Yellow fever and Nigeria’s campaign to protect the vulnerable

Nigeria is conducting its largest ever yellow fever mass campaign. The vaccination campaign is a response to the yellow fever cases reported in Nigeria since September 2017, and also part of the comprehensive strategy to Eliminate Yellow Fever Epidemics (EYE) by 2026. The World Health Organisation (WHO) has highlighted the need to protect the highly vulnerable populations against yellow fever, AJUMA EDWINA OGIRI writes with agencies

The first case of yellow fever was confirmed in Kwara state in September 2017. Since then, 41 cases have been confirmed in seven states, and more than 1,700 suspected cases have been reported from all states of the country.
In Borno state, where millions of people are in need of humanitarian assistance, no case of yellow fever has been confirmed so far; but the presumptive positive case of the disease highlighted the importance of protecting the highly vulnerable populations against yellow fever in this extremely fragile area.

Since the humanitarian crisis unfolded in North-east Nigeria and the rise of Boko Haram in the region depriving people of their lives, including their right to health, Borno has been one of the most affected areas. With the partial or complete destruction of more than two-thirds of health facilities in the state, the remaining functional health infrastructure is limited to respond to the healthcare needs of the population, including outbreak response.

Hence, in February 2018, health authorities in Borno state, in collaboration with WHO and partners, preventively vaccinated more than 2 million people in internally displaced people (IDPs) camps and surrounding host communities. The reach of the health service delivery established for yellow fever vaccination in the IDPs can serve as a backbone for delivery of other vaccines and indeed more diverse health services and strengthen the routine immunisation delivery system.

At Madinatu IDPs camp, Farida, 39; and her 3-year-old son, Abdul; were vaccinated against yellow fever on the third day of a 10-day campaign that took place in February 2018.

“Not only do we face insecurity and a humanitarian crisis, but not finding adequate care within reach, is quite difficult and frustrating. But we are comforted when you bring care to our doorsteps. Last time, it was polio vaccination, then cholera and malaria prevention and now yellow fever,” said Farida.

In Muna IDPs camp, Borno state, a crowd of men, women, and children queue up patiently to be vaccinated against yellow fever.

In the same vein, Zainab, 33; testified that yellow fever infection is dangerous, adding “I had an experience of yellow fever last year when my 13-year-old daughter developed fever and headache. Within five days, my daughter became nauseous and started vomiting. I was told it could be yellow fever but thank God she survived it.

“This is why I came to this vaccination post today even before the vaccinators came, because I wanted to ensure my family would be protected against yellow fever.”

Borno state reported suspected cases of yellow fever, which were not confirmed by the WHO Regional Reference Laboratory, Institut Pasteur, in Dakar. Despite the lack of confirmation, the emergency living conditions of millions of people in the state and the tide of outbreaks across all states in Nigeria made it urgent to target the most-at-risk people with yellow fever vaccination.

Immunization is considered the most important and effective measure against yellow fever. A single dose of the vaccine is sufficient to confer life-long immunity and protection against the disease.

According to WHO Nigeria Representative, Dr Wondimagegnehu Alemu, “vaccinating internally displaced people in Borno state is crucial because protecting vulnerable populations living in high-risk conditions will prevent the spread of yellow fever if an outbreak occurs.”

Conducting a mass vaccination campaign during an ongoing humanitarian crisis, when reaching people is difficult, but also dangerous, presents several challenges. For this reason, Nigeria has chosen a tailored approach, which takes into account the accessibility component, to protect populations in Borno.

For Dr Jorge Castilla, Senior Emergency Officer, at WHO, in Geneva, the main difficulties regarding the implementation of vaccination campaigns in humanitarian settings are related to the limitation of access to people in need of assistance.

“In the conflict-affected area, vaccination has to add the dimension of access and feasibility, and when a window opens that allows vaccinating a low coverage area, that window of opportunity must be taken whenever it is possible,” Dr Castilla said.

According to the Borno state Health Commissioner, Dr Haruna Mshelia, the availability of polio infrastructure made planning and implementation a lot more feasible.

“The existence of polio infrastructure, health personnel and expertise with years of experience in vaccination campaigns enabled the rapid development of strategic plans, definition, and prioritization of most-at-risk populations based on available micro plans, implementation, and monitoring using a standard checklist to ensure a high-quality campaign,” he explained.

WHO is supporting the yellow fever campaign in Nigeria by training thousands of healthcare workers, helping to track cases and providing coordination and logistical support.

According to the organisation, awareness is a critical part of the yellow fever vaccination campaign. Informing and educating community members on the importance of the vaccination against yellow are crucial to guarantee the protection of a high number of people.

WHO and partners collaborated with the government health authorities, community and religious leaders, camp coordinators and community informants to create awareness and educate the target groups through various platforms.
“Initially, I didn’t want to be vaccinated because I suspected that it was meant to depopulate IDPs since there are no places for us anymore. It was not until I heard the announcement on the radio explaining why IDPs alone were selected for the exercise that I agreed to be vaccinated,” Mohammed said.

Within the EYE Strategy framework, the prioritisation of areas that will implement vaccination campaigns takes into account, among other things, immunization coverage, levels of risk, and population vulnerability, as these factors directly affect the ability of communities and health systems to detect, confirm, and respond to yellow fever epidemics in a timely manner.

The EYE Strategy, steered by WHO, Gavi, and UNICEF, was developed in response to the increased risk of outbreaks with international spread. It aims at protecting at-risk population, preventing international spread, and containing outbreaks rapidly.

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