The last year has been tough. As of April 29, 2021, over 150 million confirmed cases of COVID 19 infection and over 3.15 million deaths due to COVID 19 globally had been reported to the World Health Organization. Thankfully, Nigeria, like a lot of African countries, seems to have been spared the worst of the pandemic. To date, the Nigerian Center for Disease Control (NCDC) has recorded about 165,000 confirmed cases of COVID 19 infection and just over 2,000 deaths. 1 life lost would have been too many; 2000 deaths is tragic.

Despite it all, it was not all gloom and doom. One of the many incredible feats accomplished largely because of the ingenuity and collaboration that resulted from the fact that the entire world had one common problem to surmount was the development of the several COVID vaccines. Some of these vaccines have now received emergency use authorization (EUA), and are being administered in different countries.

According to the Nigerian Primary Health Care Development Agency (NPHCDA), the agency in charge of the vaccine roll-out, the country received 3.92 million out of the expected ~ 14 million doses of Oxford/AstraZeneca vaccine through COVAX on March 2nd 2021. [*The Vaccine arm of the WHO launched a public-private partnership called Access to COVID-19 Tool (ACT) Accelerator]. The NPHCDA also recently announced that it placed a bid for 70 million doses of the one-shot Johnson and Johnson vaccines.

In this article, we review some of the information we know about the vaccines that are likely to be used in Nigeria over the next few months based on the bids reported to have been placed through COVAX. This review is by no means exhaustive. For common questions about the COVID vaccines not answered in this review, you may please refer to the NPHCDA webpage on frequently asked questions – FAQs | NPHCDA. The page includes information about when different groups of people will become eligible to receive the vaccines. It also has a link for electronic self-registration Self-Registration COVID-19 Vaccine Introduction Checklist (vaccination.gov.ng).

To be clear, vaccine efficacies listed in the table below are not for the purpose of comparison as there were elements of each of the trials that make them unique and not directly comparable to one another. Comparing one vaccine to another is somewhat analogous to comparing one child to another–the results depend on what you test, who is testing, when the testing was done, and data continues to be collected throughout their lifetimes which may change outcomes. For instance, the trial for Pfizer reporting the very high efficacy of 95 per cent was before the variants became prevalent. Whereas the trial for Johnson and Johnson was in part from South Africa where almost 95 per cent of the COVID infected patients there had the B135.1 (South African Variant). The countries, racial identities, ages, and medical conditions of the people that participated in the different studies were also different. The table below synthesises some of the key findings for each of the vaccines.

 Pfizer-BioNTechAstraZeneca/Oxford VaccineJohnson & JohnsonSputnik

Ages eligible for vaccine16 and older*                   Trial for 12-15 years concluded. company  seeking EUA in US18 and older18 and older18 and older

Vaccine technologymRNAViral vectorviral vectorViral Vector

Number of doses required.2 doses2 doses *1 dose **2 doses

Source: Trial data, ** Trial for 2 dose series is ongoing

Length of time between doses21 days12 weeks (more recent guidance per UK DHSC and endorsed by NPHCDA)N/A21 days

Source for pfizer: Trial data

Cost/dose20$2-31010

Evidence of efficacy in the trials94.6%, 7 days after the second dose. *66.7%, 14 days after second dose66.9%, 14 days after second dose91.6%, 21 days after first dose

(numbers are from initial phase III trials). Subsequent real world suggest similar efficacies for mild-moderate illness; ~ 100% protection against death from COVID)*Variable vaccine efficacy observed depending on dose received and interval between doses. Combining low dose-standard dose and interval of 12 weeks seemed better for efficacy. It had very minimal efficacy against the mild-moderate COVID disease by the South African variant.*85.4% efficacy against severe/critical COVID disease after 28 days

Reported (expected) adverse reactions from trial and post trial data.In the arm where you got the shot:In the arm where you got the shot:In the arm where you got the shotIn the arm where you got the shot

*More common in younger than older peoplePain, redness and swelling.Pain & Tenderness Pain, redness and swelling.Pain and itching

*Listed adverse effects here are thought to be associated with the vaccine. General:GeneralGeneral

*Most were not serious events and resolved within 1-3 daysGeneral:Headache, tiredness muscle aches, malaise, feverishness and chills, bone pain, nauseaHeadache, tiredness, muscle aches, nauseaFever, headache tiredness, muscle and joint aches

Tiredness, Headache, muscle pain, chills, fever, nausea.Less common: fever >38°C, lymph node swelling, dizziness, belly pain, sweating, rash, anaphylaxis (swollen lips/tongue with trouble breathing)Less common: rash, anaphylaxis (swollen tongue/ lips), high feverLess common: rash, runny nose, sneezing, diarrhea

