It is widely accepted that vaccination is one of the most important achievements in public health. Yet, in the face of this ‘consensus’, vaccines are constantly challenged by individuals and groups on religious, and even political grounds.
The determinants around vaccine acceptance or hesitance usually include public trust, the source of the vaccine, and socioeconomic factors such as cost. In Nigeria, these factors hold true for COVID-19 vaccines, including Chinese-made vaccines.
What Is the Current COVID-19 Situation in Nigeria?
Nigeria recorded its first COVID-19 case on February 27th, 2020. Since then, Nigeria has fared relatively well in its COVID-19 response. Comparatively, South Africa has been severely affected with 1.51 million cases and 49,993 deaths. This success is largely due to Nigeria adopting an early response, by implementing social distancing measures before 50 cases were recorded and enforcing a full lockdown on March 30th, 2020.
The Nigerian federal government also created a COVID-19 intervention fund, which equated to N500 billion (US$1.4 billion, equating to 0.3% of GDP), to divert financial resources to combat challenges by COVID-19. Other government initiatives include an N2.3 trillion (US$5.9 billion, 1.5% of GDP) COVID-19 stimulus package to mitigate longer-term economic impacts induced by the pandemic, with a focus on sustainable economic recovery.
In terms of vaccines, the Nigerian government aims to vaccine 40% of its total population in 2021, with an additional 30% in 2022, to achieve an overall goal of 70% of the population to be vaccinated. Assuming that the vaccine can be purchased for $3 per dose, the maximum ceiling cost set by COVAX for low and middle-income countries would cost $844.2 million to vaccinate 70% of Nigeria’s population of 201 million with two doses. However, when factoring in that 54.2% of Nigeria’s population is under 20 years old, meaning a significant number are unable to accept the vaccine (recipients must be aged 18+), the cost of a 70% vaccination rate falls to $386.6 million for the population aged 20+. Alternatively, if each dose cost US$19, the same as Senegal recently paid for doses of SinoPharm, it would cost Nigeria $2.4 billion to vaccinate 70% of the population aged 20+.
The Nigerian Government’s Attitude Towards a Chinese Vaccine
The Nigerian government’s attitude towards vaccines has been very pragmatic, more so as Nigeria was not shortlisted for the WHO’s COVAX Pfizer-BioNTech vaccine sharing formula, nor is Nigeria currently planning to produce vaccines locally.
During the visit of Wang Yi, the Chinese Foreign Minister, to Nigeria back in January, the Nigerian Minister of Foreign Affairs Geoffrey Onyeama said that Nigeria is in talks with China to acquire Chinese-made vaccines. But so far, Nigeria has only received 4 million doses of the AstraZeneca vaccine through COVAX, despite other African countries, including Nigeria’s West Africa neighbour Senegal, already receiving Chinese vaccines. Furthermore, with the cost of Senegal’s SinoPharm vaccine order high at nearly US$19 per dose, it equated to a total of US$3.72 million for 200,000 doses. Equatorial Guinea, another neighbouring country, also received a donation of 100,000 doses of the SinoPharm vaccine.
So, what is the issue?
Well, a major concern shared by both government officials and the Nigerian public is the regulatory process for vaccines before they are used locally. Ben Igbakpa, a member of the Nigerian House of Representatives shared his opinion;
“The matter is not the origin of the vaccine but the efficacy of the vaccine subject to certification by NAFDAC, SON, NMA and all relevant regulatory authorities in Nigeria. If the vaccines from China pass all regulatory tests and are approved by the WHO, there should not be an opposition to it.”
Igbakpa added that “The national interest is to safeguard the lives of Nigerians and shore up the immunity of Nigerians against the deadly virus.”
The Nigerian Minister of Health, Dr. Osagie Ehanire, announced on February 24th that Nigeria is expecting COVID-19 vaccines from three donor sources; COVAX, the Global Alliance for Vaccines and Immunization (GAVI), and African Vaccine Acquisition Task Team (AVATT) set up by the African Union. These sources should satisfy the needs of the country without having to procure more. Dr Ehanire continued by stating;
“Now, you can see that all of these are coming from various sources but put together, they almost satisfy our needs so that we don’t really need to go procure. But the question is, when are they delivering? That is not in our hands. It is in the hand of the person who is bringing it to us.”
The Nigerian Public Attitude Towards Chinese Vaccines
Unlike in some areas of the world, the Nigerian government is not under immense public pressure to commence a national vaccination programme. This is in part because, as mentioned, Nigeria has fared well in its COVID-19 response, with a relatively low prevalence of cases and deaths. However, recent discussions and debates concerning vaccines have also played a central role, as public concerns and uncertainty around vaccines have led to an increasing number of people questioning the veracity of vaccine safety, seeking alternatives to vaccines, or even refusing vaccination.
