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How dysfunctional health system robs Nigerian children of vaccines (Part 2)


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Adetola BADEMOSI, in this concluding segment of a two-part report, writes on how children miss out on important vaccines and irregularities between public and private hospitals routine immunisation schedules.


VACCINES racketeering thrive in some government hospitals visited

DURING this investigation,  Nigerian Tribune discovered nurses also engage in sharp practices through vaccine racketeering for interested parents.

Once they sense mothers’ willingness and readiness to get the vaccine, they offer to provide the shots at a cost believed to be lesser than what is obtainable in private hospitals.

Sadly, the trend has continued to thrive because parents can strike a bargain with the nurse, making fast money.

For instance, findings in the FCT revealed that a dosage of chickenpox vaccine in a private hospital costs N22,000 or more, depending on the healthcare provider. Simultaneously, the same can be gotten from between N16,000 to N18,000 in a public hospital.

A child between ages 12-15months is then required to take the first and second doses at different intervals, making a total of N36,000.

At a popular private hospital within the Central Business District (CBD), close to Church Gate, the cost of getting the Hepatitis A vaccine is N16,500.

In an interaction with this reporter, a parent, Mrs. Gloria Ndubuisi, explained how she could get the Chickenpox and Pneumococcal IV vaccine at the sum of N22,000 altogether with the help of a nurse at a popular Government hospital in Abuja.

To further authenticate the racketeering claim, this reporter visited the Federal Staff Hospital, Abuja, with a two-year-old child to enquire about the cost of getting a child immunized against Hepatitis A.

The dark, slim nurse on duty, who owns an account with Access bank account number 0041***183, tactically ushered this reporter to a quiet corridor and said, “we don’t give, but if you need it, I can get it for you. It is N8,000 for a dose. The second dose will be after four weeks.”

However, the efficacy or safety of these vaccines cannot be vouched for, as inappropriate storage could affect its potency.

The WHO 2015 report on vaccine storage titled:” The vaccine cold chain” describe vaccines as sensitive biological products. While some vaccines are sensitive to freezing, some are sensitive to heat and others to light.

According to the report, vaccine ability to adequately protect the vaccinated patient can diminish when exposed to inappropriate temperatures.

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“Once lost, vaccine potency cannot be regained,” the report stated.

“To maintain quality, vaccines must be protected from extreme temperatures. Vaccine quality is maintained using a cold chain that meets specific temperature requirements.”

While confirming the findings by Nigerian Tribune, the National Primary Health Care Development Agency (NPHCDA) said it had commenced a discreet investigation in partnership with the Department of State Services (DSS) to arrest perpetrators in Abuja.

It particularly mentioned such acts were mostly rampant at the Jabi Medical Centre, Abuja.

But the case was completely different at the Lagos State University Teaching Hospital (LASUTH).

The immunisation nurses on the seat had instead directed this reporter to get a vaccine prescription from the staff clinic before proceeding to the pharmacy to make payment.

After the process was completed, the total cost for a dose of both the MMR and Chickenpox vaccine, alternatively known as varicella, was put at N14,630.

Rota., Chickenpox, MMR, PCV IV, how important?

According to the WHO, Rotaviruses are the most common cause of severe diarrhoea disease in young children worldwide.

As a result, it recommends that rotavirus vaccines be included in all national immunization programmes and considered a priority, particularly in South and Southeast Asia and sub-Saharan Africa.

While corroborating this, the Centre for Disease Control and Prevention (CDC) says the virus can easily spread among children and could cause severe watery diarrhoea, vomiting, fever, and abdominal pain.

UNICEF describes diarrhoea as the leading killer of children, accounting for approximately 8 per cent of all deaths among under-five globally, as of 2017.

Besides exclusive breastfeeding, UNICEF, among several other preventive measures, recommended the rotavirus vaccine, saying it “protects one of the most common causes of childhood diarrhoea-related death.”

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On the other hand, chickenpox is described by UNICEF as, “single virus that can linger for a lifetime.”

According to WHO 2015 report titled: Immunization, Vaccines and Biologicals, the varicella virus, alternatively Chickenpox, is regarded as highly transmissible via respiratory droplets or direct contact with characteristic skin lesions of the infected person.