Less Common: Lymph node swelling, dizziness, anaphylaxis (swollen lip/tongue with trouble breathing)

Ingredients of the vaccinesActive ingredient: mRNAActive ingredient: Active ingredient:Active Ingredient:

Sources: Inactive:Recombinant, replication-incompetent chimpanzee adenovirus vector encoding the SARS CoV 2 Spike (S) glycoprotein. Recombinant, replication-incompetent adenovirus type 26 expressing the SARS-CoV-2 spike protein.recombinant adenovirus particles 5 serotype/ serotype 26

* FDA Briefing Document Pfizer-BioNTech COVID-19 Vaccine, Lipids ((4-hydroxybutyl) azanediyl) bis(hexane-6,1-diyl) bis(2-hexyldecanoate), 2 [(polyethylene glycol)-2000]-N,N-ditetradecylacetamide, 1,2-Distearoyl-sn-glycero-3- phosphocholine, and cholesterol)Inactive:Inactive: expressing the SARS-CoV-2 spike protein

* REG 174 AstraZeneca Information for UK Healthcare Providers Salt – Potassium chloride, Monobasic potassium phosphate, Sodium chloride L-Histidine, citric acid monohydrate,

* Fact Sheet for Recipients and Caregivers EUA of Janssen COVID 19 vaccineDibasic sodium phosphate dehydrates.L-Histidine hydrochloride monohydratetrisodium citrate dihydrate,Inactive: 

*pay particular attention if with prior allergies to substances highlighted in red.Sugar – SucrosePolysorbate 80, Ethanolethanol,tris (hydroxylmetyl) aminemethane, sodium chloride sucrose, magnesium chloride, hexahydrate, 

Magnesium chloride hexahydrate, Disodium edetate dihydrate, 2-hydroxypropyl-β-cyclodextrin (HBCD),EDTAdinate salt digidrat,

Sodium chloridepolysorbate-80,polysorbate, ethanol.

 sucrosesodium chlorideinjection water up to 0.5 ml.

Water for injections

As of April 28, 2021, about 1.08 billion doses of the vaccines had been administered. Nigeria has reported a little over 1 million vaccinations. Most of these have been given to health workers, older people and people with medical comorbidities There were rare but serious events of interest that occurred in the trials and post-trial period.  These include reports of rare but serious cases of blood clots with low platelets likely associated with both the astrazeneca and Johnson & Johnson vaccines according to the European Medical Agency (EMA) and US center for disease control (CDC) respectively. These rare types of blood clots mostly occurred in women less than 60 years old. A few of these events resulted in death.  Both CDC and EMA continue to advise that the benefits of vaccination outweighs the risk for a vast majority of people. Israel and a study among some US military members also recently reported rare cases of  myocarditis – inflammation of heart muscles in young men <  30 years old after the pfizer and moderna vaccines. It will not be unusual to hear more reports of seemingly bad events happening after the vaccines are administered. These do not always mean that those events were caused by the vaccine. Before having your “ehn hen. I said it” moment, it’s important to wait for the appropriate investigations first. If 200 million Nigerians watch the “Wedding party”movie and 60 develop bad breath, we cannot conclude that watching Wedding Party causes bad breath. They could have stopped at the suya place and had some onion and garlic so would have had bad breath even if they had never watched Wedding party but spent all day watching Papa Adeboye.  When experts urge people not to panic or countries hold distribution like they did for both the Johnson & Johnson and Astrazeneca vaccines, it is not proof of a big conspiracy or evidence that the vaccines are not safe; They are often acting out of an abundance of caution till investigations are concluded. 

The landscape of COVID 19 infection, treatment and prevention is constantly changing. Many lessons have been learned but there is still a lot of information that is not unknown. How long immunity from natural infection and vaccination last, whether vaccines fully prevent spread of infection, how well vaccines protect people with weak immune systems, long term effects of the vaccine, how the vaccines will fare long term in the face of a mutating virus are among questions that have not been fully resolved.  We, however, know the devastation that COVID-19 has wrecked in our world so far, and until everyone is safe and protected, no one is safe. 

Many clinical experts were very pleasantly surprised by how well the vaccines work to prevent people from getting critically sick and/or dying from COVID. Real world studies have continued to suggest that the vaccines are highly effective and so far, most of the side effects have been tolerable and short lived. When I got my vaccine earlier in the year, for about 2 days, I felt pain in parts of my body that I didn’t know existed. But then all the pain was gone. More significantly, I also felt less anxious about getting sick from COVID or getting my child sick. I stand with a lot of clinical experts in the belief that for most people, the benefits of getting the vaccines may outweigh the risks. 

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