A recent study by Malik Sallam M.D. from the Jordan University Hospital provides an overview of global COVID vaccine hesitancy. The analysis, which includes data from 30 studies, reveals Nigeria has an acceptance rate of 65.2%, which is significantly lower compared to South Africa’s acceptance rate of 81.6%. Another recent piece in the American Journal of Medical Sciences and Medicine revealed that only 51% of Nigerians (499 total surveyed, aged between 19-35) were willing to take a COVID-19 vaccine while 30% were not willing, with 18% being indecisive. Other studies have shown that unreliable clinical trials, self-trust in the personal immune system, and skepticism towards a potential COVID-19 vaccine, were listed as the top reasons for non-acceptance in Nigeria.
Local media have generally avoided politicizing the COVID-19 vaccines and have played an important role in sensitizing the public about COVID-19 and the importance of vaccines. Yet, earlier this month, The Guardian, a widely read newspaper in Nigeria, published an article that questions the safety of the SinoPharm vaccine, which will likely cause distrust of Chinese-made vaccines.
What Other Issues Are Impacting the Vaccine Rollout in Nigeria?
Coupled with skepticism, cost plays a general role in what vaccine is deemed suitable for Nigeria’s COVID-19 vaccination program. There is an assumption that Chinese vaccines are cheaper than vaccines from other vendors. This alongside the fact that SinoPharm’s vaccine does not require storage in ultra-cold freezers, has resulted in SinoPharm’s vaccine seeming a natural choice, alongside the AstraZeneca and Sputnik V vaccines. However, the WHO approving AstraZeneca’s COVID-19 vaccine for use will have an impact on the preference of Nigerians.
“There’s skepticism towards COVID-19 vaccines in general, but people will be far more open to a WHO-approved vaccine than a similar vaccine without WHO approval,” says Iguehi Omole-Irabor, a program officer at The Kukah Center, an independent policy center in Abuja which is currently working on a COVID-19 project involving several states in Nigeria.
So, What Role Can Chinese Partners Play in Addressing the Concerns of the Nigerian Government and the General Public?
Firstly, addressing limited public trust can be overcome through Chinese partners, including the Ministry of Health and other related government agencies, sharing timely clinical information on Chinese-made vaccines. In the early stages of the pandemic, China’s Public Health and Customs Departments shared vital information with health leaders from 20 African countries. Extending this knowledge-sharing support regarding vaccines will help establish trust amongst the general public. Building on this, as China has already commenced its vaccine rollout, relevant government agencies and healthcare actors should share knowledge on how to distribute vaccines safely and efficiently to minimize costs and maximize vaccine uptake.
Secondly, whilst Chinese-made vaccines are approved by the Chinese regulator, the National Medical Products Administration, vaccine producers should also seek to put their respective vaccines through the WHO regulatory process to achieve WHO approval. A WHO-approved vaccine, like AstraZeneca, is more likely to increase the public’s trust due to WHO-backing, and therefore reduce overall levels of vaccine skepticism. As a report by the ACDC with the London School of Hygiene & Tropical Medicine highlighted, 79% of respondents across 15 African countries, including Nigeria, would be willing to take a COVID-19 vaccine considering it was deemed safe and effective. However, the survey demonstrated a fluctuation in the valuation and trust amongst different international organizations. For instance, the WHO is ranked as the top trusted voice for providing safe messages, whereas the ACDC had a lower trust recognition. As such, Chinese vaccine producers, and the ACDC, should seek to partner with trusted sources like the WHO to convey safety messages regarding vaccines to the general public.
Thirdly, local manufacturing can play an important role in building confidence too. Faster delivery now is key and only three countries in Africa are planning to manufacture international vaccines – Morocco (the Chinese vaccine), Egypt (Russian vaccine), and South Africa (US Johnson & Johnson vaccine). Local manufacturing can scale up output, create jobs and reduce costs in the long run. Investing in local manufacturing beyond Morocco will also build trust.
Overall, the primary issue regarding COVID-19 vaccination in Nigeria concerns a lack of confidence in a novel vaccine. This is combined with safety doubts due to the unfortunate history of vaccine accidents in Nigeria, Kenya, and other developing countries, which had little to no reparations to dispense justice or hold necessary individuals/organizations responsible. Uninformed media reports, in combination with lack of access to multiple knowledge perspectives, also play a role in vaccine refusal. This attitude is extended towards COVID-19 vaccines in general, including the Chinese vaccines. Yet, there are ways to overcomes these hurdles, and Chinese support regarding information-sharing will be central for both increasing public trust in Chinese-manufactured vaccines and an efficient vaccine rollout.
Ovigwe Eguegu is an Abuja-based international security analyst.