MAY 14, 2021
Lack of or under-immunisation against diseases should not be a problem for a country like Nigeria. But many still find themselves in this tight corner of not getting the appropriate vaccines with data from the United Nations Children’s Fund (UNICEF) shows a decline in Nigeria’s immunisation coverage in the year 2020 compared to 2019, writes MOSES EMORINKEN
On a hot afternoon in Maiduguri, Borno State, Hajia Bintu Mustapha sat alone outside her room in the Gwange 3 area of the city, dressed in a full-length black hijab. The house was silent as was much of the city whose residents were mostly fasting. But the silence in Mustapha’s compound was from a broken heart.
It was exactly one week that her five-year-old daughter Zara succumbed to an ‘attack from evil spirit’. Mustapha had lost seven other children to sickle cell anaemia but, according to her, the ever bubbly Zara was the first to die from ‘a spiritual attack.’ She has had
14 children with only six surviving.
“I never took Zara for routine immunisation appointments, but I believe she died of a spiritual attack,” said the 45-year-old. Mustapha rummaged for a while in a white paper carton for Zara’s death certificate before remembering that she had yet to collect it at the Maiduguri University Teaching Hospital.
Sickle cell disease runs in the family. But Mustapha maintained Zara did not die of an anaemic condition. Zara was a healthy child, unlike some of her other children.
“Zara was not a sickle cell carrier. She never spent a day in the hospital. Unlike my other children, she crawled and walked at the right time. She was never sickly or frail. I was ill for some time after Zara was born. Another child was also ill at the same time. I forgot to take her to the clinic for immunisation in the confusion. But to me, this was a spiritual attack,” said the bereaved mother.
However, a neighbour, Hassan Kachallah, an engineer, disagreed with Mustapha. Kachallah runs a popular after school Islamic centre in the Gwange neighbourhood. Zara had been a punctual student.
“Unlike her usual character, I noticed that Zara had started lying on the mat complaining of headache at the centre. When I spoke with her mother, she said Zara had been administered Paracetamol. This continued for about a week and she kept coming to the centre with the same complaints. At a point, we thought it was a spiritual attack, so we invited a Mallam for spiritual prayers.
“But her condition got even worse. Suddenly, Zara started clenching her left palm and it would take a serious effort of the right palm to force the left palm open. I never knew the mother did not take her for routine immunisation. This is just negligence. By the time we rushed Zara to the MSF clinic close to the house, the left side of her body had started drooping. We were told to rush her to the Teaching Hospital and we did. She died two days after her admission,” said Kachallah.
Kachallah stressed that the untimely death of little Zara could have been averted had her mother taken her for routine immunisation. “This is looking more like a vaccine-preventable death,” he added.
Zara’s death is one too many. While immunisation is the right of every Nigerian child, Zara, like many other children, have become victims of lack of or under-immunisation against diseases that could have been prevented had they taken appropriate vaccines. Sadly, for those that survive the claws of death due to treatment, their lives never remain the same as they perpetually grapple with lifelong disabilities.
The national immunisation outlook for the country is worrisome, as data from the United Nations Children’s Fund (UNICEF) shows a decline in Nigeria’s immunisation coverage in the year 2020 compared to 2019. In 2019, a total of 6,842,505 children were immunised. This dropped to 6,616,734 in 2020.
Furthermore, there has been a decline in the number of children immunised across the country in the first quarter of 2021, compared to 2020 and 2019.
According to Patrick Akor, a UNICEF Immunisation Specialist, “in terms of the absolute number of children immunised in Nigeria in the first quarter (January – March) of 2019, 2020, and 2021, a total of 1,710,665; 1,683,011; and 1,626,644 children were immunised respectively.
“However, at the state level, nine (9) states performance was higher in 2021 compared to 2020. The states are Anambra, Cross River, Ebonyi, Ekiti, Kano, Ondo, Oyo, Yobe and Niger.”
Why Nigeria must ramp up routine immunisation?
According to the World Health Organisation (WHO), immunisation currently prevents 2 to 3 million deaths every year from diseases like diphtheria, tetanus, pertussis, influenza and measles.
The WHO maintains that the very low risk of an adverse event caused by a vaccine greatly outweighs the risk of illness and complications caused by natural infection.
There are now over 26 vaccine-preventable diseases, according to the WHO. Some of the main vaccine-preventable diseases are – Tuberculosis, Poliovirus, Diphtheria, Tetanus, Pertussis, Measles virus, Hepatitis B virus, Rotavirus, Streptococcus Pneumoniae, Yellow fever virus, Human Papillomavirus (HPV), Hepatitis A virus, Varicella-Zoster virus.
