UNICEF Calls For Multi-Sectoral Strategy In Nigeria To Close Immunization Gap

... Lauds EPI Landmark Of Over 13 Life-Saving Vaccines In 50 Years

Dr Ijeoma Agbo, Health Specialist, UNICEF 

The United Nations Children’s Fund (UNICEF) has urged Nigeria to adopt a multi-pronged and sectoral approach to close the gap between unvaccinated and zero-dose children and improve its immunization program as the global immunisation week draws to a close.

UNICEF also lauded Nigeria’s efforts in responding to the need to develop a resilient immunization program and Primary Healthcare (PHC) system as the world marked the 50-year Expanded Programme on Immunisation (EPI).

In an interview with Independent Newspapers, Dr Ijeoma Agbo, Health Specialist, UNICEF commended Nigeria for ensuring equitable access to health and routine immunization services for children despite that the country still has a high number of unvaccinated and zero-dose children.

She also said that the EPI program has recorded significant milestones, noting that the world has over 13 life-saving vaccines after 50 years of EPI.

 The Expanded Programme on Immunization (EPI) was established in 1974 to develop and expand immunization programs throughout the world. In 1977, the goal was set to make immunization against diphtheria, pertussis, tetanus, poliomyelitis, measles, and tuberculosis available to every child in the world by 1990.

However, Agbo said, “Over the 50 years of the EPI program, we have come a long way. When we had only six vaccines, we now have 13 or more vaccines, depending on the country and context. So, we must commend Nigeria on its laudable efforts in responding to the need to develop a resilient immunization program and PHC system.

“Over the last five years, Nigeria has made significant progress in ensuring equitable access to health and routine immunization services for children. However, the country still has a high number of unvaccinated and zero-dose children, and the number varies by state and within states. We need a multi-pronged and sectoral approach with concerted efforts to bring about a strategic shift and improve our immunization program,” she added.

The UNICEF Health Specialists listed reasons for zero dose, including, knowledge and awareness, conflict and security compromised zones, hard-to-reach areas, cultural barriers and social norms, weak health systems, etc

She elaborated on ways to reach the 6.2 million Nigerian children who have not received or missed their vaccines.

Agbo said, “Understanding the factors responsible for the different areas and using this to develop strategies along with the communities.  There cannot be one solution for all states in the country.”

On access issues, she called for outreach services inwards without PHC facilities or hard-to-reach areas and improved logistics for hard-to-reach and inaccessible areas. Agbo recommended that vaccines be supplied to the last mile, campaigns, longer work hours, and weekend vaccinations.

Other recommendations are training for health workers, and getting ad-hoc staff to support immunisation services. To improve demand, she urged community mobilisers, working with vaccine champions, and community leaders.

According to her,  barriers that prevent children from missing their vaccines border on some demand issues, including, caregiver attitudes and knowledge, and social and cultural barriers, among other factors.

Agbo said, “Caregiver attitudes and knowledge include a lack of information about the role of vaccination in disease prevention, fear of adverse events, cultural or religious beliefs, and general mistrust of the health system.

“Social and cultural barriers, such as those experienced by marginalized and disenfranchised communities, cultural constraints, language barriers, and ineffective messaging in traditional and social media.

“Long distances to services and poor immunization integration with other health services also present barriers to high vaccination coverage. The costs of vaccination, including opportunity costs, travel costs, and user fees, especially at private facilities, present financial barriers to vaccine access

She lamented, “Ensuring the availability of essential, high-quality commodities– including vaccines – at the lowest level of the healthcare system remains an ongoing challenge in Nigeria. Multiple factors contribute to this challenge, including lack of funding to move commodities from State levels to the LGA/Health facilities/outreach sites, and weaknesses in the supply and logistics systems, including inadequate and poorly maintained cold chain equipment.

“Human resource constraints do not allow simultaneous staffing of outreach services and fixed posts. Poor interpersonal skills may lead healthcare workers to exhibit attitudes and behaviour that prevent caregivers’ clients from attending immunization services.

“Vaccine hesitancy due to myths and misconceptions. In addition, misinformation about the safety and efficacy of vaccines is proliferating on digital channels and is exploited to sow mistrust,” Agbo added.

World Immunization Week is celebrated in the last week of April, to promote the use of vaccines to protect people of all ages against disease.

The week takes place from 24-30 April, and the 2024 theme is “Humanly Possible: Saving Lives through Immunization.”