Nigeria to begin local production of vaccines
Nigeria will tomorrow, July 24, 2015, be celebrated all over the world for having for the first time ever been able to interrupt the transmission of the Wild Polio Virus (WPV). The most recent case had onset of paralysis on July 24, 2014, in Sumaila Local Government Area (LGA), southern Kano state. This means that the country may be delisted from the list of polio endemic countries that include: Afghanistan and Pakistan by mid August and may be certified polio free by the World Health Organisation (WHO) if she can maintain the tempo for three consecutive years. Executive Director National Primary Health Care Development Agency (NPHCDA), Dr. Ado Gana Muhammad, in an exclusive interview with The Guardian said the agency has set up a Think Tank play the End Game, which has come up with recommendations for sustainable financing for vaccines that include looking at the States co-joining the federal government to fund immunization and resuming local production of vaccines with the help of the private sector, among other things. CHUKWUMA MUANYA writes. Excerpts:
NIGERIA will tomorrow mark one year after the last case of polio recorded the same time last year. What does this mean to the country’s efforts towards stopping the transmission of WPV and eradication of the virus? For us as a programme, we are very fulfilled, fulfilled in the sense that this is one-year without the case of poliovirus in Nigeria.
With the last case recorded in the Sumaila LGA of Kano state, precisely on the 24th of July 2014. So by Friday, which will be 24th of July 2015 that would have made a year without the case of poliovirus.
This has a lot of significance, particularly public significance, first Nigeria will be delisted as a polio endemic country, leaving just Pakistan and Afghanistan. And secondly, what it also means is that no child has been paralyzed in Nigeria in the last one year, which is also very good for us.
And thirdly, is a major milestone towards eradication, because for any country to be certified polio free, and then to also receive certificates from WHO, that country should not have seen any case about poliovirus for three years. So with one-year milestone that the country would be achieving by Friday, it will take us additional two years that is by 2017, for us to receive certification. Is a journey that was rough, rocky, with difficult terrain in terms of program challenges here and there that we had.
But happily for us, and also commendable for Nigerians that we are there, but I also want to say that we cannot afford at this stage to be complacent, because we do not want a situation that will deal with the infection because we have seen countries that have interrupted and they got infected, so that is why we are strengthening the quality of the campaign, we will continue to improve on the quality of the campaigns.
And secondly, we will continue to insure that our routine immunization works along very well. Am sure you are aware of the fact that, the routine immunization system in Nigeria is getting improved.
Then thirdly our surveillance system, you know also have to be very responsive and then pro active. So far the sensitiveness of our surveillance system is about 85 per cent in the polio endemic areas, that is the average.
Before now, in 2010, 2011, the surveillance system was only about 65 per cent sensitive, so you can see that all those parameters that will determine the sustainability of the progress we have made would put them in place and continue to improve them. Does it mean that WHO will certify Nigeria polio free after Friday? WHO will not certify Nigeria polio free after Friday, there are criteria that will determine weather a country should be certified polio free or not, and there are milestones that we need to achieve.
Now, Nigeria, has never interrupted transmission of world poliovirus, what it means is that Nigeria has never been free of poliovirus transmission for a year, in fact the highest we have had since 1988 when the polio campaign started, it was just one month without a case of poliovirus.
This is the first time in the history of public health in the country, in the history of the agency that Nigeria has been without a case of poliovirus for a year. So Nigeria will be interrupting world poliovirus transmission for the very first time in the history of public health, in the history of the agency, in the news of federal ministry of health on Friday, July 24, 2015.
We still have samples in the laboratory that are pending, now those samples, the moment they come out negative, then Nigeria, and which we expect to come out negative, we are optimistic that they will come out negative in two weeks after July 24, we will receive formal communication, after all the samples have been cleared from WHO.
And by the time we seek that formal communication, Nigeria will be removed as a polio endemic nation having attained a critical milestone as part of the polio eradication efforts. The road to eradication is long, but the major milestone on that journey is interruption, which we are about to achieve.
Two years after, if there is no infection, if the surveillance system is ok in such a way that if any case immerges anywhere, that case will be picked. Routine inspection is working very well, and the quality of the campaigns that are being held are also very good just the way they have been the last time.
Three years after, then Nigeria will be issued certificate of eradication, and then Nigeria will now be called polio free nation. But the first stage, which we will attain on Friday, is when Nigeria will be delisted as a polio endemic country. How about the issue of inactivated injectable polio vaccine (IPV)? How far with the plans? Has it started? Yes, we commenced using inactivated polio vaccines about a year ago, and then we took the wrong approach to it.
First, we used the accelerated introduction, and then secondly we also went into the routine immunization aspect. Remember that inactivated polio vaccine, has two key benefits among others. First, it is part of the end game strategy for polio eradication; countries are being asked to use inactivated polio vaccine as part of the routine immunization and as part of polio campaign.
