A Story of Triumph and Ongoing Struggle
Nigeria’s immunization journey is a tale of remarkable victories and persistent challenges. While we’ve achieved milestones that once seemed impossible, millions of Nigerian children still remain vulnerable to vaccine-preventable diseases. Understanding where we’ve been and where we need to go is crucial for building a healthier future for our children.
The Beginning: A Colonial Legacy
The formal history of immunization in Nigeria began in the early 20th century when British colonial authorities introduced smallpox vaccination, primarily as a reactive measure to outbreaks. However, the true foundation of systematic immunization was laid in 1979 when Nigeria, following the World Health Organization’s (WHO) lead, launched its own Expanded Programme on Immunization (EPI).
Initially, the EPI targeted six vaccine-preventable diseases: Tuberculosis, Diphtheria, Tetanus, Whooping Cough (Pertussis), Polio, and Measles. This program was driven by alarmingly high child mortality rates, global health initiatives, and the recognition that preventing diseases was far more cost-effective than treating them.
Historic Victories: When Nigeria Led the Way
Nigeria’s immunization program has achieved victories that have saved countless lives:
Smallpox Eradication (1978): Nigeria successfully eradicated smallpox, a monumental achievement that contributed to the global elimination of this once-deadly disease.
Polio Elimination (2020): After a long, hard-fought battle with numerous setbacks, Nigeria was declared free of wild poliovirus in 2020. This is perhaps the crown jewel of Nigeria’s immunization efforts, achieved through massive national and sub-national immunization days and unprecedented community mobilization.
Maternal & Neonatal Tetanus Elimination (2019): Nigeria eliminated maternal and neonatal tetanus as a public health problem, protecting mothers and newborns from a preventable killer.
Measles and Other Diseases: While outbreaks still occur, vaccination has drastically reduced mortality and morbidity from measles, whooping cough, and diphtheria.
The Evolution of Nigeria’s Immunization Program
The program has evolved significantly from its 1979 beginnings:
Expansion of Protection: Nigeria now provides vaccines against 13 diseases—the original six plus Hepatitis B, Haemophilus influenzae type b (Hib), Yellow Fever, Pneumococcal Conjugate Vaccine (PCV), Rotavirus, and Human Papillomavirus (HPV) for girls.
Introduction of New Vaccines: Major milestones include the introduction of Pentavalent vaccine (DTP-HepB-Hib) in 2012, PCV in 2014, and Rotavirus vaccine in 2022.
Strategic Innovation: The program shifted from purely facility-based delivery to incorporating outreach services, periodic intensification of routine immunization (PIRI), and leveraging mass campaigns for polio and measles.
Improved Governance: The establishment of the National Emergency Routine Immunization Coordination Centre (NERICC) in 2017 provides urgent, data-driven oversight to struggling states.
Greater Self-Reliance: Nigeria is transitioning from heavy donor reliance (Gavi, WHO, UNICEF) to increased government ownership through the Basic Health Care Provision Fund (BHCPF) and state-level financing.
The Persistent Tragedy: Children Still Dying
Despite these successes, vaccine-preventable diseases (VPDs) remain a leading cause of death among Nigerian infants and children. This is our stark reality:
When routine immunization coverage is low, herd immunity is not achieved, leading to dangerous outbreaks. Major killers such as measles, pneumonia (from pneumococcus), diarrheal diseases (from rotavirus), and meningitis continue to be significant contributors to under-5 mortality. A child who misses their scheduled vaccines remains highly vulnerable.
The Numbers Tell a Sobering Story
Immunization coverage in Nigeria has historically been low and uneven. While there are recent signs of improvement, we’re still far below global targets:
Years of Stagnation: For decades, Nigeria had some of the lowest routine immunization coverage rates in the world. The National Demographic and Health Survey (NDHS) 2018 showed only 31% of children aged 12-23 months were fully vaccinated. Coverage was highly inequitable, with the North-West and North-East zones consistently performing worst—sometimes with coverage below 10% in security-compromised areas.
