Three vaccines have been licensed for use in controlling the COVID-19 pandemic – Oxford-AstraZeneca, Moderna and Pfizer. Nigeria is currently expecting 100,000 doses of the Pfizer/BioNTech vaccine by the end of January through COVAX, the global alliance to ensure equitable access to vaccines for everybody. Because each person needs two doses of the vaccine spaced three weeks apart, this can only be used for 50,000 people, a microscopic 0.0025% of our 200 million population. Strategic leadership and people at the highest risk of exposure – the frontline healthcare workers – will be prioritized in this first consignment. The Government plans to buy 42 million doses for the campaign in 2021, with more people to be vaccinated in 2022. However, nobody knows when we will be able to get enough doses to inoculate all the millions of people that need the vaccine. We have to rely on what the producing countries can afford to sell or donate for now. We do not produce any of the vaccines, so we are not at the negotiating table.
Meanwhile, India has been outsourced to produce millions of doses for the global giant AstraZeneca and has leveraged on this to demand a good proportion of the doses for its own population. Over the years, India has developed a massive capacity for the commercial production of a broad range of pharmaceuticals and biologicals, including vaccines. A huge chunk of the drugs and vaccines used in Nigeria come from India. Apart from producing for AstraZeneca, India’s indigenous Bharat Biotech has also developed its own COVID-19 vaccine, which is currently being produced for the mass vaccination campaign.
COVID-19 is just the latest disease that has exposed Nigeria’s dangerous reliance on other countries for its vaccine supply. Every year, the government spends billions of naira to vaccinate its millions of children against childhood killer diseases. It has also relied on the support of global partners like UNICEF, WHO, Rotary, Bill and Melinda Gates foundation and the global vaccine alliance, GAVI, to meet the huge demand. Many have perished because of acute shortages of meningitis and yellow fever vaccines.
Has it always been like this?
No, we used to produce much of the vaccines we needed in this country. The Federal Vaccine Production Laboratory (FVPL) – how many people have heard of this entity? – was created from what was left of the Rockefeller Yellow Fever Laboratory which had been in existence in Yaba, Lagos, since 1925. In the 1930s, it started to produce smallpox vaccines in sheep. This laboratory was said to have contributed tremendously to the elimination of smallpox from West Africa. Smallpox is the only human infectious disease to have been eradicated. Its eradication is a major historical triumph of global health. The FVLP started to produce human rabies vaccine in sheep’s brain in 1948. In the same year, a yellow fever laboratory was built which started to produce yellow fever (YF) vaccines in 1952. The locally produced vaccine was approved by WHO four years later. It continued to produce YF vaccines for Nigeria and neighbouring African countries like Cameroon for decades until it was shut down in 1991. Since then, Nigeria has depended on importation for its entire vaccine supply.
But why was the FVLP shut down? By 1987 – when it was producing up to 500,000 doses of YF vaccines per year – after several decades of operations without investment in equipment and personnel, it was obvious that the facility needed upgrading. The world had advanced beyond the technology employed at the laboratory and the equipment was outdated. In collaboration with Oswaldo Cruz Foundation (OCF) of Brazil, the old structure was renovated, and vaccine quality was improved. The International Development Research Centre of Canada and other donor supported the upgrading of this facility to meet Good Manufacturing Practice standards.
However, a plan was made to build a new facility at Yaba that would produce 20 million doses of YF vaccine per year, with possible production of polio and measles vaccines as well. Staff were sent to Brazil for training. By 1991, when the old lab was producing up to 1.3 million doses of YF vaccine annually, it was decided to temporarily shut it down to implement the plan of 1987. That was the last time the facility ever produced vaccines. The new facility never took off. A new vaccine production laboratory that the Federal Ministry of Health had been planning to set up in the new capital, Abuja, since 1987 also never materialized. Someone needs to investigate what happened to all those plans.
What has the government done since 1991?
The WHO, on government invitation, assessed the old facility and the new one under construction in 1995 in order to meet WHO standards for vaccine production but most of the recommendations were never implemented. There was a lack of government commitment and funding to meet up with the requirements.
In 2017, the government went into partnership with May and Baker Nigeria to resume vaccine production at Yaba, but the agreement was not implemented. The contract was not signed. At the height of the first wave of COVID-19 pandemic, the need to resuscitate vaccine production at Yaba was voiced again by legislators. The Federal Government of Nigeria managed to sign an MOU on the 5th of November 2020 with Biovaccine Nigeria Limited (BVNL). This is a firm set up by May and Baker Nigeria for a joint venture with the Federal Government to produce locally made vaccines. The plan is to resuscitate the laboratory at Yaba and build a brand-new plant at Otta in Ogun State to produce vaccines against diseases like diphtheria, tetanus, pertussis, hepatitis. The minister of health described the event as “a milestone in our national desire for self-reliance in vaccine production.” Amen.
Vaccine production needs to be liberated from the corrupt, inefficient, and non-profit oriented hand of government. This public-private partnership model might be the best way to go.
What else needs to be done?
