Should Nigeria Go for Mass Vaccination against COVID-19 or Not? 2
Muhammad Saddiq ([email protected])
Continued from January 20, 2021…
My analysis focused mostly on one side of the cost-benefit analysis equation, the cost elements where I illustrated that using the Pfizer and BioNTech vaccine “to vaccinate 150 million Nigerians we need at least 300 million doses – this is $11,700,000,000.00 or ₦ 4,460,040,000,000.00! Approximately ₦ 4.5 Trillion! Nigeria’s budget was ₦ 10.8tn in 2020”.
Of course, there are cheaper vaccines now in the market, for example, the Oxford and AstraZeneca vaccine, which is priced at under $4 per dose. Moreover, AstraZeneca is a member of the Covax, a global initiative aiming to distribute two billion vaccine doses to 92 low- and middle-income countries (LMIC) including Nigeria at no more than $3 a dose. Neither Pfizer nor Moderna has joined the initiative. However, there is a long waiting queue and it is only 70% effective compared to 95% for the Pfizer and BioNTech vaccine. This difference is very important in assessing the benefit side of the cost-benefit equation.
The cost of vaccine alone to vaccinate 150 million Nigerians (at least 300 million doses because you need two doses per person) is ₦ 355,453,830,000.00 using the LMIC price of $3 per dose. This is within the range of ₦ 500 billion being quoted by the federal government for purchasing vaccines. The proposed budget in 2021 for the entire health sector is ₦ 547 billion. It is difficult to know the benefit we can derive if the health budget will deliver 100% performance but I think even in a worst-case scenario it is safe to assume that it would more than double the benefits of COVID-19 vaccination alone. Therefore, the jury is still out even on the cost side of the cost-benefit analysis. Now let us look at the benefits side.
So, what are the benefits of mass vaccination in Nigeria? (1) The country can potentially achieve herd immunity faster if we can vaccinate faster than the rate of spread of the disease. The rate of spread of the disease is calculated using the effective reproduction number or “r”. (2) Fewer people will become ill and save cost on treatment and hospitalisation. (3) Fewer people will die from the disease. (4) Services that have been suspended or restricted would open helping the economy to recover.
We will look at each of these points step-by-step with a GIGANTIC WARNING that the figures are much lower than the actual cases for several reasons but chief among these is limited testing. As of today 22 January 2021, only 1,225,179 tests had been conducted for a population of over 200 million!
First, the effective reproduction number (r) is currently 1 (0.74 – 1.3) which suggest that the expected change in daily confirmed cases is stable (i.e. neither increasing nor decreasing). This also indicates that the number of cases doubles every 87 days. That is, with the current confirmed cases 116,655 and given r, we expect to have about 233,310 confirmed cases by April 18, 2021. A fraction of this number will develop symptoms or require hospitalisation and treatment. The significance of this point is that our vaccination programme if we aim to achieve herd immunity must reach people faster than the rate of spread of the disease. Which means by 18 April 2021 we need to vaccinate 116,655 people at the barest minimum to beat the current rate of spread of COVID-19. Of course, r goes up or down over time and depending on the effectiveness of other preventive measures. Vaccination will only make sense if we can significantly beat the spread of the virus not just match it. This reopens the question on the feasibility criteria from the last post on this topic. Most especially how fast we can access the vaccine from the manufacturers given that 3 billion doses had already been pre-ordered by rich countries. With the US re-joining the World Health Organisation and Covax, we will keep an eye on developments in this regard.
Second, despite the current increase in cases the percentage of people that died from the disease among those confirmed with the disease or case fatality rate (CFR) is going down steadily and it is currently below 1.5% compared to 3.5% in April 2020. We can estimate that at the current rate the number of deaths from COVID-19 by April 2021 will be about 3,500. While this is unfortunate and any loss of life is regrettable, it will rank at the bottom of the list of major causes of death in Nigeria during this period. For example, 58,000 women died from pregnancy and childbirth-related causes in Nigeria in 2015. This is unlikely to be different in 2021. By the time COVID-19 killed 3,500 people well over 24,000 women would have died from pregnancy and childbirth-related causes in Nigeria.
Third, I will leave the economic and social impact of school and workplace closures, restrictions on public gatherings, transport restrictions and stay-at-home requirements to those with expertise in these areas, i.e. economists, psychologists and sociologists.
Finally, the cheaper vaccines such as the Oxford/AstraZeneca vaccine and the change in direction in Washington may all weight in favour of Nigeria pursuing a policy decision to mass vaccinate. However, the odds are still heavily stacked against this decision in terms of the total cost of the vaccine alone in comparison to our total health budget and if saving lives is a crucial consideration, as it should be, then other policy options can save 7 times more lives than the vaccination programme for a relatively less outlay.
- My position is not against mass vaccination but a holistic look at what is most beneficial for the country for sums being contemplated!
Concluded.
Mr. Sadiq ([email protected]) is a Senior University Teacher at the University of Sheffield, UK.
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