Ibadan, Nigeria. Several Nigerian states were unable to carry out preventative yellow fever campaigns late last year because of the COVID-19 pandemic, leaving thousands of people at risk of developing the disease as the country now faces a new winter yellow fever outbreak, Health Policy Watch learned.

In early November, Nigeria’s Center for Disease Control (NCDC) received several reports of a yellow fever-like illness affecting people in 4 states: Delta, Enugu, Bauchi and Benue. The NCDC quickly confirmed the illness was yellow fever.

As of Christmas Eve, 17 deaths and 101 confirmed cases had been reported from 13 Nigerian states, with the 4 states that had first reported the infection, accounting for about 85% of cases.

Yellow fever, which is 10 times deadlier than COVID-19, causes headache, muscle pain, nausea and jaundice (from which it takes its name). It is entirely vaccine-preventable, with immunity lasting a lifetime once someone has been vaccinated.

Speaking to Health Policy Watch, NCDC’s Head of Epidemiology Dr Jafiya Abubakar disclosed that Delta and Benue States were part of a cluster of states that were supposed to have undergone a preventive yellow fever vaccination campaign in November – which was then delayed.

“They were supposed to have it earlier but because of the COVID outbreak, it wasn’t held. It was planned for November even before the [current] outbreak,” he said.

Nigeria, Africa’s most populous country, is one of several on the African continent to routinely see outbreaks of yellow fever, an acute viral disease transmitted by mosquitoes, which is entirely preventable with a vaccine, but otherwise kills about half of those who become seriously ill. It is endemic to tropical areas of Africa and Central and Southern America.

Abubakar also revealed that Nigeria had previously mapped yellow fever risk across all 36 states, phasing them into clusters to prioritise vaccination.

He confirmed that Delta and Benue have since had the preventive vaccination campaign, with Bauchi’s to be held this month. According to WHO, the vaccine provides effective immunity within 10 days for 80-100% of people vaccinated, and within 30 days for more than 99% of people vaccinated.

Abubakar attributed Nigeria’s yellow fever outbreak to the existence of a “critical mass of people that are not immunised”.

Nigeria’s Fraught History with Yellow Fever

In April 2018, WHO Director General Dr Tedros Adhanom Ghebreyesus joined UNICEF representatives in Nigeria’s capital, Abuja, to launch the joint Eliminate Yellow Fever Epidemics (EYE) Strategy.

The strategy aims to rid the continent of these circulating outbreaks by 2026 by introducing the yellow fever vaccine into routine immunization programmes. With support from Gavi, the Vaccine Alliance, EYE aims to vaccinate around 1.4 billion people in Nigeria and 40 other high-risk countries around the world by 2026.

“The eligible age group for the vaccination campaign is from 9 months to 44 years. These are the ages that have been noticed to have missed out in initial vaccination campaigns,” Abubakar said.

The Risk of An Endemic Threat As the Continent Faces Its Second COVID Wave

With the emergence of a yellow fever outbreak roughly coinciding with the onset of a second wave of COVID-19 infections, Abubakar flagged how vital it is to maintain an adaptive response to the pandemic – maintaining and strengthening other critical public health services alongside COVID response.

Throughout the pandemic, Nigeria has aimed to implement and utilise equipment, structures and support systems that can be adapted to multiple public health emergencies.

Nigeria’s Emergency Operations Centers (EOCs), which predated the COVID pandemic, have made a coordinated national response much easier to mount, in comparison to some other African and Western countries, as they work with state governments to allocate resources systematically for emergency purposes.

According to Abubakar, the NCDC will continue to follow in this direction, and it has now activated EOCs in 30 states to facilitate quick yellow fever case finding during the COVID pandemic.

“These centers are hubs: they are coordination centers where the teams have been trained on how to manage emergencies and crisis,” Abubakar told Health Policy Watch. “The multidisciplinary team is also multisectoral and contains all the partners.

“For every outbreak, we use our resources together — human, financial and other resources and things that are required — collaboratively to respond to the outbreak. That is what we are doing. We cannot, just because we are in a pandemic, ignore outbreaks of other diseases and interventions that are needed by our communities.”

To avert future yellow fever outbreaks, the NCDC official said more efforts and resources need to be committed to enlightening the general public on the urgent need to be vaccinated, especially as vaccines are available for free for certain age groups across the country.

“We need to encourage caregivers and parents that yellow fever vaccination is given for free [to of children under 9 months] in all our health facilities. They should take advantage of that to ensure that their kids are protected against yellow fever,” Abubakar said.

Image Credits: Twitter: @WHOAFRO, NCDC.