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In this Nigerian city, Pfizer phobia looms over the vaccine rollout

An ill man is carried into the Infectious Diseases Hospital in Kano, Nigeria, in 2000.

MICHAEL S. WILLIAMSON /THE WASHINGTON POST

By IBRAHIM GARBA AND DANIELLE PAQUETTE | The Washington Post | Published: March 20, 2021

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KANO, Nigeria — By the time Pfizer arrived, the meningitis epidemic had struck hundreds of children, leaving many dead or partially paralyzed.

The American pharmaceutical giant pledged to fight the 1996 outbreak in West Africa while testing a new drug, enrolling 200 stricken young patients in a clinical trial. Eleven died of the brain infection - an outcome Pfizer said could not have been prevented - and families in Kano, along with the state government, later received millions of dollars in a lawsuit settlement.

Now the memory looms over the coronavirus vaccine rollout in Nigeria's second-largest city, sowing doubts around foreign-made shots that officials are rushing to distribute.

"I don't trust anything from the West," said Abubakar Sadiq Sulaiman, a 20-year-old college student in Kano, "because of what happened here."

Vaccine fears driven by the history of medical experimentation in Africa threaten to undermine the battle to end the pandemic, health officials say, as several nations kick off inoculation campaigns this month.

Nigeria has sought to soothe anxieties, deploying teams of public health educators to meet with religious leaders, village chiefs, shop owners, fishermen - voices with sway in their communities. Hesitancy to accept medicine from overseas slowed polio eradication in some areas, and leaders don't want to see a repeat.

But videos invoking the Pfizer trial and other controversial cases continue to circulate on WhatsApp and Twitter.

"We cannot just dismiss the skepticism," said Faisal Shuaib, head of the National Primary Health Care Development Agency, which is in charge of the rollout. "We have to recognize that people have their own concerns. We need to listen to them, and then we have to do the extra work that is required."

A recent survey by the Africa Centers for Disease Control and Prevention of 15,000 people across 15 African nations found that 79% would take a coronavirus vaccine if it were safe - but a quarter thought it would be unsafe. The Nigerians polled were slightly more reluctant to accept a shot at 76%.

An Afrobarometer survey of neighboring countries - Benin, Liberia, Senegal, Niger and Togo - uncovered a far less optimistic outlook: Just 4 in 10 said they'd probably try to get vaccinated, according to the early March findings.

Mistrust is rooted in a variety of factors, researchers say, including painful medical encounters of the past. Western scientists have long faced accusations of exploiting poverty, weak access to health care and flimsy clinical trial oversight in the developing world to fast-track cures.

American researchers, for instance, gave placebo pills to pregnant women with HIV during 1994 trials of a drug meant to stop mother-to-child transmission in Zimbabwe. About 1,000 babies contracted the virus despite the availability of a proven regimen, triggering global backlash.

Even during the pandemic, a French doctor sparked outrage by suggesting on television that the first coronavirus vaccines be tested somewhere in Africa, where people "don't protect themselves."

Then there are the scars of the Pfizer trial in Kano.

The ancient walled city of 4.1 million in Nigeria's north was the epicenter of a meningitis epidemic that killed more than 15,000 people across West Africa.

Researchers camped for weeks at a local field hospital, administering an experimental antibiotic called Trovan - which was not yet approved in the United States - to 100 children and infants with brain infections. They gave the standard treatment to 100 others.

At the same hospital, a Doctors Without Borders team worked only to save lives. Several expressed concerns about Pfizer's work to The Washington Post in a 2000 investigation.

"In an epidemic, where you have a very high number of cases who will die, you don't go and experiment," one said. "You are talking about human beings, after all."

The young patients arrived in grave shape, The Post investigation found: Some could no longer talk or move their limbs, and it was unclear if their parents - all of whom were under extreme stress - truly understood they had options. Pfizer said its researchers obtained verbal consent.

"The local Nigerian nurses explained - in the native language, Hausa - the details of the study to parents or guardians, including that participation was voluntary," the company said in a statement.

Five children died after receiving Pfizer's experimental antibiotic. Others developed signs of arthritis - though there is no evidence the drug caused it. Six more died while taking the standard treatment. Pfizer has maintained that the children died of meningitis.