While commemorating this year’s World Immunisation Week, with the theme ‘vaccines bring us closer,’ the Director-General of the WHO, Dr Tedros Ghebreyesus, disclosed that thanks to vaccines, measles deaths fell dramatically from 2,600,000 in 1963, to 200,000 in 2019.
Also, 30 million children were saved between 2001 to 2010, and 40 million lives saved between 2011 to 2020. Ghebreyesus further stated that 50 million lives will be saved between 2021 to 2030 if global targets of immunising more children are met.
“By 2030, the Immunisation Agenda aims to achieve 90 per cent coverage for essential vaccines given in childhood and adolescence; halve the number of children who completely miss out on vaccination, and introduce 500 new vaccines in low and middle-income countries,” the WHO boss stated.
The big question is: can this be achieved domestically when globally, Nigeria is also not looking good; being garbed with the highest number of under-immunised children.
A 2019 estimate of the National Immunisation Coverage by the WHO and UNICEF, revealed that 10 countries account for 12.2 million (62 per cent) of the 20 million under or unvaccinated children globally. This list includes some countries with moderate or high coverage and very large birth cohorts, and other countries with substantially lower coverage. Middle-income countries occupy an increasing share of this list.
Ten countries account for 62 per cent of unprotected children. Nigeria accounts for 15 per cent, which translates to 3 million under or unvaccinated children globally. Other countries like India, accounts for 2.1 million; DR Congo, 2.1 million; Pakistan, 1.4 million; Ethiopia, 1.1 million; Brazil, 0.8 million; Philippines, 0.7 million; Indonesia, 0.7 million; Angola, 0.5 million; and Mexico, 0.5 million.
With the staggering figure of 3 million Nigerian children not fully immunised, if this number represented countries like Jamaica, Qatar, Namibia, Gambia, Botswana, Gabon, etc., with almost the same population number or less, it would mean that their citizens would have either died from vaccine-preventable diseases or rendered disabled.
The United Nations bodies posit that the African Region and countries affected by conflict are home to large numbers of “zero-dose children.” Among the countries, Nigeria is considered the most fragile, conflict-laden, and vulnerable.
‘Nigeria’s polio-free status still fragile’
In August last year, Nigeria celebrated her hard-earned and long-awaited poliovirus certification from the Africa Regional Certification Commission (ARCC) of the WHO. This is coming against the backdrop of decades of hard work by present and past patriotic Nigerians.
However, UNICEF has called for caution and the need for the country to ramp up efforts, and not celebrate too early to avoid a resurgence or importation of the disease on account of a drop in routine immunisation coverage, especially in conflict-ridden states. Also, two countries – Pakistan and Afghanistan are yet to be cleared of poliovirus, hence, the global health body’s warnings.
Will Nigeria let the labour, tears and blood of her heroes past (who created the template for the eradication of poliovirus) be in vain?
Speaking during a media dialogue on Routine Immunization and COVID-19 vaccination in Yola, Elizabeth Onitolo, the Communication for Development (C4D) Specialist with UNICEF, said: “Nigeria’s polio certification calls for cautious celebration. The success recorded is still fragile because immunisation coverage is still low. Many parents are still not compliant, while many children have not been vaccinated.
“Because of the COVID-19 lockdown last year, we told our mobilisers to urge mothers to go to health centres for immunisation. Many missed their schedule due to the lockdown. The mobilisers collected the numbers of the mothers, called and followed them up.
“For children under two years to combat recurring measles disease, one dose of measles vaccination is no longer enough. It has now been increased to two. Environmental sanitation and personal hygiene in communities are still very low, providing a possible ground for disease outbreak.
“Major causes of death amongst children are vaccine-preventable diseases. We must work assiduously to avoid a resurgence or importation of polio. Afghanistan and Pakistan are still polio-endemic. Routine Immunisation is very low in the country.
“Children are more vulnerable, therefore there is an urgent need to vaccinate them. We need to maintain herd immunity. This means that every child must complete routine immunisation. All caregivers must take their children for immunisation and ensure they complete their routine immunisation. We also have targeted mobilisation efforts at leaders including heads of households.”
Another issue is the frantic efforts by countries, including Nigeria, to ensure that their citizens are vaccinated against the deadly COVID-19 disease. As much as this is a worthy cause, health experts have warned that other vaccine-preventable diseases are suffering a decline in vaccination.
“But even as COVID-19 vaccines give us hope of light at the end of the tunnel, the pandemic has caused severe disruptions to immunisation services around the world. New WHO data shows that as a result of COVID-19, 60 immunisation campaigns are currently suspended in 50 countries. That means about 228 million children are vulnerable – right now – to deadly, vaccine-preventable diseases such as measles, yellow fever and polio.
