Africa Vaccination Week: Matters arising

The Africa Vaccination Week (AVW) is an annual event held in April throughout the African continent, in synchronisation with other WHO regions and the World Immunisation Week (WIW). The goal of the AVW is to strengthen immunisation programmes in countries of the African region by increasing awareness of the importance of protecting every person (in […]

The Africa Vaccination Week (AVW) is an annual event held in April throughout the African continent, in synchronisation with other WHO regions and the World Immunisation Week (WIW). The goal of the AVW is to strengthen immunisation programmes in countries of the African region by increasing awareness of the importance of protecting every person (in particular, every child and woman) from vaccine-preventable diseases. 

The goal of the 2018 campaign – Protected Together, #VaccinesWork – is to urge greater action on immunisation around the world. For us in Nigeria, our focus must be on spotlighting the role that everyone – the government, individuals and partners – can play in this effort. At the end of the activities of the AVW, it is expected that the delivery of high quality immunisation and other high impact lifesaving interventions would become routine, regular, accessible and available in Nigeria. 

The celebration of the AVW this year in Nigeria was with a series of public media and policy-directed activities at local and global partners, drawing attention to Nigeria’s commitment to achieving universal vaccination coverage. The grand finale of the AVW activities was to be the National Stakeholders Meeting/ Recognition Award ceremony to recognise success stories and identify and recruit champions of immunisation. 

A few days before the commencement of the AVW activity, the organisers felt constrained to postpone the grand finale activities. While the activity was postponed or cancelled, it did not appear as if the speech of the guest speaker was either cancelled or postponed. So, here it is.

Since you know we are not likely to stop having children in Nigeria, the hope is that you will continue to champion the cause of immunising and protecting Nigerian children against vaccine preventable diseases.

Who is a champion for immunisation in Nigeria? What does a champion do? Why should you be a champion? How can you be a champion?  When and for how long must you be a champion?

Before providing answers to these questions, it is important to describe the current state of our nation, with regards to immunisation of our children. Simply put, “Over the past three generations, the preventable diseases my generation escaped from are the same diseases my children’s generation, through vaccination, were protected from, and still the same diseases that, through neglect, the generation of our grandchildren are now dying from. These diseases are measles, polio, yellow fever, Lassa fever, cerebrospinal meningitis. In addition, we now have Ebola and monkey pox, which has replaced smallpox. 

In 2017, we recorded 21,974 cases of measles, with 117 deaths; CSM affected 10,043 individuals and 617 of them died. According to the NCDC, 2018 has been the most severe year for Lassa fever infection. From January 1 to April 22, 2018, a total of 1,865 suspected cases were reported from 21 states. Out of these, 416 were confirmed positive, 9 are probable. 

Lassa fever was first reported in Nigeria in 1969, almost 50 years ago. Twelve years ago, three Nigerian children were paralysed by polio every day. The situation has significantly improved that over the last five years, we had only 10 polio cases; and since 2017, not one case of polio has been reported in accessible areas of the country. 

An aggressive anti-polio immunisation campaign is responsible for the improved situation. You will all recollect that we succeeded in dealing with Ebola in 2014. However, we have not been able to repeat the success with other diseases, such as Lassa fever, yellow fever, CSM and monkey pox. These diseases have raged uncontrolled throughout the length and breadth of Nigeria.

The current situation in our country tells much about why we need champions to reverse the trend.  Several factors are responsible for Nigeria’s inability to protect her citizens from incessant outbreaks of controllable and often preventable diseases. These factors include an unreliable and ineffective health care delivery system, a national government that provides insufficient funding to take care of the health problems of the nation, and a citizenry that pay scant attention to health and powerless to hold government accountable

Champions are volunteers or selected individuals within a group, an organisation or a country who facilitate positive change. They see the vision for change and desire to actively advocate, facilitate and support its implementation. A true champion who believes in change is driven by vision and energised with passion. The champion is the dynamo and a motivator of change, solving problems, removing social barriers of change. 

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What are the changes we desire for Nigerian children? We want to reverse the destructive trend of low vaccination coverage in Nigeria. We want to ensure that no child is left behind in the vaccination drive. We want to ensure that the number of zero dose vaccination for any vaccine is zero. We want to keep immunisation high on our national agenda through advocacy and partnerships. We also want to promote the delivery of other high impact lifesaving interventions. The overarching objective for our champions is to work for “vaccinated and healthy communities,’’ leaving nobody behind or unvaccinated. 

Why do we still have a situation where a total of 4.3 million children in Nigeria miss out on vaccinations every year? In Nigeria, only one in four of our children receives all the recommended vaccines. These children who have never been vaccinated are at the greatest risk of contracting diseases such as measles, whooping cough and tetanus; diseases which may be fatal or lead to long-term debilitating effects on survivors. 

I do not think we lack the financial resources to take care of the health of the citizens of this nation, or at least to provide sufficient doses of all the vaccines we need to protect our children. 

Imagine how many doses of vaccines we could have purchased with the huge sums of money stolen from our country and recovered by the Economic and Financial Crimes Commission (EFCC) between January and December, 2017. Simply put, if we maintain the same armoury of vaccines and our birth rate, (producing 4-5 million children every year), the stolen money is enough to fully vaccinate every Nigerian child born in the next six to eight years.

Last year, funds for polio intervention activities were not released until January 2018. Our immunisation activities survived on the generosity of external donors, including Bill Gates.

The blame for this disaster is spread all around – the executive blames the legislature, who in turn blames the ministry, who blames civil servants, who returns the blame to the government – whoever that is.

The other issue is the attitude of the society to issues of health in general and immunisation in particular. Since routine immunisation started in Nigeria, it has not yet attained the routine status. At best, routine immunisation has attained a supplementary status in the wake of polio eradication. Even at that, Nigeria still remains the only country in Africa yet to interrupt the transmission of polio. The reasons given for our failure dance around the drumbeats of missed children (at home, in school, in the playground or at the naming ceremony). 

Some areas of this country are inaccessible because of insurgency problems. Sometimes, the vaccines are just not available or the poorly trained health worker performs duty to the best of his or her non-ability. The good worker may not be provided with the basic requirement to enable effective performance, sometimes as a result of corruption in its diverse and various forms. In many of the institutions of public and private enterprise, accountability is disdained, despised, scorned, spurned, disparaged, vilified and hated. 

Being a champion for immunisation in Nigeria is not an easy task. It must not end with receiving plaques and handshakes. You must quickly put the plaques on the shelf and identify which area of the challenges of immunisation in Nigeria you want to tackle and become the champion that brings about positive change.

Where there are issues of people not accepting vaccines, join health workers in the education of our people, making them aware of the benefits of vaccinating their children. Let us start with getting our people to embrace and buy into immunisation. Use your highly exalted position to bring awareness to parents and families. 

Another area that urgently requires the involvement of champions for improved and sustained high quality immunisation is the insufficiency and untimely release of funds. It is essential for all champions of immunisation to call on the different arms of the government to ensure that budgets are approved on time and funds released as appropriate. Perhaps more importantly, every champion must join in the national cry for transparency, integrity and judicious use of funds with integrity and accountability. 

We need champions with the courage to demand accountability and fair play from our leaders, champions to fight for the wellbeing of our children. 

Tomori is the chairman, Expert Review Committee (ERC) on Polio and Routine Immunisation.