And now for us, the advantages are two: first, we are using it to consolidate on the gains we have met with the use of OPV, because it is proven that if a child that has received two three doses of OPV, receives a shot of inactivated polio vaccine, that will boost the population immunity. It will boost the sero conversion of the child to about 85 per cent to 90 per cent, which is very good.
So we have over taken advantage of that, to consolidate on the gains we have made with OPV. Secondly, the introduction of inactivated polio vaccine too is a way of containing the type 2 circulating vaccine-derived poliovirus (cVDPV2). For those areas that inactivated polio vaccine has been introduced it also brings to zero the cases of cVDPV2.
Thirdly, using inactivated polio vaccine, we are also achieving the switch because by 2016 countries are being advised to switch over. So it is a strategy to making the switch over from OPV to injectable inactivated polio vaccine happen. In Nigeria, it has also been introduced as part of routine immunization.
What we have done is that we have targeted Borno, Yobe and Kano and we have used it as part of the accelerated introduction. So it has not gone round the country? It has. It has. So the first phase was to use it as part of the accelerated introduction, as part of the polio campaign, which we have done in Kano, Borno and Yobe.
The second phase was introducing it as part of routine immunization. As it is now, inactivated polio vaccine is part of routine immunization in Nigeria and I think we just have about seven states left that has not come on board. How about Lagos? Lagos has come on board.
You can go to the facilities in Lagos. But Nigeria is still reporting cases of cvdPV2. What does this mean to Nigeria’s efforts to eradicate polio? The cVDPV2 is indication of some challenges with routine immunization and what we have done is that we have introduced inactivated polio vaccine (IPV), which will address cVDPV2.
Secondly we are also strengthening routine immunization in all the political wards in this country and that is why vaccines are available all over the country. Secondly we also are providing cold chain infrastructure in all the political wards in the country. Out of the 10,000 political wards we have in Nigeria it is only about 1,200 political wards that we have not provided with direct solar drive.
The idea behind it that when the vaccines have been made available we make sure that do not remain at the local government headquarter, because for enumeration officer to move from a ward to go to local government headquarters becomes a challenge sometimes.
So we are moving the vaccines to the frontlines. So the vaccines will be made available in all the political wards so that each and every child can be immunized right in front of their households and that has really improved. It is feared that this issue of cVDPV2 affects Nigeria’s chances of being delisted as polio endemic country? No! When was the last case of cVDPV2? We had the last case of cVDPV2 about few months ago.
But before then the last case was in November 2014 but we had a case few months ago. I want to assure you that we also treat that as an emergency and we respond to it just like we respond to any case of wild poliovirus. But does it affect Nigeria’s status? No it does not.
What are your plans for the final push to eradicate polio? Are you still going to be holding mass campaign? We have a campaign that will take place in August immediately after the Expert Review Committee (ERC) meeting, which will be in the second week of August. After the second week of August when we have the ERC meeting, we will be proceeding to the field to carry out another campaign.
That is part of our strategy to sustain the gains we have made and we are making. We want to ensure that the quality of the campaign is not less than 90 per cent across all the endemic states. Secondly as part of the end game strategy we are strengthening routine immunization particularly with OPV component of routine immunization. So every child irrespective where he or she is receives the appropriate dose of OPV.
We have also introduced IPV as part of routine immunization all over the country and that will be consolidating the gains we have made in OPVC sero-conversion and that will also assist us in terms of curtailing the cVDPV2. In addition we will continue to work at the subnational level.
First the federal government will continue to support the programme in terms of funding, in terms of oversight, in terms of political support. We are also going to advocate to states and local governments to continue to support the programme at that level because interruption does not mean eradication.
Our aim and goal is to eradicate not only to interrupt. Interruption is only a milestone towards eradication. We are on a journey and we have reached certain level in that journey through interruption.
But the ultimate goal is that we will not rest until we attain eradication. So this calls for all stakeholders to redouble their efforts; not only government but also civil society organisations and media, traditional institutions and religious leaders.
So we will continue to advocate to all stakeholders that have assisted us to this level, ‘let us not over celebrate because we have not reached our destination. Our destination is eradication.’
Hopefully by the third week of August we would have interrupted WPV. But after interruption will mass vaccination continue or are we going to stop and concentrate on routine immunization? The vaccination will still continue but the frequency will not be as it used to be.
We will scale down on the number of mass campaigns that will be undertaken. While doing this we will keep on looking at the epidemiology because this programme is guided by data; we are data-driven. So we keep on looking at the data, we keep on looking at the epidemiology, we will keep on looking at the surveillance report and that will determine the frequency of the campaign.