When infected, the virus remains latent in nerve cells and may be reactivated, causing a secondary infection called herpes zoster in adults.

The report adds that the Varicella vaccines are available either as a single antigen and in combination with measles, mumps and rubella vaccine (MMR).

While the WHO describes measles as a highly contagious disease caused by a virus that mostly results in high fever and rash, Rubella is an acute, contagious viral infection that usually causes a mild fever and rash in children and adults.

Although Nigeria has introduced the Measles II vaccine dose in the national schedule, the WHO recommends that countries take the opportunity of accelerated measles control and elimination activities to introduce rubella-containing vaccines.

FG, stakeholders react

When contacted Dr Bassey Okposen, Director, Disease Control and Immunisation, National Primary Health Care Development Agency (NPHCDA), in a 26 minutes interaction with this Reporter, affirmed this reporter’s findings on government skipping the Rota Vaccine despite its inclusion in the schedule.

He said the vaccine included in the national schedule was not approved because the GSK brand being sought for was not available globally.

But, Okposen disclosed that its roll-out would commence in the third quarter of 2021 as the agency already got its approval.

“We have currently gotten approval from GAVI. It is the timeline of delivery which we are looking at in the third quarter.

“For us, we are bent on getting the RotaSiil because it is the best in the world. That is the brand from GSK, but the story is that it is not available globally, and for Nigeria, it will not be enough.”

Okposen further stressed that the MMR vaccine had not been approved by the FG, saying: “you cannot introduce MMR in a country if you don’t have a routine immunization of 80 per cent and above. It’s the standard anywhere.”

He argued that introducing mumps to the measles shot may prime children for CRS or down syndrome.

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“We have severally said this, there is no need to introduce mumps vaccine in Nigeria like the MMR, but if you go to private clinics, you will see it, and many such children will still come down with CRS,” he stated.

Like others, he asserted that private hospitals who give such vaccines are merely “out for business”.

For other vaccines listed in the report, the Director noted that the government could not fund vaccines for diseases or viruses considered eradicated.

From his explanations, he said before vaccines are introduced, the significance of such disease on public health is considered.

“…If you look at chickenpox, for instance, where did you see a typical case of such? So why would we give the vaccine? We will just be wasting money,” says Okposen.

On the likelihood of disease resurgence, he explained that: “In public health, once the herd immunity is building, the disease disappears on its own, and that is what we are trying to do in COVID-19. Once we have herd immunity of 70 to 80 per cent on its own, it will move to where the herd immunity is low. It is natural.”

On the contrary, a Virologist and Medical Laboratory Scientist, Dr Solomon Chollom, argued that every disease prevention vaccine should be administered regularly.

He reminded that Nigeria lacks vaccine-producing institutions and resorts to importing these vaccines, which cost the nation a fortune.

As a result, Dr Chollom said: “in an attempt to cut costs, they look at the epidemic map in Nigeria to see which diseases are much more prevalent and likely. So they seem to streamline.”

He, however, said irrespective of the circumstances surrounding this, every vaccine-preventable disease that already has a vaccine developed for it, should be captured in the schedule.

The Virologist further faulted claims that the MMR vaccine could prime children to CRS or down syndrome, saying: “…but there have not been such clear cut instances that had to do with safety.

“You need to understand that when people want to do the wrong things, they will always get intelligent reasons. They put up intelligent reasons to defend their positions but scientifically, there is no evidence backing that claim.”

In his reaction, Dr Chris Akude, a Family Physician with a leading private hospital in Abuja, countered claims that such vaccines were listed to swindle parents.

He said public hospitals do not list them in their schedule as they are paid for.

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“It is not entirely true. You know, sometimes, when you don’t answer a question, you label everyone as bad. It is not swindling. Secondly, those you actually pay for them, those who can afford it get it and those who can’t don’t get it.

“So what it means is that their children will be exposed to it. If you go abroad, all those things are covered. It is not covered. It is like here if you want to do a CT scan, it is N60,000. How many people can afford that? But it is there in private hospitals. Does that now mean we are swindling them? It only means that we can provide the service to those who can afford them.”

This report is done with support of Wits Journalism and the African Investigative Journalism Conference.’

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