IBADAN, Nigeria — As the world continues to grapple with the COVID-19 pandemic, Africa’s most populous country has been hit by a yellow fever outbreak.
At the beginning of this month, there were 530 suspected yellow fever cases and 48 confirmed cases, as well as 172 deaths, reported across five states in Nigeria. Two weeks later, a situation report from the Nigeria Centre for Disease Control showed that the outbreak had spread to 13 of the states in the country, with more than 3,000 suspected and 108 confirmed cases.
While COVID-19 has resulted in the deaths of about 1.5% of those that tested positive for the coronavirus in Nigeria, the case fatality rate for the yellow fever outbreak is 17% among confirmed cases and 22% when including suspected cases.
In addition to yellow fever and COVID-19, Nigeria is also dealing with ongoing outbreaks of Lassa fever, measles, monkeypox and cholera, and health officials in the country are stretched as they are saddled with the task of responding to multiple disease outbreaks at the same time.
However, despite the burden of the multiple outbreaks, primary health care workers believe that a yellow fever vaccine campaign in response to the new outbreak will provide them with an opportunity to test-run their grassroots vaccine delivery chain in preparation for the COVID-19 vaccine.
“We heard that the COVID vaccine will be distributed next year. We are the ones that will distribute it, and this is an opportunity for us to get ready.”— Alaba Seun, primary health care worker, Iyana Church Primary Health Centre
In a statement, NCDC told Devex that it is coordinating mass immunization efforts in various parts of the country while also enlightening the general public on yellow fever.
“We are producing information, education and communication materials that will be distributed to states to sensitize communities and increase awareness for yellow fever [and we will] continue to support affected states across all pillars of response in addition to continued harmonization of surveillance and laboratory data,” NCDC stated.
In the local government area of Egbeda in Oyo State, a vaccination campaign is already underway, despite the area only having two suspected cases of yellow fever.
Alaba Seun, a primary health care worker at the Iyana Church Primary Health Centre — a local government facility — said that she and other health workers in the local government and across the state were drafted to participate in the vaccination campaign at the beginning of the month.
Seun added that the double burden of COVID-19 and the new outbreak has put pressure on health workers.
“Aside [from] looking out for patients with COVID symptoms, we now have to also be conscious of patients that may have yellow fever. We are very scared of what else is out there that we are not yet tracking but is also deadly,” she said.
A test run for the COVID-19 vaccine
Though this new outbreak has put a strain on health workers, Seun said that it has also provided the country with an opportunity to test-run its grassroots vaccine delivery chain in preparation for the COVID-19 vaccine.
“We heard that the COVID vaccine will be distributed next year. We are the ones that will distribute it, and this is an opportunity for us to get ready,” she said.
Last week, Nigerian Health Minister Osagie Ehanire announced that Nigeria could get some doses of the approved COVID-19 vaccines in early 2021 through the COVAX Facility.
“We signed up for advanced market participation in COVAX. So, if we will be able to get our own, I think it will be in January,” he said.
A survey conducted in 15 African countries found that about 80% of people would take a COVID-19 vaccine. However, researchers warn that those who are reluctant might be able to influence those on the fence.
According to a survey conducted by the Africa Centres for Disease Control and Prevention, the London School of Hygiene & Tropical Medicine’s Vaccine Confidence Project, and ORB International in Nigeria and 14 other African countries, about 80% of people there would take a COVID-19 vaccine once it is publicly available and deemed safe and effective.
The yellow fever vaccine campaign has also been well received by the community. Seun said she has not encountered any vaccine hesitancy — a development she attributed to the long-standing trust that the primary health center has gained with the people.
“I’ve been working here for nearly 15 years now, long before COVID or this yellow fever outbreak. I know everyone, and they all know me. I stay in this area with my own family, so we have developed trust that will extend beyond present or future pandemics,” she said.
Banke Ibidun, a local hairstylist who recently received the yellow fever vaccine, said she was inoculated despite her fear of needles after health workers explained the dangers to her.
“They told us that several cases have already been reported in our local government and that the disease can be easily transmitted. So I summoned courage to receive it. … I wouldn’t have received the vaccine if we weren’t convinced that yellow fever could be life-threatening,” she said.
The need for better surveillance
However, despite these positive indications, public health experts have warned that the country needs to do more to improve its response to outbreaks.
Devex bought an official yellow fever travel document for $8.50 with no evidence of immunization.
Dr. Hilde De Clerck, emerging infections adviser for Médecins Sans Frontières, said that Nigeria and its partners need to commit additional resources toward ensuring that personal protective equipment and other hygiene tools are available wherever they are needed, while World Health Organization consultant Oyewale Tomori added that more needs to be done to improve disease surveillance.
Tomori warned that failure to improve surveillance and cohesion among public health players will result in regular outbreaks with an “unacceptably high number of deaths that are due to failure of past and present governments to take appropriate public health measures that could help prevent and control diseases.”
Last year, Devex reported that many Nigerians were illegally procuring yellow fever vaccination cards for travel purposes, despite the government’s efforts to clean up the process. This latest outbreak comes after the government issued tens of thousands of electronic yellow fever immunization cards to citizens, according to the Nigerian port health authority. Tomori said that this oversight has put the country at risk.
“The well-being of the country should be the primary thing and not the few bucks people illegally selling the cards without vaccinating the people will get. We should always ensure that we do whatever has to be done,” he said.