Having access to adequate supplies to vaccines against especially epidemic-prone diseases is critical for health and national security. The surest way to achieve this is to maintain a considerable capacity for local production of licensed vaccines and conduct vaccine research and development for new ones. Local production of vaccines will also help to get rid of one source of vaccine hesitancy – the perennial fear that Western countries are lacing vaccines with contraceptive components in order to reduce the population of developing countries. When you cook your own food by yourself in your own kitchen, you need not fear that the food will be poisoned by your enemies. Apart from this health security argument, there is also an economic case to be made for local vaccine production in Nigeria. There is a massive vaccine demand to protect the teeming millions of Nigerians from several infectious diseases that kill thousands of people every year. There is a lucrative market for vaccines. Investing in it their production will create jobs, save foreign exchange, and potentially earn us foreign exchange if we produce enough for export. Even though Africa accounts for about 14% of the world’s population and responsible for a huge proportion of its vaccine demand, it produces less than 0.1% of global output.
There is one government institution that has been able to maintain the production of much needed vaccines over the decades. Established in 1924, the National Veterinary Research Institute in Vom, Plateau State produces a wide range of vaccines for different diseases and animal species. The vaccines the institute produces include rabies for dogs and cats; brucella, anthrax and contagious bovine pleuropneumonia for cattle; Newcastle disease, fowl typhoid and fowl cholera for poultry. The production methods and mechanism of action of animal and humans are basically the same. All the vaccines produced by the NVRI are based on traditional methods – none of them is a DNA or RNA vaccine. It has over the years collaborated with the Federal Vaccines laboratory at Yaba in supplying eggs for yellow fever vaccine production.
This shows that we have considerable in-country capacity for making vaccines against bacterial and viral agents, which we can leverage upon as we expand our capacity. But more importantly, what can we learn from how the NVRI has maintained vaccine production all the years? What business model are they employing? The NVRI facility appears to have sustained itself by selling its products to livestock farmers and pet owners. Should the FVPL at Yaba be resuscitated one day, it should be freed from the Federal Ministry of Health and allowed to sell its products to the National and State Primary Health Care Development Agencies which are the ones responsible for administering the immunization system. Another opportunity might be through the National Health Insurance Schemes that is sitting on billions. Routine Immunization for children should be within the scope of what the NHIS covers. Health providers would purchase the vaccines from the suppliers, administer it on the children and claim payment from the NHIS.
Two of the vaccines – Pfizer and Moderna – licensed in the past couple of weeks are mRNA vaccines, rather than the traditional killed or live-attenuated whole organism vaccines. A third, AstraZeneca, is an adenovirus vector virus vaccine. This indicates a shift from traditional methods to biotechnology-based methods, for which we have shown some capacity. For instance, Nigeria was the first to sequence the SARS-CoV2 virus in the whole of Africa. This was done at the African Centre of Excellence for Genomics of Infectious Disease (ACEGID) located in the Redeemer’s University, Ede, Osun State. The same centre detected a new variant of the virus that has been in circulation as early as August. The Nigeria Medical Research Centre at Yaba in also involved in genomic sequencing as other molecular research related to COVID-19. In fact, ACEGID researchers have developed a DNA-based vaccine targeting strains of the virus circulating on the continent. This vaccine has demonstrated a high-level of protection (90%) in animal models. The centre urgently needs a lot of funding to move on with the trials and further development. The Central Bank of Nigeria introduced the Healthcare Sector Research and Development Intervention Scheme in May. It aims to strengthen Nigeria’s public healthcare system with innovative financing of research and development in new and improved drugs, vaccines, and diagnostics of infectious diseases. Vaccines undergoing clinical testing or trials are eligible for consideration under the scheme, but they cannot access more N500 million naira. This is a far cry from the kind of money needed to develop a vaccine, take it through clinical trials and get it approved.
The government needs to get a multi-disciplinary team together to conduct a situational analysis and develop a strategic plan for vaccine self-reliance and make sure it is funded and implemented. Political will is critical. At the beginning of the COVID-19 pandemic in Nigeria there was an acute shortage of personal protective equipment like facemasks. We panicked as we relied on importation for our supplies. I was shocked to find out that Nigeria was not producing something as basic as facemasks. Other countries were not exporting. We had to rely on Chinese charity. But with government support and the industry of local manufacturers, we met up with the challenge. Now, we are inundated with facemasks and other PPEs. The pandemic pushed us to produce facemasks for the first time.
I believe that government should fund vaccine-related research in its universities and research and public health institutes like Nigeria Medical Research Institute, the NVRI, the National Biotechnology Research Institute and the National Pharmaceutical Research Institute. However, production should be the business of pharmaceutical companies. The role of the government should be to provide an enabling environment, regulate quality through NAFDAC and buy from local manufacturers to meet it enormous demand.
We are in the age of emerging infectious diseases in which new pathogens previously circulating in animals – like swine flu, bird flu, Ebola, Lassa fever, SARS, MERS and COVID-19 – burst into human populations. More of such spillovers are expected in the years to come. We don’t know how bad the next one will be. Meanwhile, the old ones are still with us, wreaking regular havoc. We need to act now.