But even when the campaigns will be held, I want to assure you that the quality of the campaigns will have to be better than what it use to be. We are working towards improving it. It is dynamic so we keep on improving the quality.
In addition we will continue to strengthen routine immunization because ultimately even after eradication, routine immunization is the way to sustain the gain. I am cognizant with that fact so we keep on ensuring that our facilities provide very reliable routine immunization services.
Polio is not the only disease the agency is tackling. How far with the immunization campaign against other vaccine-preventable diseases? Polio is only one of the diseases that we are trying to prevent.
We also have diseases lined up, some for elimination. First of all routine immunization is the bedrock of any health system and we as an agency has deliberately made effort to ensure that all vaccines are available for all vaccine preventable diseases.
So everywhere in this country we have vaccines in all our health facilities but there are some diseases that we are controlling through mass vaccination because of the epidemic nature of those diseases like measles. Over the years measles has continued to bring a lot of burden both in mortality and morbidity on our children. So the programme is working towards eliminating measles by 2020.
Every two years we carry out mass vaccination against measles. In fact the next phase will take place in November 2015 in northern part of the country while the southern part will benefit in December this year. We will be targeting about 32 million children aged one to five years both in the northern and southern part of the country.
That is another major intervention that the agency is carrying out in terms of containing this disease. We are also working on preventing meningitis.
You will recall that in December 2011 we introduced the Mening A vaccine initially in seven states targeting one to 29 years. In 2012 we also took on additional seven states. By 2013 we have immunized all the states of the federation and that also is another strategy to make sure that we do not record any outbreak.
Before 2011 when it is meningitis season, there is panic because people will get morbid and thousands of people will die. But we have not had any outbreak of meningitis since 2011 due to Mening A vaccine we have introduced. So all these are things we are putting in place to ensure that we contain and manage epidemic diseases while also ensuring that our routine immunization system also works.
While doing this we are bringing new vaccines as part of routine immunization. We have brought in pentavalent vaccine to replace diphtheria (DPT) we have brought in IPV as part of our routine immunization. We have also introduce the pneumococcal conjugate vaccine to contain pneumonia, which is a major killer of under five and we are about to roll out rotavirus vaccine for diarrhoea diseases and we are also working on Human Papilloma Virus (HPV) vaccines for cervical cancer.
When is the Rotavirus vaccine coming? We are working towards the end of 2016. How about the HPV vaccine? We are carrying out demonstration studies in a number of locations because you don’t introduce HPV vaccine on a mass scale. It has to be pretested to see the efficiency and also look at the response then the scientific finding from that will now determine the scale up.
When are you planning to introduce it? The outcome of the findings will determine that. There is a big challenge globally in terms of funding for health especially increasing domestic funding.
So how are you addressing the issue of funding in terms of sustaining your programmes and introducing new vaccines? The cost of immunization is increasing as well as the cost of immunizing a child and that is not unconnected with the introduction of new vaccines.
It is becoming difficult for government alone to bear the cost of immunizing a child. There is nowhere in the world where you expect only government to do that. Our private sector should come in and organize business community should also come in to support immunization.
How are you footing the bill? We are being proactive. Already we have constituted a Think Tank team that is working on sustainable financing for vaccines.
There are a lot of options that we are looking at. We are looking at the States co-joining the federal government to fund immunization because as it is now it is only the federal government that is providing funds for immunization. So we are looking at the option of states co-financing procurement of vaccine.
We are also exploring the possibility of the business community also contributing to financing of immunization. Another option that the team is looking at is the possibility of taxation.
As part of taxation a component will be dedicated for immunization and then even though it may not be very easy the option of people adopting children because the cost of immunization is known per child and we want to see if people can adopt children, maybe an entrepreneur adopting children in a whole local government by providing the fund for their immunization.
We know how many children in each local government and we know how much it costs to immunize a child in that particular local government which is uniform across the country. We will be able to advise individuals on how much it will cost to adopt a local government.
So all these models are being worked upon to ensure that we maintain the gains, we sustain vaccine availability. Are you considering local production of polio vaccines? While working on these options it also important to note that sustainable vaccine financing goes beyond just money for the vaccine, money for procurement of the vaccine itself but it also include local production of vaccine.
We have seen instances that even when you have the funding vaccines are scare in the global market. So what we have done and what we are doing as part of that team that is working on sustainable financing for vaccine is also to explore local production for vaccine.
We are talking to a number of pharmaceutical outfits that have indicated interests to commence local production of vaccine so that even when we get the funding for vaccine there wont be scarcity because of competing needs with other countries. So we just procure the vaccines in country and that will confer some advantages.
First it will conserve scarce foreign exchange for us and also generate employment for the youths. So why have we not been producing vaccines local all this while? Does it mean we do not have the capacity? You remember in the 1960s and early 1970s yellow fever vaccine was been produced in Yaba, Lagos, but the a lot of things happened and we could not continue and that is not unconnected with the issue of equipment breaking down and the expertise that were managing the facilities.