"The 1996 Trovan clinical trial was approved by U.S. and Nigerian health officials, was conducted with the consent of parents or guardians," the company said in a statement, "and the treatment saved lives and proved to be at least as effective as the gold standard treatment available at the time."

Some medical experts questioned why the company did not switch to the proven pills when it was clear the young patients were approaching death.

Pfizer said Trovan was "at least as effective as the gold standard treatment," adding, "There is no basis on which to conclude that a change in treatment would have improved outcomes."

The Food and Drug Administration never approved Trovan for the care of children in the United States. The drug was later linked to reports of liver damage and deaths in adults. European regulators outlawed it entirely.

Fury erupted in Nigeria.

Pfizer conducted "an illegal trial of an unregistered drug," a Nigerian panel of medical experts wrote, according to a document The Post obtained in 2006, and a "clear case of exploitation of the ignorant."

The state of Kano and the Nigerian federal government filed criminal and civil lawsuits against Pfizer in 2007. Two years later, the company agreed to pay $75 million to the state and relatives of children who died or were disabled during the trial.

One of the settlement recipients, a 70-year-old man, recalls feeling hopeful in 1996 when a neighbor told him about the American doctors in town helping children. He spoke on the condition of anonymity because he signed a nondisclosure agreement to receive the settlement money.

He didn't question anyone's motives. His sole focus was saving his 4-year-old daughter. Today, she cannot walk and requires full-time care.

"I was excited that the treatment was free, but that excitement was short-lived," he said. "She lost the function of her limbs. Our happiness vanished into thin air."

The experiment shaped public perception of Western drugs in the region. Parents told their children about it. Teachers lectured about Pfizer in classrooms. Pundits spoke of Western physicians seeking human guinea pigs.

"If I had an enemy, I would not let him take their drugs," said Najib Ibrahim, a 19-year-old tailor in Kano.

By 2003, three northern states - including Kano - were boycotting polio vaccination campaigns, citing, among other reasons, the Pfizer trial. The resistance added years to Nigeria's fight against the virus.

So public health officials have doubled down on coronavirus vaccine safety messaging even as recent surveys show rising confidence.

"We've been confronted with this problem," said Chikwe Ihekweazu, director of the Nigeria Center for Disease Control in the capital, Abuja. "We know how much of an impact it had - how much it took us back. We can't take anything for granted."

President Muhammadu Buhari received his jab live on television, urging viewers to follow his lead. The nation aims to inoculate 80 million people this year, starting with doses from AstraZeneca through the World Health Organization's Covax initiative.

Pfizer shots are expected to arrive, officials said, once Nigeria ramps up its ultracold storage capacity.

"Pfizer's vaccine and the other vaccines are outperforming everybody's wildest expectations," said Ihekweazur. "It's how we will save lives and end this pandemic."

By Monday, the country had recorded 161,000 cases and 2,013 deaths after enduring a second wave this winter. Officials say the national surveillance system offers only a conservative estimate.

One in 5 people in Lagos state alone - a metropolitan sprawl of 21 million - may have caught the coronavirus by last October, according to a recent antibodies survey from the Nigeria Center for Disease Control. That would be more cases than every African country combined has confirmed.

In Kano, more than 500 medical clinics are being transformed into vaccination centers. The city received its first 200,000 shots in early March.

Local health officials are preparing for the deliveries with "fact and myth" seminars, hoping to boost enrollment.

Musa Abdullahi Sufi, a public health doctor, estimates that 20% of Kano residents would be ready today to accept a dose.

"But that will move to 80 percent," he said, "once we build more trust."

Some in town say that hope is futile.

Abdul Murtala, a 45-year-old trader, remembers reading about the 1996 Pfizer trial as the details emerged. The experience changed him, he said.

"Pfizer reminds me of recklessness with human lives," he said. "It makes me want to forever avoid receiving vaccines from foreign establishments."

___

Paquette reported from Abuja, Nigeria.
 

A makeshift pharmacy at Kano state's Infectious Diseases Hospital in 2000 is adorned with stickers promoting American drug companies.
MICHAEL S. WILLIAMSON /THE WASHINGTON POST