Vaccines are among the greatest advances of modern medicine. It is an essential, cost-effective strategy to reduce childhood morbidity and mortality. Unvaccinated children, according to medical experts, remain vulnerable to vaccine-preventable diseases. Isioma Madike reports.

Immunisation efforts worldwide, according to medical experts, have made it possible for children to be able to work, play, dance and learn. Vaccinated children, the experts added, do better at school, with economic benefits that have a ripple effect across their communities.

Today, vaccines are estimated to be one of the most cost-effective means of advancing global welfare. Despite these longstanding benefits, low immunisation levels persist.

However, millions of Nigerian children miss out on these life-saving vaccines annually, according to global statistics. Those in this category are mostly poor, marginalised children. Many of them live in remote areas, or where some of these diseases remain endemic. In such places, low immunisation rates also compromise progress in areas of maternal and child health well-being.

A public health physician and former President, Guild of Medical Directors (GMD), Prof. Olufemi Babalola, admitted that vaccines protect children from deadly diseases such as polio, tetanus, diphtheria, and keep children safe by eliminating or greatly decreasing dangerous diseases that spread from child to child.

There are five important reasons why one should vaccinate their children, he said, while insisting it is important for responsible parents to ensure that their children get all the recommended vaccination at the appropriate time.

Although there is a lot of disinformation out there on vaccination that dissuades parents from taking their children for immunisation, he further said.
He sees this as responsible for the resurgence of hitherto “forgotten” diseases such as measles and mumps.
He said: “There are at least five reasons why children should be vaccinated: Immunisation can save your child’s life. Because of advances in medical science, your child can be protected against more diseases than ever before.

“Some diseases that once injured or killed thousands of children have been eliminated completely and others are close to extinction – primarily due to safe and effective vaccines.
“Polio is one example of the great impact that vaccines have had around the world, particularly in Nigeria. It was once a most-feared disease, causing death and paralysis across the country, for instance.

“Nowadays, due to vaccination, there are few or no cases of polio in most countries. It will be recalled that Nigeria and Pakistan were the last two countries to struggle with polio due to vaccination hesitancy in some parts even though vaccination is very safe and effective.”

Another professor of Veterinary Medicine and Clinical Virology at Michael Okpara University of Agriculture in Umudike, Abia State, Maduike Ezeibe, while agreeing with Babalola, added that children need revaccination in their adulthood.

Among children diseases, he said, some are “vaccine preventable”, meaning that when children are fully vaccinated, immunity from the vaccines lasts until they are adults and can no longer suffer the diseases.

“When a disease is not a children’s disease (affects people of all ages) it may hardly be ‘vaccine preventable’ because immunity from vaccines does not last forever.

“However, if a vaccine can provide immunity for a very long time (10 years) like the yellow fever vaccine, it can be used on the condition that people are revaccinated long before their immunity reduces below the level that protects against the disease.”

The professors say that vaccines are one of the great breakthroughs of modern medicine, saving millions of lives every year, at a low cost. Africa experienced the eradication of the wild poliovirus a few years ago, they added, due to the power of vaccines and the dedication of immunisation workers.

Sadly, in 2020, the world witnessed an alarming decline in global vaccine coverage and uptick due to the COVID-19 pandemic, which disrupted the delivery of immunisation services.

A unique effort by the Nigerian government, communities, global polio eradication partners, and philanthropists, for instance, shook off the country’s weak health systems and significant logistical and operational challenges to inspire greater hope ahead for the future.

It was resolved that vigilance was vital among campaigners in order that a polio disease reversal would not be witnessed.

But Nigeria, according to some analysts, is not cautious enough considering the negligence by some concerned officials and other stakeholders in what is supposed to be a concerted effort at warding off the threat of other preventable diseases from children.

Apart from polio, other vaccine-preventable diseases like tuberculosis, measles and pneumonia continue to rank among the top killers of children under age 5 in Nigeria and other developing countries.

Each year, nearly 31 million children under 5 suffer from these diseases and many of them end up dying from the diseases.

