What a difference a year makes

But given that Nigeria has one of the highest numbers of vaccine preventable deaths in Africa, with 756,000 children dying from diarrhoea and pneumonia in 2011 alone, one year on what progress has been made? Last month, I visited your great country to see for myself. Encouragingly, I discovered that penta appears to be having […]

But given that Nigeria has one of the highest numbers of vaccine preventable deaths in Africa, with 756,000 children dying from diarrhoea and pneumonia in 2011 alone, one year on what progress has been made? Last month, I visited your great country to see for myself. Encouragingly, I discovered that penta appears to be having a catalytic effect. In some parts of the country routine immunisation rates have risen, from levels so low in recent years that they were unlikely to make an impact on mortality, to higher than 70 per cent in several states. Indeed progress has been so positive that the government’s National Primary Health Care Development Agency (NPHCDA ) has committed to reaching a target of 80 per cent immunisation coverage across the country by the end of the year.
Given the political com-mitment, and funding being invested by organisations such as mine, the GAVI Alliance, a public private partnership aimed at imp-roving access to vaccines for the world’s poorest children, this is a once-in-a-generation opportunity to rid Nigeria of the scourge of vaccine-preventable diseases. Indeed, if successful, this would have a positive impact that would be felt not just in Nigeria, but the world over.
For, with Nigeria being one of the three remaining countries where the wild polio virus remains endemic – the others being Afghanistan and Pakistan – there is now a widely held belief in the global health community, that it is only by boosting routine immunisation, which includes polio, in these countries that we will see an end to polio.
So this means that increasing routine immuni-sation in Nigeria is not just a top priority for my organisation but it also plays a critical role in the global polio eradication effort. In other words, even though Nigeria already spends a third of its US$ 57.5 million immunisation budget on periodic national polio cam-paigns, it still needs to build a solid foundation of routine immunisation in order to bid farewell to polio once and for all. It won’t be easy, and there will be formidable challenges along the way, but my belief is that Nigeria is now on a trajectory that could well make this happen.
NPHCDA’s goal is ambitious and will require substantial efforts to tackle major challenges in the immunisation system today. Among these are the gaps that exist within Nigeria’s supply chain and data collection. Indeed supply chains are a particular problem. Many areas do not have sufficient cold chain equipment to keep vaccines cool (which is necessary to maintain their potency), while even in some areas that do have the necessary equipment, up to half of the fridges are not functioning.
Similarly, during my visit I heard about shortages of basic data-collection tools like data log books. Without log books how can staff keep accurate records? Moreover, for many children there is simply no data on which vaccinations they have received; without reliable data it is impossible to improve surveillance and identify high risk areas in any meaningful way, and so plan accordingly. Without data we cannot identify weaknesses in supply chains, strengthen health systems or reduce wastage; and without data it is impossible to predict shortages and avoid disastrous incidents where vaccines run out completely, such as the one that occurred in Nigeria in 2011 and then again in 2012.
To this end, as part of the US$ 600 million GAVI has already invested in immu-nisation in Nigeria, GAVI is investing US$ 21 million to strengthen the supply chain, purchase cold chain equipment and improve data collection. Granted, this is not going to solve all of Nigeria’s problems overnight, but it should help plug some of the biggest gaps.
This is truly an exci-ting time of change for Nigeria. And as I left Abuja it was difficult not to feel a great sense of admiration for the enthusiasm and pride with which health workers and officials are embracing the challenge of boosting vaccine coverage and saving lives. It is clear also that there is a genuine desire to not just see immunisation rates rise, but to go further and use this momentum to introduce new vaccines, such as those that target pneumococcal disease, one of the biggest causes of pneumonia which claims more children’s lives in developing countries than any other disease.
In the year since Nigeria introduced penta we have seen a lot of progress being made. Now, following the unexpected resignation of Dr Muhammad Pate, Minister of State for Health and a long time champion of childhood immunisation in Nigeria, the question is where will we be a year from now? Given the great commitment I have seen, I am encouraged to believe that with strong backing and support, Nigeria’s immunisation infrastructure will be in a position to save not just one million lives, but also many more lives in the years to come.
But this will require strong leadership, resolve and inno-vation – all skills that are well honed in Nigeria. People in Nigeria, and the world over, look forward to seeing the results.

Dr Berkley is the CEO of the GAVI Alliance