latter half of 2021, we began to get additional vaccines. And this has made it possible for us to increase coverage. But at a point, we were able to vaccinate 10 per cent of the populace with the first dose of the vaccine and only about five per cent have taken both doses and that is a far cry from what we liked to be. But given the fact that we didn’t get vaccines on time, I think we are making progress.
But are we even up to the percentage you are quoting? Because what I have seen of recent was two per cent, five per cent and there is so much resistance to it in terms of the problems you highlighted initially?
Yes, especially the last couple of weeks, we’ve seen a ramping up of vaccination uptake. So towards the end of the year and November that was the number we were looking at. We are still hovering around two to three per cent. But, the Presidential Steering Committee, the federal ministry of health and the National Primary Healthcare Development Agency actually collaborated to roll out mass vaccination campaigns. This was launched and what people are seeing is a replication of that launch all across the country. We’ve seen governors take leadership, making sure that, there is increased communication allaying people’s fears around the vaccine and we begin to see more than a doubling of the vaccination rate. So, in the early months of 2021, the daily vaccination rate was around 100,000 per day. But since we launched the mass vaccination campaign, we’ve doubled that. We’ve seen a vaccination rate of more than 200,000, so we have been able to increase the uptake up to 10 per cent for the first dose and about five per cent for the second dose.
Are we sure that these vaccines are going into our arms and not being thrown away as was the case with some other vaccination programmes in Nigeria?
Absolutely, these vaccines are going into the arms of individuals and we have come a very long way from the polio eradication days when some health workers will pour out the vaccines. These are injectable vaccines. It is not a liquid vaccine. And then, the level of monitoring and supervision is way beyond what it used to be in the past and we have now moved away from manual coding to an electronic database. So, there is closer monitoring of the vaccines that are being issued and we also make sure that we tie in the vaccine doses and the data that is being recorded. You mentioned the issue of vaccine hesitancy. Vaccine hesitancy is a global phenomenon, especially because of the social media. Right now, anybody can just sit in his living room and overnight become an epidemiologist and begin to make decisions and develop conspiracy theories about vaccination.
And what are you doing about it to combat all this hesitancy and all the mass hysteria created about it and the fake news? I remember some of the early rumours that if you get vaccinated, you could die within a year or two?
Absolutely. So what we’ve done is to work with our sister agencies, like the National Orientation Agency and the federal ministry of information to also push the current information out there, debunking that misinformation and disinformation, by really demonstrating to Nigerians that, it is not true that you will die two years after taking the vaccine. Nobody knows when he or she will die. So, why would anybody believe that exactly two years after you take the vaccine you will die? And we’ve seen that in the course of the vaccination, over 15 million people have been vaccinated. 15 million Nigerians cannot be wrong. We’ve not seen these Nigerians fall like a pack of cards after taking the vaccines. Vaccine hesitancy is a global phenomenon and it’s the same result that we’ll see when we use the same approach, which is to make sure that we provide the right information to Nigerians so that, they are very clear about what the vaccination process is all about and the fact that, the data speak. So, right now over 80 per cent of the people who are dying from COVID-19 are unvaccinated. So, dying from COVID-19 is a thing of those who have not been vaccinated.
But is the strategy of literally forcing government workers, office workers to get vaccinated working? Is this something that will work especially given the stories we’ve heard of fake vaccines or vaccination cards?
So, there is a vaccine mandate. It depends on how you look at it. On the one hand, the government has the responsibility to protect everybody. So, what the Presidential Steering Committee said is, you can take a decision not to take the vaccine, but you do not have the right to infect others. There are people who have vulnerabilities such as hypertension, diabetes. If they contract the COVID-19 virus, they are likely to die. And these people are in our offices. What the federal government is doing is protecting those who are vulnerable. And the federal government in my interpretation is not making this mandatory. What the federal government is saying is that it’s rather you get the vaccine or you issue evidence that you are not infected. I do not see that this is mandatory if you have been given these options.
What about the cost of testing? Because you are required to do these testing almost every day?
Every 72 hours. It is a choice for you to make. Whether you are so averse to the vaccine that you want to spend that kind of money every 72 hours, just to prove that you are negative or you want to go and get the vaccine for free. Not only to protect yourself from severe disease and hospitalisation but you also protect those you love and also help build herd immunity. So, it is not about the individual. You look at it at the population level, that you are also doing it for your family members, friends and community members, because when you are protected, when you don’t transmit the disease, it means that you are also helping to make sure that those who are vulnerable amongst us are actually protected from COVID-19.
Given the tentative, that is we are not sure of the numbers. I mean in terms of population in Nigeria when we are talking about a census that is about to be conducted this year or so. But, do you have a clear idea as to the numbers that you need to vaccinate? I mean, the vulnerable groups. Those may be above 18 upwards. Do you have the idea of how many millions, will guide you as to the progress you are making or not making?