Pneumonia alone, according to reports, claims the lives of more than 800,000 children every year. These are deaths that could be prevented with adequate vaccine coverage.

According to the Federal Ministry of Health, a child is considered fully vaccinated if he or she has received a Bacillus Calmette-Guérin (BCG) vaccination against tuberculosis; three doses of DPT to prevent diphtheria, pertussis (whooping cough), and tetanus; at least three doses of polio vaccine; and one dose of measles.

Nigeria, reports say, contributes about 30 per cent of the global number of unimmunised children under-5. Government efforts to strengthen routine immunisation coverage and reduce under-5 mortality, according to such reports, have had limited success over the last decade. Recent review however, is not reassuring.

The WHO and UNICEF have agreed that COVID-19 related disruptions may have reversed any hard-won progress in immunisation rates world- wide.

These organisations pointed out that the situation is compounded in the northern part of Nigeria by persistent conflict and insecurity, especially for the poorest households and most vulnerable children.

According to them, delivery of essential services and life-saving immunisation to these zones is now becoming more difficult. They have also noted that the rural–urban divide continues to widen in the country.

This, they say, is sustained by various barriers preventing access to health services, such as the limited number of available or accessible facilities in remote areas and high out-of-pocket payments for health service.

As a result, the uptick of basic essential services like antenatal and post-natal care, they added, remains low, especially among women and children in rural communities.

In a story by UNICEF Nigeria, a Director of Nursing and the Local Immunisation Officer in the Ahiazu Mbaise Local Government Area in Imo State, Mrs. Margaret Uwakwe, shared her first-hand experience of the effects of not getting vaccinated.

Part of her job is to make sure vaccines are available from the local government, and to educate workers on new vaccines, and follow through with vaccination campaigns. She recalled once trying unsuccessfully to change the minds of parents who refused to vaccinate their children.

A few years later, two of their children died of measles – a vaccine-preventable disease, she said. “It was a very sad situation,” Uwakwe added.

“Because of that, I have always seen my profession as a vocation. It’s a very important job, as it helps prevent so many deaths. I don’t think I will ever get tired of talking to people about the importance of immunisation.”

In Nigeria, immunisation coverage varies dramatically, and all states fall below the global goal of 90 per cent coverage for three doses of pentavalent vaccine, which protects children against five major diseases: diphtheria, tetanus, pertussis (whooping cough), hepatitis B and Haemophilus influenzae type b.

But within the country, the South-East region has the highest immunisation rate. This is a point of pride for Uwakwe.

She said: “My local government area was among the three that were selected for documentation evaluation during the polio eradication exercise and it came in first place, with 99 per cent coverage.

“I am proud that I contributed to Nigeria being a polio-free nation.”

However, many people aren’t able to seek vaccination due to poor road access in rural communities and difficulty in finding health centres. Others avoid vaccines due to incorrect beliefs about their safety.

With a struggling health system and too few health workers and facilities within reach, frontline workers like Uwakwe are key to keeping children and adults healthy and vaccinated.
UNICEF, together with partners and donors, is working with the Nigerian government to ensure that health workers like Uwakwe can continue to deliver routine immunisation services in a safe way.

A Family Physician, Dr. Rotimi Adesanya, fears for this period as he said that administration changes have been known to stall the continuity and stability of previous progress, particularly in the health sector.

He nonetheless said that a strong PHC system is vital to delivering vaccines to all children, especially those with least access to health services, who are the most vulnerable.

He said: “Across all public health policies, there is a need to deliberately emphasise on strengthening maternal, newborn and child health services. Efforts to empower, train, and retrain health workers will need to be scaled up and extended to Community Health Workers (CHWs), which is the backbone of PHC.

“To make these changes sustainable, public health authorities will need to continuously evaluate and consolidate relevant policies to create an enabling environment. Scaling up immunisation coverage in Nigeria is not just a goal, it is imperative.

“It is incumbent on the authorities to rethink how it can make immunisation work in Nigeria despite the challenges and complex dynamics.”