“Measles campaigns are the most affected, accounting for 23 of the postponed campaigns. Many measles campaigns have now been delayed for more than a year. In addition to targeted campaigns to prevent or respond to outbreaks, routine childhood immunisation services also continue to be disrupted by COVID-19.
“The latest WHO pulse survey shows that routine immunisation services were disrupted in more than a third of countries in the first quarter of 2021. While this represents a significant improvement over last year, it remains a serious concern. Gaps in vaccination coverage are already having grave real-world consequences.
“Serious measles outbreaks have occurred in several countries, including the Democratic Republic of the Congo, Pakistan and Yemen. And the risk of measles outbreaks is mounting elsewhere, as more and more children miss out on the vaccines they so urgently need. So we must turn the tide quickly and rebound from these disruptions,” Ghebreyesus said.
UNICEF Chief of Immunisation Dr Robin Nandy added: “On the importance of delivering COVID-19 vaccine in parallel to existing childhood vaccinations as well, as more and more COVID-19 vaccines are available, there is a chance of further disruption of routine immunisation services. What we don’t want to see is the concurrent outbreak of other vaccine-preventable diseases, as we respond to the COVID-19 pandemic because that will be a disaster to the health system, economy, families and communities.”
The WHO stated that: “every dollar spent on childhood immunisations yields US$44 in economic benefits. These include savings on medical costs and productivity loss.”
Immunisation does not only save lives and protect people, it is also an investment in the economic future of any country, as it improves the productivity index of its people.
Lack of immunisation is one of the major reasons for disabilities. With a lot of children being incapacitated by vaccine-preventable diseases, one can only imagine the kind of obscure and uncertain future they will have.
Since children are most at risk of vaccine-preventable diseases, once any of these precious little ones contract the disease, they usually would get some kind of disability, even after treatment. Some of the disabilities include (not exhaustive): loss of limbs, retarding of brain functions, loss of sight, and other malfunctions of psychomotor organs required for optimal productivity.
A disabled person does not only become a burden to himself or herself, family and friends, but also an economic burden to his or her country. Such a person contributes little or nothing to the economic growth and development of a nation, but a substantial amount of the country’s collective wealth will be spent (directly or indirectly) for their daily well-being. Also, because such a person always needs proper care and attention, an additional person (usually a family member) will be rendered unproductive while taking care of them.
Making a success of protecting the Nigerian child from vaccine-preventable diseases is a collective responsibility of both the government and its people. While governments at all levels play a pivotal role, mothers and heads of families must ensure that their children are properly vaccinated and that they complete their immunisation schedule.
Like Hajia Bintu Mustapha who strongly believed that her daughter’s affliction and eventual demise was the result of an “attack from evil spirits,” many parents and guardians still belong to the same school of thought. Some wrap it all with trite religious statements like – “it is an act of God,” or “it is the will of God.” They waste too much time seeking spiritual interventions until it is too late for any medical intervention to save the soul of the child.
Rumours, myths, and misconceptions are as old as vaccines themselves, which go far back as the 20th century. This further complicates and emboldens false beliefs and conspiracy theories about diseases, vaccines, hence, the inertia of some to be immunised.
The government, civil society organisations (CSOs), international and local partners, and the heads of families have very important roles to play. So does the National Orientation Agency (NOA).
Speaking with The Nation, Dr Ejike Orji, a Public Health Specialist and Advocate, said: “In terms of impact, the National Primary Health Care Development Agency (NPHCDA) has been making sure that routine immunisation goes on irrespective of the pandemic. I know that during the lockdown, there have been some little itches. However, after that, the immunisation has continued.
“Routine immunisation is one of the most important interventions to reduce infant and under-five mortalities. Even in malaria, we have been able to achieve a lot in terms of reduction. However, we will lose all of that if we don’t put our eyes on the ball. That is where strategic leadership, interventions, and prioritisation comes in.
“No health worker will go to an insecure place to have himself or herself killed. Therefore, the level of insecurity is disrupting our normal lives and social interventions. That is also where strategic leadership comes in. In those areas, logistics is not the primary concern; what is important now is securing the place. That is why we are saying people should pay attention to issues of security, and make sure that anyone who wants to do anything should have a secure environment to do his or her work.
“We have been talking about public education and community engagements. For me as a public health person and an advocate, that is what I have been talking about. We need to educate our people and engage the community in some of these issues.
“At the federal level, we are not doing so badly, but at the states level, the Governors are not doing enough. We need more advocacy at the state level so that they can put it as their line items when they are doing their budget appropriation.”
SOURCE: THE NATION