Vaccination in Nigeria: Victory Path with Pending Challenges…

Nigeria 2007

By Jennifer Uloma Igwe

May 15, 2013

Also published at Environmental and More

Ada’s vaccination scare

The baby wailed and stretched his leg in pain as the nurse administered the vaccine. The health peronnel around consoled both mother and child, encouraging them that the reaction happens in rare cases. The baby they assured would overcome the pain in no time. Seconds, minutes and hours later Ada’s one month baby was still in pain. Series of hospital visitations, examinations and medications later, did nothing to change the predicament that befell the baby. Today, 18 years later, Ezera Kalu walks with a slight limp. This rare case like every bad news went viral attracting many misconceptions. As many in narrating the story added a twist to it from personal ideas to eroneous beliefs. The unfortunate incidence affected Ada. It made her and a few members of her family, neighbors, and community have reservations about vaccinations. Although this incident happened years back 21 year-old Ifeoma Idika, a fresh university graduate from the village narrated this story by capturing every detail like it was yesterday.

Benefits override worries

A story like this, is one of the reasons why some mothers are skeptical of vaccinations. It’s comforting to note however, that in spite of this, more women still ensure their babies are vaccinated. A cross section of women from different local government areas in Lagos State for instance say they are adhering strictly to their babies vaccine routines, while some have already completed them.
Taiye Odulami, a trader in Yaba, says, ” Despite fear of some people, we have also seen plenty good of the vaccinations.”
Bosede a hair stylist in Obalende noted, “I will not forgive myself if anything like polio or measles should deform my child.” According to her, she would rather take her chances.
Ada a house wife says, “There is no process without complications and since the advantages are more than the small disadvantage why expose my children to danger because of fear from other peoples' worries?”

Why vaccination

Immunization, another word for vaccination, uses the body’s natural immune system’s ability to prevent infectious illness. Vaccines are biologically active substances designed to protect babies, children and adults from infections caused by bacteria and viruses.

Five types that are today commonly used throughout the world include:
An inactivated vaccine: The dead virus is injected into a person to create antibodies (cells that remain in the blood stream that can kill off any living virus that enters the body.) Polio and typhoid are two examples of vaccines utilizing dead viral cells.
Another one is the live vaccines that are created by using a living, yet weakened, strain of the virus. The virus is too weak to cause an active infection, but it can help the body create antibodies to that specific virus. Measles, mumps, and rubella vaccinations use live virus cells.
Subunit vaccines use sterilized portions of the virus. The sterilized pieces of the virus are injected into the body to create antibodies. The vaccinations for hepatitis B and HIB (Haemophilus Influenzae) are examples of subunit vaccines.
Toxoid vaccines take the virus and use chemical measures or alter the genes to create a safe version of the viral cells. Those cells can then be injected to help create antibodies. Diphtheria and tetanus are examples of Toxoid vaccines.
Finally, naked DNA vaccines create antibodies by injecting a person with a specific strand of the virus’ DNA. The body then attacks that strand creating a defensive antibody for any future infection. Malaria and dengue fever are common naked DNA vaccines.

Prof. Oyewale Tomori (FAS) President of NAS and Chairman NAS Vaccine and Immunization Advisory Committee (NAS)

Caution in Application

Prof. Oyewale Tomori (FAS) is the President of the Nigerian Academy of Science and Chairman of the NAS Vaccine and Immunization Advisory Committee. He says Ada’s case is indeed rare. However, the strange reaction is never the fault of the vaccine but is the result of poor application. That is why health workers who administer vaccines are usually well trained because mistakes in this process can result in complications capable of destroying the confidence of many.
Animashaun an Apex Nurse, with the Island Maternity on Lagos Island said, "lack of appropriate man power in some private hospitals could be responsible for this." "The government hospitals, she says, "have better qualified personnel who are well trained and specialize in vaccines and how they are administered."
Meanwhile, Dr. Unamba with Faleti Medical Center, a privately owned hospital in Olodi Apapa, noted that they’ve never had complications or cases of abscess in vaccinations. She said their nurse are trained and re- trained on vaccine application.

