4 April 2021
When some Nigerians began to question the wisdom of allocating hundreds of billions of naira to COVID-19 vaccines, I thought it was another dimension of COVID denial. The critics argue that the money would be better spent on other pressing matters. Hunger and non-COVID health problems are killing Nigerians at a much higher rate than COVID-19, they argue. Initially, I thought that these are shortsighted arguments, that the need to combat a pandemic is of far greater urgency. I don’t necessarily think so anymore.
When I made this concession to a nephew who is a COVID-skeptic and conspiracy theory enthusiast, he pounced all over it to declare that it is all a ruse. Now, before any reader becomes so inclined, let me re-affirm a few things: COVID-19 is a serious matter and the vaccines are helping to combat its spread and morbidity. I have myself received two shots of the Moderna vaccine, and I am convinced that my good friend, Professor Ebere Onwudiwe, wouldn’t have succumbed to the virus about three months earlier had he gotten the opportunity.
So, why then have I become sympathetic with the argument against high vaccine expenditure? Putting it simply, it is that I am beginning to believe that coronavirus might never be as much of a threat in Nigeria as it has been elsewhere. The operative word here is might. There is so much uncertainty surrounding coronavirus that even the world’s topmost experts are circumspect in their projections. The uncertainties have been compounded by the spate of new strains of the virus from around the world. Anyone of them can dramatically change what we thought we knew of the virus.
Even then, I have become ever more convinced that coronavirus in Nigeria and much of Africa will never be the scourge it has been in Europe, North America and elsewhere. What seemed to be ignorant declarations that “We don’t have coronavirus in Nigeria” are beginning to take on a semblance of truth. Of course, there is coronavirus in Nigeria. Of course, it is sickening and killing people. Yet, cursory evidence points to wide spread immunity from it. As I have written before, this may have been acquired from environments with low viral loads. Or it could be residual immunity from other diseases.
I realise, of course, that these are audacious proclamations by a non-virologist. It is just that the observable evidence points in these directions. I don’t see how else to explain the fact that people in my Island city Bonny celebrated Christmas and New Year with the usual festivities and without regard for coronavirus and yet with no consequences, at least nothing commensurate. Acquaintances who recently returned from Nigeria reported crowds at bus stations and markets, with no distancing or facemasks. That was especially the case in Lagos, Nigeria’s epicentre of COVID-19 cases. In Europe and the US, lesser super-spreader events have caused a spike in infections, hospitalisations, and deaths.
Of course, we don’t have a good count of the incidence of infections and deaths in Nigeria. A study conducted in September and October last year by the Nigeria Centre for Disease Control and the Institute for Medical Research estimated that up to four million people had contracted the virus in Lagos State alone. That’s more than one quarter of the state’s population of about 15 million people. The NCDC’s figure is higher than the official figure for all of Africa, and it was obtained before the surge during Christmas holidays. The official figures for Lagos State were miniscule in comparison: 153,000 cases and 1,862 deaths.
The NCDC’s figures were based on tests for antibodies conducted in Lagos, Enugu, Nasarawa and Gombe states. NCDC officials used the figures to make the case that a vast majority of Nigerians are still at risk of infections. Yet a counter argument could be made that the figures suggest that Nigerians are generally capable of weathering the virus. A virus that has been contracted by more than 25 per cent of the people without catastrophic consequences has to be less of a threat than has been feared.
Is this an argument against vaccination? Absolutely, not. It is a case for prudent use of funds. About the time of the NCDC study, The PUNCH reported a story with the headline, “Nigeria may spend over N540bn on COVID-19 vaccines. The goal, the paper quoted FG officials as saying, was to immunise 120 Nigerians. What critics question, and I am beginning to sympathise with, is whether this is a worthy goal and sensible expenditure, or whether the government is pursuing policies without regard for domestic realities.
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Here are a few points to consider. First, people who have been exposed to the virus are now presumed to have acquired immunity against it. Cases of re-infection are rare, US and international health experts have said. However, it is not known how long the immunity lasts. As for the vaccines, they do not necessarily prevent infections. They do, however, keep them from causing health problems. And like immunity from prior exposure, they don’t work indefinitely. In fact, the current assurance is that they will work for six months.
The current advisory in the US is that people who have already been infected get vaccinated anyway. Even in the US, which has more vaccines per capita than most other countries, this duplication of immunity isn’t very logical. Why vaccinate people who have already acquired immunity given the shortage, let alone the expense, of vaccines? The answer is better to be safe than sorry. But that’s a luxury for a country such as Nigeria that barely provides basic health services.
And that leads to the ultimate point of this article. The question is not so much whether to spend money on vaccines or not, but rather how much and for whom. If, as it appears, a large percentage of Nigerians already have antibodies against coronavirus, it will make a lot a sense to exclude these people from any initial vaccination campaign. Correspondingly, it would make sense to exclude areas that have developed “herd immunity,” that is extensive individual immunity. Thence priority would be given to demographic and occupational groups that are most vulnerable or exposed. Experience around the world indicates that old people and people with existing health issues are the most vulnerable. And people whose jobs expose them to many people—doctors, teachers, taxi drivers—face greater risks. By thus vaccinating only those who truly need to be, Nigeria will spend less and accomplish more.
There’s a probable complication with aspects of the recommendations here. There is a possibility that countries will begin to require “vaccine passport” for travellers. This might call for the implementation of an “immunity passport” as an alternative. The overriding point here is that the challenge of coronavirus calls for imaginative policy making