Immunisation: Nigeria low on coverage despite huge funding


According to the World Health Organisation (WHO), Nigeria is yet to maximise the full benefits of childhood vaccination, as 77 percent of children aged 12 to 23 months in Nigeria have not received all the routine vaccinations. AJUMA EDWINA OGIRI writes on Nigeria’s struggle with low coverage despite over 40 years of an Expanded Programme on Immunisation (EPI), and several other funded immunisation programmes.

A major survey finding from 2016/2017 Multiple Indicator Cluster Survey/ National Immunisation Coverage Survey (MICS/NICS) revealed that 77 percent of children aged 12 to 23 months in Nigeria have not received all the routine vaccinations as recommended by the national EPI schedule, while 40% of children in this age group did not receive any vaccinations, setting the country far below the 90% national coverage it so desires.

The survey also disclosed that 33 percent of children aged 12 to 23 months received three doses of Penta vaccines, while 31 percent of children who received Penta1 vaccines did not complete the three doses.

The fifth MICS, jointly released by the National Bureau of Statistics (NBS) and the United Nations Children’s Fund (UNICEF), which was collated between September 2016 and January 2017 from 33,901 households in 2,239 enumeration areas across the 36 States and Federal Capital Territory, revealed the inequalities in immunisation coverage with children of younger and less educated caretakers, less likely to be vaccinated. The survey also found out that children in rural areas are half as likely to be vaccinated as those in the urban areas.

Crude full immunisation coverage
According to MICS, crude full Immunisation coverage describes the situation whereby children have received all antigens defined by the expanded programme on immunisation (EPI) without regard to the specified age or time interval between doses as prescribed by the national schedule. A child is considered fully vaccinated if he/she has received BCG (Bacillus CalmetteGuérin) vaccine, at least three doses of Polio vaccine, three doses of Pentavalent vaccine (Diphtheria, Pertussis, Tetanus, hemophilus influenza Type B and Hepatitis B) Measles Containing Vaccine (MCV) , mophilus Influenza Inactivated Polio vaccine (IPV ), and Yellow Fever vaccine.

The first key finding of this survey is that only 23 percent of Nigerian children aged 12 to 24 months received complete doses of the prescribed vaccinations. The study also found that 40 percent of Nigerian children did not receive any vaccination at all, while the remaining 37 percent received some form of vaccination.

Another key finding from the survey was the drastic variation in immunisation coverage across Nigeria, with all states below the global goal of 90 percent coverage for 3 doses of pentavalent vaccine. The survey also revealed that immunisation performance was weakest in the North East with 8 percent complete immunisation coverage, and was best in the South West of Nigeria with 50 percent coverage. Also, the North East region had the worst non-vaccination coverage of 61 percent, while, by contrast, the South East region had the best at 8 percent.

Inequalities in immunisation coverage in States
The survey showed that Lagos State had the highest utilisation of routine immunisation rate of 80.2 percent, followed by Anambra State at 76.2 percent, while Sokoto State had the lowest utilisation rate at 2.9 percent, followed by Zamfara state at 8.7 percent and Yobe State 8.9 percent.

Surprisingly, Borno State which is the worst hit in the country by insurgents and conflicts, had a utilisation rate of 47.7 percent, and even surpassed 17 other states including all the states in the North-East; Adamawa 37.9 percent, Bauchi 18.5 percent, Gombe 25.0 percent, Taraba 16.4 percent and Yobe 8.7 percent.

Borno also had a higher utilisation rate than the states in North West namely Jigawa at 7.1 percent, Kaduna 29.5 percent, Kano 15.9 percent, Katsina 12.1 percent, Kebbi 11.3 percent, Sokoto 2.9 percent, and Zamfara 8.9 percent. Borno State also has a higher Penta3 value than four States from the North-Central namely Kogi which is at 38.4 percent, Nasarawa 34.9 percent, Niger 20.0 percent and Plateau 45.2 percent, and one State from South-South which is Bayelsa at 42.6 percent.

Withdrawal of immunisation funding
The Chairman, National Immunisation Financing Task Team (NIFT), and Health Sector Reform Coalition (HSRC), Ben Anyene, said lives of millions of children will be at risk between now and 2021 if the federal government fails to take charge of funding immunisation in the country.

Responding to questions from journalists in Abuja, he said the Global Alliance for Vaccines Initiative (GAVI), that funds all new vaccines in Nigeria has started withdrawing from the country and will withdraw totally in 2021.

He also noted that GAVI had reduced its support by 20 percent in 2017, will take off another 20 percent in 2018, 2019, 2020, and by 2021 it will withdraw the last 20 per cent making it 100 per cent withdrawal.

”Unfortunately, now, we are not even paying for the routine things. That is why I get worried when people see the 12.5 billion in this year’s budget for immunisation and were clapping but the actual requirement is N114 billion and nobody is talking about it.

“The question is, will Nigeria be ready to finance her immunisation 100 per cent by 2021 with the requirement of about 560 million dollars?

“Or is there any plan in the pipeline for that? And if there is any plan on the pipeline, implementation ought to start by now, we don’t have to wait till 2021 because already there is a gap,” he queried.

He recalled what happened in the 1980s when, according to him, the United Nations children Fund, UNICEF, started withdrawing and the Nigeria’s immunisation rate dropped from 80 per cent to less than 20 per cent in three years, and further warned that Nigerians should expect the worst in the next few years if governments at all levels fail to act now.

According to him, “there will be total stock out of vaccines, unimmunised children will increase and that will eventually lead to mass deaths of children across the country. Those who are lucky to be alive will be incapacitated for the rest of their lives.

“The question is: How much does it cost to immunise a child? The total cost to fully immunise a child in Nigeria in his/her whole life is N13,000. Why can’t we afford it?”

“If you say each state government should put down 2 billion naira for immunisation for their people, is it too much? That already gives us 72 billion and the federal government can pay the rest. What is more important than the health of the people?”

“Alternatively, this oil we pump, dedicate, for example, two or three days to paying for immunisation. We know how many barrels they pump per day so that we can pay for the immunisation of our children.

“The worrisome aspect is that the people who are supposed to realise the enormity of these issues are not realising it, let alone talking about it. They are busy looking for money from partners.”

Anyene, therefore, called on the federal and state governments to take proactive measures to avert the looming disaster in the country.

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