Author: The Nation

In this report, Joe Agbro Jr. writes on the need for and challenges confronting vaccination in Nigeria

 Baby Ahmed looked guardedly at his mother as she handed him to the Vaccinator. And between screeches from Ahmed, his mother held him tight for the brief seconds it took the vaccinator to administer the oral polio vaccine (OPV) drops. For many Nigerian children, this little vaccination exercise could mean the difference of life in the fight against child-killer diseases such as tuberculosis, meningitis, measles, polio, diphtheria, tetanus, pertussis, and yellow fever. For some of them, it comes too late.

In 2011, the World Health Organisation (WHO) posited that immunisation prevents an ‘estimated 2 to 3 million deaths every year in all age. But the use of vaccines still poses an issue in some countries. For instance, according to WHO, despite the globally accepted safety involved in vaccines, worldwide, the number of children who did not receive DTP3 (diphtheria, tetanus, pertussis (whooping cough)) vaccine below their first year increased from 21.1 million in 2010 to 22.4 million in 2011. And more than 70% of these children live in 10 countries: Afghanistan, Chad, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria, Pakistan, Philippines and South Africa.

In December 2011, MenAfriVac, a new vaccine against meningitis A, with financial support from GAVI Alliance, a public-private partnership focused on making vaccinations accessible to poor countries, was introduced to Nigeria. MenAfriVac was expected to dramatically cut meningitis epidemics. Hitherto, meningitis, which causes death and disability, ravaged people in northern Nigeria.

“People are always apprehensive, scared ahead of the meningitis season. They never know what will happen,” said Muhammad Sani Adamu, Head of Accelerated Disease Control in Nigeria’s National Primary Health Care Development Agency, in an interview with GAVI website. “In 2009, we had nearly 50,000 cases and more than 2,000 dead.”

Praising MenAfriVac, Adamu said so far, about 16 million people have received the vaccine. He however identified logistical challenges to include lack of cold rooms as well the difficult terrain in some places. MenAfriVac costs less than N80 per dose but is expected to save as many as 150,000 lives between 2010 and 2015.

To further improve vaccination, in April 2012, a National Vaccine Summit was convened in Abuja, Nigeria. The summit brought together local and international stakeholders focused among other things, on routine immunisation of the six million babies born annually in the country, eradication of polio, and the impact on health systems of introducing new vaccines. It culminated in the establishment of a Nigerian Alliance for Vaccines and Immunisation (NAVI), while Dame Patience Jonathan, the First Lady of Nigeria, announced a plan to convene a biannual African Vaccine Summit in order to measure progress against milestones set forth by the Decade of Vaccines.

Though efforts are being made to ensure that all children are routinely immunised from birth, sadly, the challenges are far from over in some countries. For instance, Nigeria, together with Afghanistan and Pakistan remain the only polio endemic countries. In 2012, Nigeria recorded 122 cases of polio, an infectious disease which invades the nervous system and causes paralysis. And, the first reported polio casualty in 2013, two year old Abubakar Al Hassan who resides in Abuja, is probably one of the unfortunate victims of vaccinators’ slight. Or perhaps his parents’ slight? However, Al Hassan’s older 13 siblings were all vaccinated.

And despite the fact that numerous organisations partner with the federal government, routine immunisation campaigns still suffer some challenges. One of them, according to PATH, a non- governmental organisation, is that, in many parts of northern Nigeria, not up to 10% of children get the required vaccinations. And, data released by the Polio Global Eradication Initiative for the first half of 2012 revealed an increased in the polio cases from 24 at the same time in 2011 to 61. The statistics also showed that eight northern states; Sokoto, Kano, Katsina, Zamfara, Kebbi, Borno, Yobe, and Jigawa, accounted for 95% of the cases.

Also, recently, measles ravaged about 12 northern states including Benue, Kano, Niger, Taraba, Zamfara, Kano, Borno, Nasarawa, Katsina, Bauchi, Yobe and Kaduna states, killing about 36 children. Measles, a viral disease is great child-killer which spreads by contact when an infected person releases tiny droplets of the virus into the air. Lack of MMR (measles, mumps and rubella) vaccination encourages its spread.