Other Challenges

A number of children are needed in order for a valve of vaccine to be opened and administered, both in the government and privately owned hospitals. For Pentavalent vaccine (the five vaccines-in-one that prevents diphtheria, tetanus, whooping cough, hepatitis B and haemophilus influenza type B in a single dose) and measles, 10 babies are required for a valve. So if a baby is due for immunization and the mother gets to the hospital, and there are no other babies to make up the needed number, she would be asked to return another day.

In the some government hospitals however, If 5 out of 10 babies are available, vaccines are administered. The remaining in this instance, which would have served five more babies, would be discarded.

Nurses at the Island Maternity pointed out that due to the nature of these vaccines should be disposed 6 hours after the dose is opened. Some medical experts say that this ‘wastage’ situation could lead to vaccine scarcity. A situation some nurses in a public hospital in Lagos (who would not want their identities disclosed) said occured 2 years ago.

Dr. Memunnah Kadiri

Dr. Mamunnah Kadiri, a consultant Psychiatrist, said,  "when I went to get my child immunized in a private hospital there were no other babies, so I was asked to come back another day. I had to just buy up the whole valve for N5000 after waiting for some time. After using it for my baby the remaining, which I would have gladly given to other babies for free, was discarded”. Dr. Kadiri could afford to buy up the valve, but what of mothers who are not so buoyant?
Tosin Alade another mother lamented that the crowd and the health center is a problem.She said, “On immunization day I always try to get there very early in the morning by 7.30 a.m. because of the number of people." Sighing she continued with emphasis, “We are usually many my sister, but its an important effort for the baby.”

‘Corruptitude’and Lack of Continuity

Prof. Tomori is of the opinion that attitude is what is affecting progress in the country. Corruption he noted is not just with politicians and the government, but a cankerworm that has affected every sector. According to him, “We have seen cases of officials pouring vaccines away instead of into the mouths of babies. They return and give false data about vaccines they never administered”. The Professor pointed out that, “It's also possible the officials were not paid or someone in government was sitting on funds meant for their salaries. In some cases, an official who is to be paid 400naira might have his wage slashed in two, with someone in the authorities pocketing the rest”.
Lack of continuity is also an issue because when a good initiative is started by one government, it is never completed by a subsequent administration. Prof.Tomori said it's a norm for the new leadership to embark on new ideas without carrying along progressive plans that worked in the previous government.
According to him, “this attitude needs to changed for better results in the country. Late Professor Ransome Kuti, the country’s health minister from 1985-1993, achieved the World Health target of 80% and even above, how come we did not maintain that standard but dropped?” he said.
Although Nigeria is making progress in the vaccination coverage percentage, experts say there is need to improve in many areas.

National Primary Health Care Development Agency (NPHCDA), a parastatal of Nigeria’s Federal Ministry of Health, presented the figures below in July 2012:

VACCINES and %COVERAGE IN NIGERIA 

BCG (Vaccine against Tuberculosis)——74%
MCV (Vaccine against Measles) ———–72%
Vaccine against Yellow Fever ————- 35%
DPT3 (Vaccine against Diphtheria,
            Pertussis and Tetunus) ———— 38%
OPV3 (Oral Polio) —————————— 67%
Hep B3 (Hepatitis)—————————— 53%
TT2+ (Tetanus Toxoid) ———————– 52%

The India Case

The strides India has made in polio eradication, Prof. Tomori, said can be attributed to their attitude towards the issue. All hands were on deck in the country as they set a target for themselves. India is a country with different classes of people with strong cultural and religious beliefs. However, they were able to aggressively wipe out polio and ensure every child got vaccinated.
In line with this, Dr. Amida Fernandez, who started the first milk bank in Asia, while speaking to fellows of the International Reporting Project in Mumbai said the resolve of the government, people and private sector, led to the polio success story of the country. The structure used has now become a laid down process for all other immunization drive in the country.
Rotary International for instance aggressively took up the campaign, working with the government and members of the communities.
India according to UNICEF completed two years without any case of polio on 13 January 2013, an unprecedented progress for a country, which in 2009 accounted for nearly half the world’s polio cases.This progress makes India more confident in achieving its goal of totally eradicating polio. It also demonstrates that the existing polio eradication strategies in the country are effective in stopping polio even in the most challenging conditions.

