By Kemo Cham and Rachel Williams
Dr Tom Sesay is the Programme Manager of Child Health and the Expanded Programme on Immunization (EPI) in the Ministry of Health and Sanitation (MoHS). He is also the Vaccination Pillar Lead at the National Covid-19 Emergency Response Center (NaCOVERC).
In this interview, he talks to the Kombra TV on Sierra Leone’s efforts to increase uptake of Covid-19 vaccines, misconceptions that have held back these efforts and the authorities’ approach in beating these obstacles and ensuring access.
KMN’s Rachel Williams started by asking him to give a summary of where the country is in terms of the vaccination process.
Dr Sesay: I think we have made a lot of progress since 15th of March 2021, when we started the exercise. There were a lot of suspicions. A lot of people were in doubt because there were a lot of misinformation. People were unsure as to whether it [vaccine] was safe. So many questions.
But with the leadership of His Excellency the President [Julius Maada Bio], who happened to be the first person to receive the Covid-19 vaccine, followed by other leaders in government, political leaders, senior people in the Ministry of Health and Sanitation, I think that helped to break the doubt and obstacles of lack of confidence in the vaccines.
Initially the main problem we had was lack of adequate vaccines. But now we are surmounting that, as we have received a good number of vaccines. We have reached a stage where over 400, 000 Sierra Leoneans have received at least one dose of a Covid-19 vaccine. If we are looking at the population above 18 years, it means 10 percent of the population have received at least one dose of a vaccine.
We do have the challenge of many people who have taken the first dose and have not come forward to get the second dose. Maybe because of various reasons, but also because time to time we had stockout of vaccines. It is only recently that we received a stock of the AstraZeneca vaccine. A lot of people who took AstraZeneca vaccine had to wait for long before they get the second dose. We are now trying to prioritize these people to receive their second dose.
We are also happy now that we have the Johnson and Johnson (J&J) vaccine, which is a single dose. That will help to improve on the number of people who are fully vaccinated, which currently stands at 140, 000.
You mentioned that the first vaccines required two doses and now J&J requires just one. Explain to our audience why this is so.
The development of vaccines involves a lot of studies, including clinical trials. They monitor the immune responses. And the outcome of these studies determines how many doses are required to stimulate the immune system.
What is your overall target in terms of the vaccinated population of Sierra Leone?
For now, our strategic target is to vaccinate all people above 18 years of age. The estimated target number is therefore about 4.8 million to 5 million people.
In other countries, now they are even giving children. That is why when we do coverage calculation, we look at the total population. On that basis we can say that about 4 percent of the Sierra Leonean population has received at least one dose of a vaccine.
Other countries have done so well with the population above 18 years that they are reducing the age limit to 12. But for now, as a country, ours is 18 years.
Within that age bracket, what do we know about the category of people that is taking the vaccine more?
I think we are doing very well with healthcare workers, because the data is showing us that about 65 percent of healthcare workers, both in the formal and informal sectors, have been reached with at least one dose of the vaccines.
But we have specific groups of people we are deliberately targeting - 60 years and above. We are not doing well with this group. And that is why we have issued a public statement urging people who have family members within that age bracket to encourage them to come forward for the vaccine. They can call 117 [toll- free] so that we can send a mobile team to go to your home to administer the vaccine.
You think it’s because of the movement that is required of them that prevents them from coming for the vaccine?
That is one of the reasons, because a lot of people in this country who are above 60 have been afflicted with a lot of illnesses.
But on the whole, the younger age group between 18 and 30 years are majority of people we are targeting. We have devised programmes that target bike riders, for instance, footballers - the national teams - and we have encouraged them to accommodate vaccination teams around some of the football venues.
I am a proponent of the idea that if you want to attend crowded gatherings, for the safety of others, you need to demonstrate proof of vaccination. I think we are making a lot of progress in that. Even at the community level, at the chiefdom level, we see good uptake in places like Kenema and Kailahun, followed by Bo District. Western Area Urban is also doing very well.
Earlier you mentioned that some countries have reduced the age limit for the vaccine. With the Johnson and Johnson, do you have similar considerations here?
It is the same age limit for Johnson and Johnson. Most of the countries that have gone below 18 years are using Pfizer.
For us to change our policy we have a technical group - the National Immunization Technical Advisory Group - which usually advises on that. We did discuss that and we may advise on that later. For now, we are targeting 18 years and above for all the available vaccines in country.
Another issue is concerns for pregnant women, lactating mothers and people with comorbidities. What is the policy for these people?
I can say that Covid vaccines are safe for everyone, including pregnant women and lactating mothers. But the current position of the technical working group is to leave pregnant women out for the time being, for the simple reason that pregnancy is a very delicate situation. There are a lot of instances of miscarriages, and we do not want a situation wherein someone gets a miscarriage and attributes it to the vaccine.
But in a situation where the infection is very high in a particular area, then we advise pregnant women to take the jab. But for now, in as much as the evidence show that it is safe for them, we just don’t want a situation that can undermine the vaccination process and affect its credibility.
For lactating mothers, there is no doubt that it is safe.
And are pregnant women taking the vaccine?
Looking at the data, very few are taking it.
What about lactating mothers?
They are taking it too.
There is so much rumor around the safety of the vaccines. One source of this has been about the expiry of previous vaccines. What would you say to this?
No qualified medical practitioner will administer a vaccine that has expired. As a matter of fact, this Thursday (October 14), we had vaccines that had expired destroyed. We always endeavour to use the vaccines before they expire.
For the layman, why do we have to take the vaccine? How does it work?
That is an interesting question. I want to approach it this way. Sierra Leone is part of the global world, which is going through a pandemic that affects everybody. And we are not an isolated nation. We are also human beings. All scientific evidence show that covid affects humans and lead to illnesses and deaths.
