Posted on: Tue 30-04-2024

Fifty years after the expanded immunisation programme, a UNICEF Health Specialist – Dr. Ijeoma Agbo has said that Nigeria needs a revamped vaccination system to address uneven vaccine access and other immunisation gaps that leave many children vulnerable to vaccine-related diseases.

Agbo who noted that the world has come a long way since 1974 till now, said the country started with 6 vaccines back then and now with about 13, while some countries even have a bit more.

She lamented that currently, Nigeria accounts for the largest cohort of zero-dose children in the world with about 2.2 million unvaccinated children.

In an exclusive interview with Good Health Weekly, Agbo said despite decades of immunisation push, Nigeria is still struggling with unequal access. “We are still having inequities when it comes to immunisation.

“We find that we have varying vaccination coverage. We have varying numbers of unvaccinated and zero-dose children. Right now, Nigeria accounts for the largest cohort of zero-dose children in the world.

“We have about 2.2 million children that are unvaccinated or turned at zero-dose, which we know is a huge risk or a huge threat to a lot of the work that has been done when it comes to immunisation.”

She said WHO is calling for more investment looking at all these indicators. Stating that Nigeria has done well, she said there’s still a lot that can be done.

“Another thing we’ve seen is that within the last couple of years when we had the pandemic, we’ve seen a regression. We had reached a peak and then we went a bit back due to COVID. That was another thing we saw. Also, within that pandemic time zone now, we’ve had outbreaks, of toxic, preventable disease outbreaks, which were unexpected. For instance, we had a large diphtheria outbreak last year, which included in our Northern States and even Lagos.”

She explained that these were outbreaks that the country had not seen in years.

“We’ve not seen diphtheria in years in any of our children and it came back. So, it just shows that some of the unvaccinated children from years before were now exhibiting those diseases that we assumed were no longer around within the country.

“We are seeing vaccine-preventable outbreaks that if we have a good immunisation system or we have good indices, we won’t expect to see them. So those are all the issues that we are seeing and saying that we need more investment in immunisation.”

Agbo said the call for more investments was not just about finances but goes across the entire health system because of the country’s weak health system  We’re looking at not just financing, but in terms of structures, human resource for health, you know, having the vaccines available at every facility and close to everyone. Those are all the investments that we are calling out for government and communities to come together to see how we can make immunisation a priority for all within the country.

Risk of missed vaccination  

She said the implication of having unvaccinated children poses a risk for even those who are vaccinated and those who are unvaccinated.

“From time to time you see us talking about the measles outbreak, just as I mentioned, the Diphtheria outbreak last year. We are seeing a variant of the polio virus. We are still  seeing variants of this within the country, which is why we continue to have polio campaigns. “We still have issues of malnutrition and sanitation issues. So even children do not have the immunity to fight diseases and to withstand them.

We start to see that our morbidity and mortality rates are even higher and there’s no way we can bring down those targets that we set for ourselves as a state and as a country without having an immunisation rate go up. For us to bring down those numbers, we need high immunisation rates. So, we can prevent those diseases, that they will ordinarily would come down with and due to underlying issues such as nutrition and all.

She said immunisation is one singular intervention or public health intervention that prevents diseases and it cannot be overemphasised.

“I would say it’s undeniably a public health triumph and that is why this day we’re not just talking about the issue. We want to celebrate where we are coming from because before we had just six vaccinations and immunisations in place. We’ve eradicated smallpox, we’ve eradicated the wild poliovirus. “I think it’s only two countries, that still have the Wild Polio Virus. So, we’ve come a long way. We’ve had new vaccines that have been introduced, which have reduced our under-five morbidity and mortality rates.

Looking at second dose measles, rotavirus, pneumococcal infection, by pneumococcal vaccine, all these have been put in place. And there is more research being done, even bringing more vaccines.  For instance, this year, we’re looking at supporting the government by introducing the malaria vaccine. So just imagine the three major causes of under-five mortality in the country, which are pneumonia, diarrhoea, and malaria.

“Can you imagine a world where we have vaccines to prevent all these diseases? It means that there will no longer be death.  It brings down our numbers when it comes to under five child killer diseases and that is a huge thing for the country and that is what UNICEF stands for. We want a world whereby every child will survive and thrive and reach their full potential in life and we can only do this by ensuring that their well-being and their health is optimal.”

Immunisations

Within the Nigerian immunisation schedule, we expect that at birth, a child would have BCG-OPV0 and HPV. By six weeks, we expect that the child will get OPV1 and PENTA1. Do you know what PENTA is? That’s five vaccines in one.  By six, 10, 14. By ten weeks you’ll get between OPV2 and PENTA2. By the third, which is the third one, which is in 14 weeks, you’ll get OPV3 and PENTA3. There’s also the IPV that was also introduced. They will also get IPV at that age. Then by nine months, they will get measles and yellow fever. Then by 15 months, they will get measles second dose.

Agbo further explained: “If it’s a girl, nine to 14 years we have introduced the human-papilloma virus vaccine.

“But I always like to mention that we expect that from six months, every six months, our children get vitamin A supplementation up until they are five years old.

She said “Nigeria introduced the HPV vaccine in October 2023 and one of the main issues is information.   There is a need for correct information and awareness on vaccines. The media needs to put out the right message because as it is now, the HPV vaccine is the only vaccine we have that prevents a form of cancer – cervical cancer.”

She noted that cervical cancer is the second most common disease in Nigeria, adding that every year, about 14,000 new cases of cervical cancer occur and about 8,000 people die of the disease.

“It is one vaccine that has been seen to prevent this cancer. Imagine a world where all our girls have been vaccinated against the HPV virus, which over the years can lead to cancer later in future. What does that mean? It means that in years to come, we will not be talking about cervical cancer.

“For me, it’s about them having the right information. You know that already there’s a lot of stigma, in the country we find that when it comes to cancer it’s not publicised when people have it which is why you don’t hear. If you go to the facilities, it is very common and most scientists, always discover it when it is very fatal.

“There are lots of myths and misconceptions and it was the same kind of misconceptions we had during the polio vaccination years ago, which was eventually reversed.”

She said UNICEF is working very closely with the government but this is not just about the government but taking the trust and right information down to the people, as well as building the trust in the vaccine.  We are working very closely with community leaders in the communities too”.

She urged mothers to take their children for vaccination, adding that immunisation is free in all our public health facilities, family health care centres, secondary health facilities that provide immunisation, and even in some of the tertiary facilities.

“If for anything you are charged, please report the cases because you are not supposed to pay  in any public facility for immunisation”

“We need the help of the media. We have done well over the years, but we still need a lot of investment in immunisation so that we can reach all children. Tell everyone, whether it’s our leaders, our communities, our caregivers, or our wards, that it’s time for immunisation for all and share the humanly possible message that we can do this. The way we eradicated, smallpox and polio. It’s humanly possible for all the other diseases.

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