Should Nigeria Go For Mass Vaccination Against COVID-19 or Not?
By Muhammad Saddiq
A key starting point for any policy is to have a policy goal. Therefore, before addressing the main topic of this post I will first tackle the question:
What is the goal of COVID-19 vaccination for Nigeria?
Even though COVID-19 vaccination has been a subject of much debate and misinformation, as of now, there is no information about Nigeria’s goal for the vaccination programme from either the presidential task force (PTF), federal ministry of health (FMOH) or its relevant agencies. The closest information about this was in the recent (January 15, 2021) broadcast on arise TV, where the Executive Director/Chief Executive Officer National Primary Health Care Development Agency stated, “We are looking to vaccinate 70% of the population… up to 150 million Nigerians”. This suggests that the thinking is towards mass vaccination, which is also consistent with the African Union-led plan to vaccinate at least 60% of the population of the continent. Therefore, it is safe to assume that the goal is mass vaccination aiming to achieve herd immunity.
Now back to the main question.
Should Nigeria go for mass vaccination against COVID-19 or not?
There is a wide range of criteria that could be used to address this question. However, the majority of the conversation on this topic is limited narrowly to the questions of safety and efficacy/effectiveness of the available vaccines. There is no doubt now that there are at least three vaccines certified safe and effective for COVID 19 by some of the world-leading regulatory agencies.
Moreover, data is publicly available for “doubting Thomas’s” who may wish to have a closer look before making up their minds. If the decision is purely that of medical science, that is, the safety and effectiveness of the vaccines then it will be wicked to deny Nigerians the benefit of a safe and effective vaccine against a disease that has killed many, destroyed livelihoods and pushed the country into recession. However, much more than biomedical evidence is required for policy decisions. Therefore, to fully address the question posed here, I will add four more criteria (to the first two already mentioned – safety and effectiveness) that any policymaker must take into account in making such a decision.
The most important criterion after safety and efficacy from a policy perspective is Cost-benefit. Cost-benefit is about how much health benefit would Nigerians gain compared to how much money Nigeria would spend to mass vaccinate the population as proposed. In short, is it worth the cost?
Three things are important here:
(1) The current and ongoing cost of the existing countermeasures;
(2) The extent to which introducing the vaccine would influence this cost over time; and
(3) The cost of deploying the vaccine.
In a report by Brookings Institute, the federal government of Nigeria says it will require $330 million to procure medical equipment, personal protective equipment, and medicines for COVID-19 control alone. Additionally, there were several stimulus packages by the Central Bank of Nigeria and some other interventions such as the Economic Stimulus Bill 2020. There is no doubt that the country is haemorrhaging money towards testing and tracing, public campaigns, support to families and businesses, etc.
However, it is unclear how effective these interventions have been or how long they would be sustained. The question then becomes, would mass vaccination help reduce the volume of current spending or the duration of current spending? This can be fitted in a model if data is available.
The second consideration is the cost of deploying the vaccine, that is, how much would the vaccine cost? Pfizer and BioNTech have set the initial price at $19.50 a dose, which comes to $39 per patient (since each vaccine requires a two-dose regimen). 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.
That is nearly half of the total national budget to just buy the vaccines. Remember this does not include the cost of shipping, distribution, training and administering the vaccine! The $330 million proposed for the current COVID-19 control pales in comparison to the amount we need to only buy the vaccines.
Another important factor to consider is what alternative benefits can we get from the ₦4.5tn if this money were to be spent on something else (for example, a package of primary care services) other than the vaccine? ₦4.5tn is equivalent to ₦ 22, 300.20 per person (assuming a population of 200 million). The National Health Insurance Scheme (NHIS) will provide an individual full access to primary, secondary and tertiary services at an actuarially determined amount of ₦15,000 per annum. That means with the money to buy COVID 19 vaccines for 150 million people all of us can have full Universal Healthcare Coverage with each person having an extra ₦7,300.20 to spare!
Regarding the next two criteria – feasibility and acceptability, I think because of our experience with vaccination campaigns including our success in eliminating polio through mass vaccination programmes, it would be hard to argue that we can undertake mass vaccination of this scale. This success with polio vaccination happened despite significant resistance in some areas.
Finally, equity, a sound policy aims to ensure that no section of the population is discriminated against by the policy because of certain characteristics that they may have. Even before the pandemic hit, the majority of the population in Nigeria do not have access to essential health services they needed. Without addressing the structural disadvantages such as rural vs. urban, poor vs. rich in the distribution of health services, the COVID 19 mass vaccination campaign will replicate or intensify the pre-existing disadvantages.
While we are all excited about the potential benefits that the availability of COVID 19 vaccine brings and eager to return to our “normal” lives, policymakers should reflect on factors beyond the worn-out argument over safety and efficacy or even the wild conspiracy theories. Instead, they should consider the wider implications of their decisions and ensure that policies are pursued that will bring the maximum possible benefit to the largest possible people.
Mr. Sadiq (firstname.lastname@example.org) is a Senior University Teacher at the University of Sheffield, UK.
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