Evidence shows that to protect yourself against Covid you need to take the vaccine.
One of the challenges we face is that Sierra Leone is a very young population. In this country a lot of people die before their 60th year. So, as a result, even if people are infected, a lot of people can carry and get mild fever. They might not even know that they have Covid. But the general consensus globally, even if you are a young person, is that it is safer to take the vaccine, first to protect yourself against infection. But if you are not infected, so that you do not transmit it to some old person with a weaker immune system.
So it is not just about your personal protection, it is also your contribution to the safety and the wellbeing of the community, not only as a country but globally.
The world cannot open if we do not end the pandemic. So every country has a moral responsibility to ensure that it takes the right public health steps to end Covid. If Covid ends in the rest of the world and Sierra Leone still has it because it didn’t take the right steps, then every country will be obliged to shut its doors on us.
These are recommendations that are borne out of scientific evidences from WHO, CDC, and even local expertise.
For example, in terms of admission at the treatment centers, we see that among the few people who get admitted, most of them are unvaccinated. So there is local evidence and there is international evidence that even though the vaccine will not prevent you from getting 100 percent infected, but if you do, you are unlikely to get seriously ill or die from it. And it will reduce your chances of transmitting it to others.
Since March, what kind of side effects have you seen?
As with every medication, some people get side effects, some don’t at all. Even with malaria treatment, some people get certain symptoms as reactions, but some don’t. The covid vaccine is the same.
We have received between 5 and 10 percent reports. And most of the symptoms are fever, serious pain on the sides, some feel dizziness, some feel fatigued. We encourage people to call 117 if they get side effects. If it is serious, then we try to step in to help the individual. We also respond to incidents after vaccination. We have coincidental health issues.
For instance, one Sunday, while I was preparing to go to church, I received a distress call with warning that someone who had taken the vaccine was in pain and on the verge of dying. I was worried and I made arrangement to have an ambulance take him to hospital. He was seen by a doctor, and it turned out that he had malaria. He was placed under treatment. When I checked him personally later, he was okay. This is one of the challenges we have.
Vaccination doesn’t mean that other sicknesses should end. You may be sick with typhoid, for instance, malaria, diabetes, hypertension and all of that. So when in this situation people take the vaccine and coincidentally they feel sick, they easily attribute it to the vaccine.
Do you enquire about people’s medical conditions before administering the vaccine?
Yes. In fact we do not recommend it for anyone running fever or visibly ill. Of course, if you have chronic conditions, we recommend that you take the vaccine, because with those underlying conditions, covid infection will leave you likely to have an adverse outcome.
Is there anything like resistance to Covid vaccine, as we hear in the case of medications?
Vaccine development entails efficacy studies, which determines the extent to which it prevents the sickness. They usually assign a figure to it. If they say it is over 60 percent, that vaccine is good. It doesn’t always have to be 100 percent efficacious.
Below 40 percent or 30 percent, it might not even pass regulatory level.
For vaccines to be issued license by the WHO, for instance, there has to be evidence of high efficacy.
What about the cases of delayed administration of the second dose? Doesn’t that create a situation of ineffectiveness or resistance to the vaccine?
It is recommended that you take your second dose in a particular window. Incidentally, sometimes even when you delay, your immune response can be better.
Normally we have a window of a couple of months to get the second dose. But we want to avoid people having long intervals and therefore we decided as a country on a particular window.
The UK recently removed Sierra Leone from its Covid-19 Red List. But it has also refused to recognise Sierra Leone’s vaccination certificate. What do you say to that?
The vaccines we use come from donors, given to us by the same countries that now refuse to accept our vaccination certificate.
I think it is a political issue and I think it is very important for the African Union to come together and fight some of these injustices, which is how I see it; because if you are mobilizing the vaccines and you give it to people, then you turn around to say you do not recognise it, that is unfair, it is unjust and I think our political leaders, not only in Sierra Leone but the African Union, need to speak out against this.
And I think that is happening now. I think our political leaders are engaging about it.
We have seen reports of corruption in the issuance of vaccine certificates. What do you make of this?
First of all, I want to hail the ACC [Anti-Corruption Commission] for their proactive move in this. We were invited as part of investigations to give statements. And that is what is expect when there is rule of law in a country.
We are medical people. What we do is make sure that if someone gets vaccinated, they get the certificate, but if someone goes out and steal the cards to issue them illegally, the law should take its course. Every Sierra Leonean should help to prevent this.
Criminals can do anything. But we will do our best to ensure we account for the cards.
Is the Covid-19 vaccine free?
Certainly. Most of the health facilities across the country now have vaccines. You can walk in and get it.
We have heard of people requesting money from people traveling.
That is news to me. Even if you are traveling, it’s free. In fact, when you go to the center, nobody asks you if you are traveling.
What about the airport. Do you have a vaccination center there?
At the moment, we do not have a center there. We expect that before you complete your traveling arrangement, you will have completed the vaccination process.
What word of assurance do you have for skeptics out there?
What I can say is that over 400, 000 doses of the vaccines have been administered in Sierra Leone, to Sierra Leoneans. I think that is more than 10 percent of the people of this country, and we didn’t record any major incident. That in itself is a level of assurance of the safety of the vaccines.
If you are taking a two-dose vaccine, go back after the time given to you and get the second dose, because it is the only way you can get the full immunity against the virus.
So we will only continue to encourage Sierra Leoneans to go and take the vaccines. We don’t want to get to a point where you urgently need the vaccine and it is not available.
Now we even have one of the most acclaimed vaccines, which is Pfizer. But it is not going to be around forever.
Copyright © Politico Online 10/11/21