What we’ve done is to look at the population and figures. Not only at the census figures, but also in the federal ministry of health and particularly the National Primary Healthcare Development Agency. We’ve used Geographic Information Systems (GIS), GPS to be able to make estimates of populations using satellites. So, we will be able to say, based on the population density, we can estimate very closely the exact numbers. We have approved it side by side with census numbers. This is what the ‘Degree 3’ programme does. So we were able to get a very good approximation of what these populations are. We are looking at 112 million Nigerians that are targeted all across the country. So, we are looking at trying to vaccinate at least 70 per cent of the eligible people. So, it is not every Nigerian that is going to be vaccinated. We are looking at those who are 18 years and above.
And will that achieve the much talked about herd immunity?
That is exactly what the computations and the modelling show. That if you are able to achieve up to 70 per cent population of the targeted age groups you will achieve herd immunity. But we also recognise that, apart from the vaccination, there are people who have naturally acquired protection against the disease when they fall sick. However, vaccination only helps to even improve the quality of that protection even after you’ve been infected when you get vaccinated, it will boost your immunity so that you are able to fight the virus if you are infected.
Do you have a time frame within which you want to achieve these numbers?
Yes, we are looking at vaccinating these eligible Nigerians by the end of 2022. But there is a caveat to that. At the current rate of vaccination across the states, we will not be able to achieve those numbers, 112 million Nigerians by the end of 2022. So, we have to ramp up our vaccination rate. So, I give you the scenario. We have states like Jigawa, Nasarawa that are vaccinating over 30,000 people per day then compare to other states that are barely vaccinating 1000 per day.
But are these figures reliable? What is it that Jigawa is doing that it is able to achieve these numbers?
Leadership. It is what the governor has done. After we launched the mass vaccination, he also launched a mass vaccination campaign in Jigawa State. He called all the local government chairmen and this is the same thing that the Nasarawa State governor has done as well. So, in those states where you see these high performances, you’ve seen very strong leadership from the governors, we’ve seen governors of Ogun, Lagos, Kano state and Ekiti States. These governors called their local government chairmen and gave them targets. They said you will work with your health teams, go to the communities, do social mobilisation, communicate very clearly that these vaccines are important to protect you against these diseases. But making sure that the health workers also have the vaccines and the logistics to reach the most difficult areas. So, sometimes, what health workers will do is just stay around the metropolitan and do the vaccination. They don’t get to the rural areas. But what we are seeing now is that the governors are charging the local government chairmen. So, for those local government chairmen that are reaching the daily vaccination rates based on their population, they were able to reach weekly and monthly vaccination rates. You see the governors of Nasarawa and Jigawa States actually giving cash rewards to the local government chairmen and giving them roll-up banners that they are the best local government’s chairmen for that week.
But it is not only about vaccination. The other protocols. The non-pharmaceuticals. Simple use of facemasks. I believe when you were coming for this interview, you could count the number of people on one hand that you saw with masks here in Abuja. Not to talk of rural areas. Is there anything you are doing or it is a battle that you have given up?
No, we have not given up on non-pharmaceutical interventions. This has to go hand in hand with the vaccination. Just because we are not vaccinating that doesn’t mean we are better off than people going around without masks. You also have to continue wearing the masks.
(Cuts in)But people are not wearing masks. That is the point. People feel that ok it’s got nothing to do with me, it’s elitist. Why should I have to spend a hundred naira every day to buy a mask when I can’t eat?
Well, we are very clear about the fact that you don’t have to buy a mask every day. We are very clear about the fact that you can use even just a handkerchief or a face covering. The problem there is that people do not feel a sense of vulnerability because people are not dying on the streets like we saw during the third wave in India. People feel all well. It is very important that we communicate very clearly that wearing the face mask not only protects you but also protects your loved ones from transmitting the virus. It is a piece of work that we have to continue doing. We have to continue educating Nigerians until they become aware of the virus. It is a piece of work that we will continue doing until they understand what exactly they need to do. Understanding very clearly, that this is a collective effort and it is not a question of an elite or a non-elite. It is a question of us working together and seen that we go ahead of this pandemic and begin to live our normal lives.
Are you hopeful that Nigeria and the third world generally wouldn’t be the big clog in the wheel of progress towards achieving this? Because you enumerated the problems you had. No vaccines are available to buy and now probably not enough resources to buy those vaccines. So, how will it be possible for Nigeria to get there within the time frame and not be a drag on other countries that have achieved a huge percentage of the vaccinations and all these measures?