The cold chain

How vaccines are stored can affect their potencies. It is crucial to maintain the cold chain. Vaccines are usually stored in cold rooms and at a continuously frozen state of 5°F (-15°C) or to 46°F (2° to 8°C), with a desired average temperature of 40°F (5°C), using label trays or containers according to the vaccines they contain. In order to maintain the cold chain therefore, there is need to uphold this standard, no matter where the vaccines are moved to and from. Also 6 months is the maximum recommended storage time at primary level. This includes the period required to obtain clearance from the National Regulatory Authority

Apex nurse Animashun, said her hospital for instance use ice packs and coolers to collect their vaccines and ensure they are stored at that the right temperature when they get to the hospital.
Island Maternity for instance, on Lagos Island, gets its vaccines from the Sura Primary Health Center cold room. The center gets its stock from what the central cold room Oshodi receives from the World Health Organization and USAID. The Oshodi cold room distributes to various local governments, from where primary health centers collect for the public hospitals in the state. They also serve private hospitals who register with them and collects data they submit.
From 8 a.m. to 4.p.m. on weekdays, mothers and their babies,and expectant mothers patiently wait for their turn to be immunized. Monday at some public hospitals is vaccination day for BCG, hepatitis, oral polio vaccines and tetanus toxiod. On Tuesday, pentavalent, a five-in-one vaccine, is admistered as well as haemophilus influenza type B, and oral polio. Measles, yellow fever, hepatitis and oral polio are given on Wednesday. Thursdays and Fridays are days for hepatitis, oral polio, pentavalent and tetanus toxiod vaccinations.

Private Hospital

Some mothers have opted for the private hospitals, Inspite of the fact they have to pay for immunizations there, compared to the public hospitals were vaccinations are free.
According to Dr Kadiri  "Some public hospitals are very good like the Island Maternity. But since it's free there is always a large crowd."
Island Maternity for instance has Monday to Friday vaccinations in their immunization section. They attend to children 0 to 5 years old, expectant mothers and women of child bearing age. An average of 100 mothers show up with their babies each day. The peak days are Monday, Tuesday and Wednesday.
Even some private hospitals now attend to a large number of babies on immunization days. In a hospital in Ajegunle, they see as many as thirty five babies. The hospital says they had to set aside Monday every week for just immunization. The N750 charged per vaccination, they say, is for materials used like syringes, cotton wool, and other administrative purposes.

Beliefs and Mistrust

Zainab a food vendor in Obalende is from northern Nigeria. She says although vaccines and immunization have very many positive results, some families are still skeptical about them. According to her, their reservations are borne out of their mistrust for the western world. The fact that most vaccines come from there does not help matters.
Another point she noted is the fact that women sometimes don’t have the final say on these issues. This is because in northern Nigeria, like many parts of the country, women hardly make family decisions. Immunization of children is indeed one of these. In most cases, permission is sought for this to happen from the man of the house.

Vaccinations for Adults

Series of research by scientists lead to the creation of vaccination using vaccines. Formulated to battle deadly and potentially life-threatening diseases, vaccines also prevent viruses from causing damage to the blood streams and muscles. Vaccines can also be used to prevent the spread of disease among children, adults, and the elderly.
Despite a series of awareness campaigns, many Nigerians still do not know that vaccinations can help prevent some health problems. In a vox pop in Lagos, many interviewed say vaccinations are just for children. They had no idea for instance that vaccines can serve useful purposes for adults. For instance, soldiers, missionaries and people who often travel to countries where some deadly viruses have not been eradicated need vaccinations warn medical experts.

A good example is Emma, a trader from Aba, Abia State in eastern Nigeria who said, "I travel a lot and to some countries. Sometimes my doctor advice's is to take vaccinations, but I don’t bother, because I took all my vaccine injections when I was a baby, so i am covered."
Like Emma, a vox pop conducted in Lagos with respondents cutting across some areas in Lagos (namely Makoko, Ojuelegba , Obalende, Mushin, Ikeja and Marina Lagos), showed that some people are not aware that about five different vaccines for adults currently exist. Some have vague ideas, while many only know about vaccines for children.
Today many Nigerians are still unaware that at government hospitals, tetanus toxoid is not just free for babies, children and expectant mothers but also for all adults.

Jennifer Uloma Igwe is a principal reporter, newscaster presenter and producer with the Nigerian Television Authority (NTA). In February 2013, she traveled to India with the International Reporting Project.