Yellow fever, Yellow card, Yellow lies

‘Where is your yellow card?’ Anyone that has traveled from Nigeria through an international airport has had this question posed to them. It may be asked politely, rudely or in that condescending tone that airport staff are wont to use on international travelers but be rest assured; the question is always asked. Sometimes, they ask […]

‘Where is your yellow card?’

Anyone that has traveled from Nigeria through an international airport has had this question posed to them. It may be asked politely, rudely or in that condescending tone that airport staff are wont to use on international travelers but be rest assured; the question is always asked. Sometimes, they ask the question in a hopeful manner: ‘Do you have a yellow card?’, in hope that you have forgotten it at home or that it has expired (It lasts for 10 years!) or that you are Johnny-Just-Come and so you know nothing about it. The gleam in their eyes when you say that you don’t have it, just confirms how much of a scam the whole thing is.

Their response: ‘Please pay N4000’.

Last year one of our professors from the US had to make a quick trip to Ghana from Nigeria and so he rushed to the port health facility in Kano, to obtain a yellow fever vaccination card, an essential travel document within the Economic Community of West African States (ECOWAS) region. The poor chap was shocked when he was asked for only his passport and money. He had already started rolling up his right sleeve (he is left-handed) when the guy working at the dingy office handed him his vaccination card.

‘But I was not vaccinated!’ He protested. As a public health professor, he was thoroughly mortified. The following day, he entered Accra through Kotoka International Airport, holding a yellow card ‘credible’ in name only.

Later he would ask: ‘Fatima, how is this possible?’

Sir, it is very possible. And I will tell you why.

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The Nigerian government, through its Federal Ministry of Health, has since 2019 been issuing a new e-yellow card — the international certificate of vaccination to combat forgery of the old one. It even has a shiny new emblem, barcode, and everything. The Yellow Fever Initiative, a joint collaboration of WHO and UNICEF working with national governments with the support of GAVI Alliance; and whose goal is to tackle the spread of yellow fever maintains that yellow cards are key to effective monitoring of vaccination campaigns, and, therefore, must be distributed as a proof of vaccination.

To fully grasp the intricacies of this yellow fever issue, some historical context is essential.

Yellow fever is a tropical disease that has had minimal impact in developed countries. The yellow fever virus is primarily transmitted by Aedes and Haemagogus mosquitoes from monkeys to humans, and also from one person to another. The most devastating outbreak of the last century occurred in the mid-80s. The last outbreak occurred in 2020 when the Nigeria Centre for Disease Control (NCDC) reported several confirmed yellow fever cases in multiple states. Till date, it still afflicts about 200,000 people a year, with 90 per cent of reported cases occurring in Africa. According to a 2021 review of yellow fever outbreaks in Nigeria from 2017 to 2019, the case fatality rate was 2.7%. However, preliminary data for 2023 indicates a case fatality rate of 11%. Also, there is a lot of overlap. Truthfully, many of the deaths we presume to be from malaria may be in fact, due to yellow fever.

However, because such a disease does not command the attention of big pharmaceutical corporations, only four manufacturers have been pre-qualified by the WHO to produce yellow fever vaccines. This partly explains why Nigeria ran out of vaccine supplies during the first phase of national vaccination campaign in early 2014. According to the President of the Nigerian Academy of Science, only the Institut Pasteur in Senegal produces yellow fever vaccine. It’s not something industries are interested in investing in because they are no consistent policies on what you’re going to do with manufactured vaccines, and moreover, no profit. Everything revolves around money.

Which is why, when my professor insisted on receiving the yellow fever vaccine, the bored civil servant sitting in the dilapidated lonely office, told him that it was not available. To further buttress this point, she showed him round the office; there were no needles, no antiseptic, no cotton wool and no cold storage containers. Proof that even if they truly wanted to vaccinate people, the vaccine was not readily available. Maybe it is somewhere, sitting pretty, in a cold refrigerator, in some fancy office in Abuja; but definitely not here.

Then again, there is the issue of corruption. Being the opportunists that we are, Nigerians have perfected a system that is fully committed to exploiting this vaccination gap. The official price of the e-yellow card is N2000 if you have the patience to pay via Remita. Again, because we understand our impatient selves, hardly anybody goes through remita; preferring instead to pay directly. The price also differs, depending largely on the colour of your skin (my Caucasian professor was asked for dollars), the quality of your English, accent, dressing and the type of car you drove in with. You get my drift. Nationwide, a typical yellow card ranges between N4000 to N10,000.

When asked for the reason for the discrepancy in the fee, one officer explained that the production of the vaccination certificates was in Abuja and so the extra money was for “those who are bringing the card from Abuja”.

This public health embarrassment has many times caused Nigeria national disgrace. Remember in 2012, when Nigerians were denied entry into South Africa because of fake yellow cards and the resulting feud that it sparked between the two countries? The 125 Nigerians were reportedly refused entry into the country as soon as they landed at the Oliver R. Thambo International in Johannesburg on account of yet to be proven possession of fake yellow vaccination card. Of course, Nigeria wasted no time evading the actual issue- which was that people had fake yellow cards- and played victim instead; reminding SA of the role Nigeria played in emancipating the largely oppressed black populace from the clutches of apartheid. After months of back and forth, South Africa apologised to Nigeria, and we went back to being frenemies.

Many years later, we are still in the same conundrum- issuing yellow cards (verified or not) to people who have not been immunised. In a country where obtaining false certificates like driver’s licence, tax clearance, educational qualifications, etc, is the order of the day, the yellow fever vaccination certificate is just another certificate added to the mix.

Falsification of these yellow cards, however, poses a big threat to the epidemiological control of the disease. The Lancet reports states that in the past five years, there has been an increased transmission of the disease in both Africa and tropical America and that has led to an increased need for vaccine even as the world’s stock of vaccines has recently been greatly reduced.

At the population level, protection against yellow fever is low in Nigeria. According to the recommendations of the Center for Disease Control’s advisory committee on immunisation practices, administration of yellow fever vaccine is recommended for persons aged 9 months or older, but the national immunisation programmes of most countries at risk of yellow fever, including Nigeria, only cover children younger than 5 years of age.

The verdict? With a low population immunity, the possibility of the current yellow fever epidemic to persist is very high. Current national programme on immunisation is not enough to generate the herd immunity required to protect the greater proportion of Nigerians and to raise the population immunity against yellow fever.

Also, yellow cards issued to people without vaccinating them is not helping our case.