All kind of factors affected the production but Nigeria is now interested in commencing local production of vaccines and this time around the private sector coming on board unlike before when it was government driven.
You know that government should not be involved in doing the business we should only provide the framework for the private sector run the business.
Who and who are involved in this government plan with the private sector to begin local production of vaccines? That is Bio-vaccine by May and Baker.
They have a joint venture agreement with federal government, which is being looked at now and really that has not become effective yet because it has not been finalized by the federal government. But so far they have shown much more interest than any other pharmaceutical outfit in terms of local production of vaccines and we are discussing with them.
So we are also discussing with other pharmaceutical outfits so that we leave the options open. What we want ultimately is for commencement of local production of vaccines that will be safe, affordable and we can also use that platform to service the West African sub-region because the market is huge.
There are fears that the security situation in Nigeria will bring a relapse? We, even in the hardest of times, I know that insecurity has been a major impediment for us, in terms of accessing children, particularly in the northern part of the country, and there is security challenge at security compromised areas of these country, but as public health practitioners, as a program, as an agency, we have remain committed to visit children in those areas and that is why we work out number of such issue to ensure that children in those areas are reached, because our work will not be complete without reaching each and every child, because for as long as one child is transmitting the virus , then all the children in the country are at risk, in fact not only in the country, but the whole world is at risk.
Because the world is a global village, in which there is high movement, and so we have develop some strategy, initiatives towards reaching children, particularly in Borno, Yobe, Gombe, Adamawa, that we have some security challenges.
Those strategies, those interventions are not things I should speak on air because the programme is still going on and we don’t want to share that information, not because we do not want to share with you, but because people that have walked against the programme.
You remember we lost about thirteen vaccinators in February 2013, so we do not want a repeat of that. But I want to assure you that children in those areas are covered. We are working with the security agencies, we are working with the traditional institutions, we are working with religious leaders, and we are also working with civil society organizations in those particular areas.
At the peak of insecurity, about 80 per cent to 85 per cent of the local government areas in Borno could not be reached. And then we work on strategy to see how we can reach children in those areas.
But we also have worked on what we call wall fencing in which each and every child that leave in security challenge areas, because there is no movement from secured areas to unsecured areas. So as they move from in secured areas, we vaccinate them.
And then we also have put in place a machinery in motion, that each and every child that is in any internally displaced people (IDP) camps, we have our staffs there and we vaccinate them and we also have health officials, health workers across our boarders, as people migrate across Niger, Chad, to Cameroon, we vaccinate and as they move back into the country, we also vaccinate. That is in addition to other confidential interventions that we have put in place to access children in those areas.
So is a total package and we have also have strengthen routine measures, because you know the polio eradication method is incomplete without routine measures, so we are using the routine immunization platform to also administer Oral Polio Vaccine (OPV) and that has really strengthen our polio eradication efforts.
But the issue of insecurity in the north remains a challenge? It may be, but I want to assure you that with the intervention we have put in place, and the initiative we have conceived, we are beginning to reach children, initially about 85 per cent could not be reached, and then when there was relative peace, we came back to 65 per cent, but as of now, it is only about 35 per cent that cannot be reached.
But even with that, children in those areas are still vaccinated through routine immunization, through some other confidential approach that we have conceive and put in place. There is a concern all over the world as regards immunization. Some people in countries like United Kingdom and United States are beginning to reject vaccination especially that of the measles.
What does that portend for us? We have gone through that journey before. You know the history of polio rejection in Kano around 2003 to 2007 and how we addressed it. Until 2011 and 2012 we had serious problems.
That problem that started in 2003 continued up till 2012 but the way and manner we went about it was based on dialogue with the anti-polio vaccine group.
One thing we did was to put all the cards on the table, we had interaction with them, we met the groups, and we listened to their concerns.
It is feared that what is happening in Europe will cause a resurgence of vaccine rejection in Nigeria? How do you intend to handle that? We have open communication with the same groups that had led the efforts towards rejection of polio vaccine.
We are still in discussion with them and we have an understanding that if there are issues they are concerned about the pages of newspapers, television stations and radio houses are not the best places to present those issues that we need to sit bilateral and discuss and then if we are not able to address those concerns then they can go to press. But so far we have been able to resolve those issues between ourselves.
If they are concerned about anything that is not in the interest of the programme, the best platform to handle that is through a review process and we have an understanding with those groups. Yes it is a concern, yes we are very conscious of that and we are alert to it.
Nigeria has created demand for immunization in such a way that there is rush for vaccine from parents and care givers from all eligible Nigerians and we intend to maintain that because immunization remains the most cost effective way of preventing vaccine-preventable diseases.
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