Nigeria cracked polio. So why does it have 3.5 million unvaccinated babies?
Over 20 million children across the globe have not been vaccinated against measles, tetanus, rubella or polio. Half of them come from ten countries, five of which are in Africa.
Nigeria, Ethiopia, the Democratic Republic of Congo, Uganda and South Africa have the largest numbers of unvaccinated or under-vaccinated children on the continent.
There are several reasons for this. Aside from the public not understanding the benefits of vaccination and not trusting the health systems, access to care is also limited. In addition, there are too few health care workers for timely vaccinations, infrastructure is deficient and data is of a poor quality.
Of these countries, Nigeria may be in the worst situation. Despite its monumental success in eliminating Ebola and polio, it still has nearly 3.5 million infants not vaccinated against measles. And it is also among the eight nations that are behind in eliminating maternal and neonatal tetanus.
Vaccinations have been a worldwide priority since 2012 when the World Health Organisation ratified a global vaccination action plan to stop children from dying from vaccine-preventable diseases. These include maternal and neonatal tetanus, measles, congenital rubella syndrome and polio.
The organisation dubbed it the “Decade of Vaccines” with a vision of having universal access to immunisation by 2020.
But according to an annual assessment of this plan that has been rolled out for the last five years, several countries are way off track.
The report is released by the Strategic Group of Experts on Immunisation. It makes annual recommendations to governments, international organisations and development partners on how to meet the goals and objectives of the global vaccination plan.
Why Nigeria is off track
Nigeria has successfully wiped out some diseases. It has not recorded any cases of wild poliovirus in over a year. In September 2015 the World Health Organisation removed the country from the polio-endemic list. That feat was achieved by working with technical partners to establish and enforce clear accountability systems, to measure results, reward those who achieve them, and to discipline or part company with those who did not.
But the country’s challenge is failing to translate its polio success to other diseases. Estimates based on the administration of three doses of the diphtheria-pertussis-tetanus vaccine show that in 2014 Nigeria had more than 2 million unvaccinated children.
Nigeria, like other countries that have not met vaccination targets, is also beset by healthcare data quality issues due to a lack of governance, technical know-how and infrastructure.
Political, ethnic and religious conflicts can also hamper vaccination efforts by disrupting health systems. Violent conflicts prevent the delivery of vaccines and displaced populations often struggle to receive basic services. This is the situation in northeastern Nigeria where Boko Haram is threatening immunisation programmes with ripple effects in neighbouring Cameroon.
Funding is also a concern. Currently, there is an estimated funding gap of $130 million to rid the world of maternal and neonatal tetanus. This is a minuscule amount when compared to the $1.1 billion the Global Vaccine Alliance spent in 2014 on its new and underused vaccine programmes. But the real challenge is that the funding is not getting to where it needs to go. This is all too familiar in Nigeria where the Business Anti-corruption Portal has noted that corruption risks are pervasive throughout all institutions, including the health care system.
The way forward
The latest report rightly focuses on leadership and the accountability systems as two investment areas that can take the vaccination action plan forward. But I believe that the factors highlighted in earlier reports - data quality, community involvement and vaccine supply - are still important to meet vaccination targets in countries like Nigeria.
The challenges to improving health care quality, including information and communication technologies, need to be addressed with legislation, better standards, greater investment and new infrastructure. A comprehensive approach that tackles poverty and the distribution of wealth is also needed to guarantee peace and security across the country.
Accountability and transparency at all levels of the vaccine procurement and distribution process will help ensure the right vaccines are available at the right time and place.
The plan’s goal of freeing all children from vaccine-preventable diseases is an ambitious one. At this time we are far from meeting the set targets, but it is true that significant progress has been made. With greater government commitment, it can be hoped that this lofty goal will soon become an achievement for all of humanity.
Utibe Effiong: Resident Physician at St Mary Mercy Hospital and Research Scientist for the Exposure Research Laboratory, University of Michigan
This article was first published in The Conversation