Childhood immunisation: Few vaccines not funded by FG despite threat to public health 

Globally, childhood routine vaccines are either recommended or mandatorily administered to children from age zero to 5 years or more, but in Nigeria some of these vaccines are not funded by the Federal Government despite their threat to public health. ADETOLA BADEMOSI examines these vaccines and their importance, among other related issues such as disease resurgence. 

The World Health Organization (WHO) recognises Measles Mumps and Rubella (MMR), Varicella (Chickenpox), Rotavirus vaccines  as important part of childhood immunisation schedule but these are not funded by the Federal Government (FG).

The Pediatric Association of Nigeria (PAN) also recommended these, including Cholera vaccine for children above one year which is given during epidemics or at internally displaced camps.

In 2021, the Nigerian Tribune reported how dysfunctional health system, cost, ignorance rob children of vaccines as findings revealed infants are only given the free routine vaccines for up to nine months in public health institutions.

Apart from very few vaccines like Rota, others required after nine months are paid for.

Parents who are interested in getting these shots for their child are required to pay between N8,000 and N18,000 or more. Sometimes, a child may require two shots to complete a dosage of a particular vaccine.

According to the Pediatric Association of Nigeria (PAN), health services including immunisation services are poorly funded in Nigeria.

It said significant funding for the country’s vaccination programme comes from external donors adding that due to the tenuous funding, many vaccines are not given on demand.

The National Primary Health Care Development Agency (NPHCDA), in its reactions, justified why vaccines for these life-threatening diseases are not funded, especially those already declared non-endemic or eradicated despite rising fear of resurgence.

Bassey Okposen, Director, Disease Control and Immunisation, NPHCDA, had noted that the government cannot continue to fund vaccines for diseases or viruses considered eradicated.

But findings showed that because some of these diseases are not placed under national surveillance, data to ascertain their prevalence are not available. A typical example of these is the MMR vaccine.

Although measles is included in the national schedule the Mumps and Rubella are not.

Again, Okposen had argued that MMR vaccine has not been approved by the FG saying: “you cannot introduce MMR in a country if you don’t have a routine immunisation of 80 percent and above. It’s the standard anywhere.”

He argued that introducing mumps to the measles shot may prime children for CRS or down syndrome.

But a research authored by  a group of medical professionals on the ‹Burden, epidemiological pattern, and surveillance gap of rubella in Nigeria›, called for routine vaccination policy.

Authors of the report are: Kabir Adekunle Durowade, Omotosho Ibrahim Musa, Maryam Abimbola Jimoh, Adekunle Ganiyu Salaudeen, Oladimeji Akeem Bolarinwa , Omowunmi Qubrat Bakare, and Lukman Omotayo Omokanye.

For clarity, the WHO says Rubella is an acute, contagious viral infection which can lead to congenital malformations in infants.

“While rubella virus infection usually causes a mild fever and rash in children and adults, infection during pregnancy, especially during the first trimester, can result in miscarriage, fetal death, stillbirth, or infants with congenital malformations, known as congenital rubella syndrome (CRS),” says the global health organisation.

The study explained that Rubella and CRS are neglected diseases with no distinct surveillance system in place, no national incidence figure and no vaccination policy.

It said with no national incidence figure and the gap in surveillance, rubella is under-reported in Nigeria.

“There is a need for a bridge of the surveillance gap and the government should have routine vaccination policy on rubella introduced in Nigeria,” the research stated.

Nigeria records over 3,600 cholera related deaths in 2021

Cholera, aside good hygiene practice, is also a vaccine preventable disease but not also included in the National schedule despite being a threat to public health.

Statistics from the Nigeria Center for Disease Control (NCDC) showed that the disease  claimed over 6,600 lives in 2010, 2011, 2018 and 2021, while the highest death was recorded in 2021.

According to the weekly epidemiological data from the  (NCDC) , as of 26th December 2021, a total of 111,016 suspected cases of cholera were recorded with 3,604 deaths reported from 33 states and FCT.

Also, between January to 29th May 2022, data showed that the country recorded 2339 suspected cases, 74 related deaths and case fatality ratio of 3.2 percent reported from 30 statesfive children were mostly affected according to the report.

Infograph

The figures showed that Nigeria recorded the highest cholera- related deaths in 2021, compared to outbreaks recorded since 2010.

For instance, the Federal Ministry of Health had out of 37,289 cases between January and October 2010 recorded 1,434 deaths, while a total of 22,797 cases with 728 deaths and case-fatality rate of 3.2% were recorded in 2011.

Outbreaks were also recorded in 2018 with the NCDC reporting 42,466 suspected cases including 830 deaths with a case fatality rate of 1.95% from 20 out of 36 States from the beginning of 2018 to October 2018.

Meanwhile, the data showed that children within the age bracket 0 to 14 years were mostly affected.

These findings speak to the fact that the cholera related deaths recorded in 2021 for instance, could have been prevented if the vaccine is funded for children above the ages of two years as recommended by the WHO in addition to good hygiene practices.

But findings also revealed that a bulk of these vaccines is made available only during outbreaks.