I can speak only for Nigeria. I cannot speak for other developing countries. But, one thing I know about Nigeria is that we may start slow but at the end of the day, we may brace the tape ahead of other developing countries. The resources are actually available. President Muhammadu Buhari has made funds available for the procurement of vaccines and we are in the process of analysing all of the paperwork that will ensure that these vaccines arrived. We have procured over 40 million doses, about 40 million doses of the Johnson &Johnson vaccine and we’ve started receiving some of those vaccines in batches. Because of our cooperation and our signing off on the COVID vaccine, we are going to get adequate vaccines for our population. So, the issue of scarcity of vaccines is now a thing of the past. Now we have adequate vaccines, we are looking for the arms to administer these vaccines. And I believe that by the time states ramp up their vaccination, we except on the average, that states should be able to hit around 15,000 to 20,000 minimum of vaccination per day. If governors look at that and did not stop and urge their health teams to say, look, every day, this is what you need to reach. Tell me what you need to do and I will support you. The federal government has supported states with financial resources to make sure that they are able to do communication, they are able to pay for logistics and even extra stipends for health workers. Some states that are doing very well have also added resources. But the good thing about all of these efforts is that the focus is not just about COVID-19. Apart from COVID-19, we are also integrating routine immunisation, childhood vaccinations. We are also providing Vitamin A. We are also looking at the nutritional cases. So we are using the platform of this COVID-19 vaccination to add other interventions. It is not just a narrow-minded focus on COVID-19.
Actually, that is why I wanted to take you up on that. Your work is not just about COVID-19 and vaccinations. What happened to the other aspects of your work? Has it suffered when there are all these concentrations on just one problem?
Actually, we have not focused only on COVID-19. What we’ve done is that we multitask. So, there are still things that we continued to do their routine work. What we are just trying to do was to now see how we can integrate all of the work that we are doing on COVID-19 with other works. So what we have rolled out is what we called the whole of family approach. So, when somebody goes to the health facility especially in the first and second phases, we asked them to also have their blood pressure checked, also do screening for diabetes. So, when they ask you questions that suggests and your responses suggest that, you may have symptoms of diabetes, then you are referred. So, we are doing the best that we can to work with the other stakeholders to see how we can also integrate all of the primary healthcare services, at least the most essential primary healthcare services that they don’t suffer while health workers are giving those vaccinations on COVID-19 and other communications.
There have been recent reports about polio. I mean, the vaccine-derived cases. And many people are getting confused. They don’t understand after we’ve just announced an exit being polio-free now. What exactly is the situation and what is being done to address it?
The outbreak of the polio virus like you are saying is the result of circulating mutant polioviruses, not the wild type. We have been certified as being wild poliovirus-free since August of 2020. After so many decades of fighting, we finally got the job done.
So, the problem is not wild polio?
That one is done. We have finished that. No child in Nigeria is being paralysed as a result of the wild poliovirus. The circulating mutant poliovirus is akin to what we are saying with COVID-19. Viruses replicate. They mutate. So, we started off with the Alpha, the Delta, the Omicron variants. Same thing with the poliovirus. It causes paralysis. But mostly the paralysis is in the form of weakness and a lot of times it resolves. Typically, it is a result of poor water and sanitation. So, just like the Cholera that we see. We see the advent of Cholera because people were not taking pipe-borne water
(Cuts in) which is not available.
So, people may be drinking water from streams, they are not boiling this water. Sometimes, there is poor environmental sanitation, some people don’t clean their environment and there is poor personal hygiene. These types of issues around water and sanitation exacerbate Cholera. It’s the same thing with the circulating mutant polioviruses. These viruses exist in the environment, especially where routine immunisation…
What are you doing?
What we are doing again is working with our traditional leaders, because the traditional and religious leaders were very central towards our eradication of wild polioviruses. We are engaging them again. We say we have to go back to the war front and make sure that people have a clear understanding of what is going on and that they make their children available to be vaccinated against the circulating mutant polioviruses. And we are beginning to see in a number of states that are having a positive effect of getting more children vaccinated.
What about Lassa fever? I heard that, in other places, it was also eliminated, but here we are, it is still a yearly problem. It’s a seasonal problem, when the season comes, a lot of people die and very valuable lives are lost including medical workers.
Yes, with Lassa fever, you know Lassa fever actually originated from Nigeria. It is really predominantly a Nigerian problem. This is something we are working with the Nigerian Centre for Disease Control to control, our sister organisation, we are supporting to see that, there will be early diagnosis and treatment for people who contract Lassa fever. Again, this is another challenge with environmental sanitation. So, the rats that transmit the Lassa fever will usually come around those households that do not have good environmental sanitation and once there is that contact between the rats and humans, the transmission continues and people end up in health facilities and get attended to by medical officers and health workers, and then those are the people that are likely to now contract the disease and it takes a very poor downturn. But of course, we’ve seen last year’s efforts, thanks to the efforts of the federal government, the minister of health. There are more centres that have been established to improve diagnosis, treatment, the drugs are now even more available. So, we’ve made a lot of progress from where we are, but there is still a lot of work that needs to be done. I think what will now cap our efforts as successful is when we are able to develop a vaccine against Lassa fever. And there is a lot of work that is going on within Nigeria and globally to develop that Lassa fever vaccine, just like we’ve been able to develop one against Ebola.