Recent Improvements: There has been a concerted push for recovery, with positive trends emerging:
- DPT3 Coverage: 57% in 2023, up from 46% in 2021—a key indicator of system strength, though still far from the 90% target
- Measles-Containing Vaccine (MCV1): 59% in 2023
- Full Vaccination: Estimates suggest it has risen to the 50-60% range nationally, a significant jump from 2018 but still critically low
The Challenge That Remains: Despite improvements, over 2 million children remain under-immunized or “zero-dose children”—the second-highest number globally. Coverage remains starkly unequal across states and between urban and rural areas.
Why Are Children Still Dying? The Root Causes
These deaths are not caused by vaccines but by the lack of them. Key barriers include:
Weak Health Systems: Poor cold chain infrastructure, vaccine stock-outs, and insufficient health workers, particularly in rural areas.
Logistical & Geographic Challenges: Difficult terrain and insecurity in regions like the Northeast and Northwest severely limit access to healthcare facilities.
Socio-cultural Factors: Misinformation, low awareness, and vaccine hesitancy—fueled by past controversies such as the unfounded polio vaccine boycott in the North (2003-2004)—continue to undermine immunization efforts.
Poverty: When families are focused on daily survival, preventive healthcare often takes a back seat to immediate needs.
The Path Forward: Building a Stronger System
To save more lives and protect every Nigerian child, we must take concrete steps to improve and standardize our immunization system:
1. Strengthen Cold Chain Infrastructure
Invest in a national, real-time cold chain inventory and management system using IoT sensors. Ensure standardized solar-powered refrigerators and cold boxes at all levels to prevent vaccine spoilage and maintain potency.
2. Embrace Data-Driven Accountability
Use data dashboards at national, state, and local government levels to track key indicators—coverage rates, dropout rates, and stock levels. Hold managers accountable and publicly share progress scores to foster healthy competition among states.
3. Targeted Social Mobilization
Move beyond generic health messages. Use local media, religious leaders, and traditional rulers to address specific local concerns and myths about vaccine safety and effectiveness. Standardize the training of Community Mobilization Officers and leverage “positive deviants”—respected mothers whose children are fully immunized—to become peer advocates within their communities.
4. Invest in Healthcare Workers
Implement nationwide, regular training on updated immunization schedules, safe injection practices, adverse events management, and interpersonal communication using a standardized curriculum. Address chronic issues of timely salary payment and provide legitimate non-monetary incentives such as recognition, career progression, and adequate equipment—especially for frontline workers in rural areas.
5. Increase and Ring-fence Domestic Funding
Federal and State Governments must increase budget allocation for routine immunization and ensure timely release of funds. The Basic Health Care Provision Fund (BHCPF) must flow reliably to Primary Health Care (PHC) centers for operational costs, including immunization outreach programs.
A Call to Action
Nigeria’s immunization journey has shown us what’s possible when we commit to protecting our children. From eradicating smallpox to eliminating polio, we’ve proven that with determination, resources, and community engagement, we can overcome even the most daunting health challenges.
But our work is far from finished. Every child who dies from a vaccine-preventable disease represents a failure we must not accept. Every “zero-dose” child is a call to action we cannot ignore.
As a nation, we must:
- Demand better from our health systems
- Support immunization programs in our communities
- Combat misinformation with facts
- Ensure no child is left behind
As parents and caregivers, we must:
- Take our children for all scheduled vaccinations
- Keep immunization records safe
- Encourage our neighbors to do the same
- Speak up for better healthcare services
As healthcare workers, we must:
- Provide compassionate, informed care
- Maintain the integrity of the cold chain
- Reach every child, no matter how remote
- Continue learning and improving our practice
The future of Nigeria’s children—and indeed, the future of our nation—depends on the choices we make today. Let’s choose health. Let’s choose protection. Let’s choose immunization.
Together, we can build a Nigeria where no child dies from a disease we know how to prevent.