Meanwhile, the Minister of Health, Dr.Osagie Ehanire, during a training on the Oral Cholera Vaccine (OCV) pointed out that the availability of the vaccine has unfortunately been limited, adding that this has restricted its use and the much-expected impact.

Resurgence of vaccine preventable disease 

The World Health Organization August 2020, certified Nigeria free of Poliovirus but barely two years after the announcement, Nigeria recorded 396 cases of the Circulating Mutant Poliovirus Type 2 (CMPV2). This was as of April 2022, according to figures from the Global Polio Eradication Initiative.

In 2021, about 415 cases of this virus were recorded, bringing to fore, stakeholders’ worries on likelihood of the disease resurgence, years after the Federal Government (FG) may have stopped funding for it.

Although Polio vaccination is still part of the childhood immunization schedule,  Okposen said, “In public health, once the herd immunity is building, the disease disappears on its own and that is what we are trying to do in COVID-19. Once we have herd immunity of 70 to 80 per cent on its own, it will move to where the herd immunity is low. It is natural.”

But findings revealed that because a country is declared free of certain diseases does not rule out possibilities of outbreak like in the case of Polio.

To corroborate this, InterAction, a non-governmental organisation (NGO),said the re-emergence of vaccine-preventable diseases is a global threat that demands international action.

On the other hand, the WHO, in 2019, said the rates of diphtheria, hepatitis B, measles, meningitis, mumps, tetanus, tuberculosis, and yellow fever all increased—primarily due to vaccine hesitancy and resource shortages.

Should vaccinations be stopped for diseases considered eliminated?

Diseases that have become rare or nonexistent in Nigeria for instance may still exist in other parts of the world, hence experts opine that children should continue to get vaccinated against them.

Although the Federal Government would usually launch immunisation campaigns in case of outbreaks, experts argue that every disease-preventable vaccine should be duly administered.

A virologist and medical laboratory scientist, Dr Solomon Chollom argued that every disease-prevention vaccine should be administered at their various scheduled times.

He explained that Nigeria, because it lacks vaccine producing institutions, resorts to importing these vaccines, thus putting a strain on the nation’s fortune.

As a result, Dr Chollom said: “in an attempt to cut costs, they look at the epidemic map in Nigeria to see which diseases are much more prevalent and likely. So they seem to streamline.”

He, however, said irrespective of the circumstances surrounding this, every vaccine-preventable disease that already has a vaccine developed for it should be captured in the schedule.

Also,  Dr. Adebowale Salako, a public health expert in his contributions, said: «Government should continue to vaccinate against these diseases because some of them are still prevalent in other countries. That is when you say they have been eliminated in your country but not eradicated across the world.”

He further stressed that “it is only safe to stop vaccinations for a particular disease when it has been eradicated across the globe.”

This story was produced under Dataphyte Data and Development Reporting Fellowship 2022.

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The PDP spokesman recalled how the opposition party had on various occasions alerted that the APC government had ceded sovereignty over a large portion of our country to terrorists, “many of whom were imported into our country by the APC.”

He further stated: “From the video, in a brazen manner, terrorists as non-state actors boldly showed their faces, boasting, admitting and confirming their participation in the Kuje Prison break, some of whom were former prison inmates who were either jailed or awaiting trial for their previous terrorism act against our country.

“Nigerians can equally recall the confession by the Governor of Kaduna State, Mallam Nasir el-Rufai that the APC government knows the plans and whereabouts of the terrorists but failed to act.

According to Ologunagba, about 18,000 Nigerians have been killed by terrorists between 2020 and 2022 “as the criminals continue to be emboldened by the failures and obvious complicity of the APC and to which the PDP had always drawn attention.”

“This is not politics; this is about humanity and leadership, which leadership sadly and unfortunately is missing in our country at this time,” he said.

The PDP added that it is appalled by “the lame response by the apparently helpless, clueless and deflated Buhari Presidency, wherein it told an agonizing nation that President Buhari “has done all and even more than what was expected of him as Commander in Chief by way of morale, material and equipment support to the military…”

“This is a direct admission of incapacity and failure by the Buhari Presidency and the APC. At such a time, in other climes, the President directly leads the charge and takes drastic measures to rescue and protect his citizens.

“In time of adversity, the President transmutes into Consoler-in-Chief to give hope and succour to the citizens. Painfully, Nigeria does not have a President who cares and can stand as Consoler-in-Chief to the citizens.

“It has now become very imperative for Nigerians to take note and realize that the only solution to this unfortunate situation is to hold the APC government accountable. We must come together as a people, irrespective of our political, ethnic and religious affiliations to resist the fascist-leaning tendencies of the APC administration.

Ologunagba called for an urgent meeting of the National Council of State to advise on the way to go over the nation’s worsening insecurity.

“Our nation must not fall. The resilient Nigerian spirit and ‘can-do- attitude’ must be rekindled by all to prevail on the President to immediately and without further delay, accede to the demand by the PDP and other well-meaning Nigerians to convene a special session of the National Council of State to find a lasting solution since the President has, in his own admission, come to his wit’s end,” the PDP spokesman declared.

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