Osahon Enabulele, President of the Nigeria Medical Association, blames the outbreak on parents not accessing vaccination for their children.

“You must understand that we’ve been having challenges with the issue of acceptance in that part of the country, which is quite sad really,” he was quoted as saying. Recoding an average of 51 new cases daily in 2011, according to WHO, Nigeria is ranked as the third country with the highest infection in the world with 18, 843 cases. Ranked ahead of Nigeria are The Democratic Republic of Congo (DRC) with 134, 042 infections and India with 29,339 infections.

Speaking on the problem, UN Spokesperson for the polio campaign in Nigeria, Melissa Corkum, said, “We still continue to miss too many children. In a campaign where you aim to reach 32 million children house-to-house there are a number of challenges.”

According to Corkum, the nomadic nature of most populations in the north of Nigeria means they have no fixed addresses and a door-to-door campaign becomes tedious.

The education of mothers also seems to play a huge role in the vaccinations of babies. During antenatal and post-natal clinics in public health centres, mothers are usually educated on the need to vaccinate their children. But, the question of what happens to the league of mothers that do not patronise such health centres remain largely a puzzle. In a recent report by Save the Children UK, “A child’s immunisation status is strongly associated with their household wealth, mother’s education and urban/rural location.” The 2008 report also found out that a mother with secondary education is twice more likely to receive DTP3 than one with no education.

However, immunisation is getting popular in the country and according to Dr. Ali Pate, minister of state for health who heads the presidential campaign against polio, “People are becoming more aware and are realising that in fact the vaccine is safe, it’s efficacious, and that other parts of the world have actually used it to eradicate this disease.”

But, in a report, Dr. Taiwo Ladapo, a consultant paediatrician at the Lagos University Teaching Hospital, LUTH, believes the greatest challenge of immunisation is funding. Though she agrees that factors such as accessibility, lack of electricity, and inadequate storage act as cogs, she said, “when the right political will is generated, and funds are available, the vaccines will also be available.”

Recently, the Japanese government donated N443 million towards procuring cold chain equipment to boost routine immunization to eradicate polio in Nigeria.

There is also the issue of lack of production of vaccines. Nigeria depends solely on the United Nation Children’s Fund, UNICEF, for its vaccines which the Federal Ministry of Health says cost over N648 billion annually. To combat this, the Director General of National Agency for Food and Drug Administration and Control, NAFDAC, Dr. Paul Orhii, in March, announced that the country was set to begin local production of routine immunisation vaccines for tuberculosis, hepatitis B, diphtheria, tetanus and pertussis/whooping cough (DPT), polio, measles and yellow fever.

Also, not all necessary vaccines are within reach of the average Nigerian child. For instance, pneumococcal vaccines is not given routinely, and though, it is available, it is not free. To counter this trend, Ladapo said, “Government should come up with a decisive immunisation policy.”

And while funding is a challenge, ignorance and religion also seem to be compounding vaccinators’ nightmare. Last year, nine female vaccinators were killed in Kano State. And many Kano residents would not forget the 1996 Pfizer fiasco in a hurry. The global pharmaceutical company had used a drug which promised to combat an outbreak of meningitis. Sadly, the catastrophic result of that trial was that 11 children died, while many were disabled. Also, rumours that vaccines were a western ploy to sterilise Muslims thrive in certain quarters. Earlier this year, a Muslim cleric and two Kano-based journalists were arrested for broadcasting that vaccinations were not safe.

It seems this empathy has disassociated some people from believing in vaccines despite cries from health authorities and traditional rulers. “In some areas, we know it is risky to be seen taking these vaccines,” a health worker in Kano said. “So, I understand when some families refuse to open their doors to us.”

Happily that is not the usual situation. As Mrs. Deola Akinyele lovingly preens Victor, her three year old son, she recalls standing on the queue of mothers, clutching babies and cards showing immunisation records, snake slowly towards the vaccinators. “I think it is the most sensible thing to do,” she says of vaccination. “After all, they say prevention is better than cure.”