COVID-19 has disrupted health services across the world but one major routine health service that had suffered a setback and disruption in Nigeria remains childhood immunisation.
Findings show that many children under the age of 5 are not being immunised as and at when due. Sadly, without sustained routine immunisation, many children risk vaccine-preventable diseases that may lead to uncertain future and dire health prospects. Chioma Obinna writes
The World Health Organisation, WHO, Regional Director for Africa, Dr Matshidiso Moeti, recently identified routine immunisation as playing a vital role in improving child survival, and contributing to halving the death rate of children below 5 years in sub-Saharan Africa in the past 20 years.
Preliminary data from WHO also shows that an estimated 16.6 million children in Africa missed planned supplemental measles vaccine doses between January 2020 and April 2021.
Sadly, the COVID-19 pandemic and the lockdown imposed to check the spread of the virus continued to affect the functionality of health facilities on which immunisation depends.
Many newborns and some children already scheduled for immunisation during the period have stories to tell.
Master Emmanuel Chukwuebuka has just received the measles vaccine 12 months after the due date for the measles vaccine. No thanks to COVID-19, a year and seven Emmanuel could not get his vaccination as at when due.
His immunisation according to Edith, his mother, was delayed because the health facility where she registered for vaccination was partially closed throughout the period lockdown.
Edith could not travel to the next village, as a result, Emmanuel also missed out on other vaccines like polio and Vitamin A.
Just like Emmanuel, Baby Adaeze who just marked her first birthday also missed her measles vaccination. Fondly called Miracle, she was born during the lockdown.
“We were lucky she survived. She was born at home with help of my neighbour who happens to be a nurse. Even when the lockdown was over, I was afraid of visiting any of the centres for fear of being infected. Sometimes, the centres are not opened.
“The few times I visited, some health workers were also afraid to touch our babies,” Adaeze’s mother narrated.
Emmanuel and Adaeze, and millions of other Nigerian children are among the 60 per cent of children below age 5 living in Nigeria, the Democratic Republic of the Congo and Ethiopia, that make up the estimated nine million children in the Region, who miss out on routine immunisation.
Emmanuel and Adaeze are also at risk of measles, cholera among others still plaguing the country and resurgence of polio if routine immunisation is not sustained.
Nigeria was certified polio-free by the WHO, following consistent Routine Immunisation, supported by global partners.
But gains of the decades of routine immunisation in the country are beginning to face setbacks due to the disruption of the COVID-19 pandemic and may lead to epidemics of vaccine-preventable diseases which experts warned may skyrocket child mortality and deny Emmanuel, Adaeze, and others the opportunity to be immunised against identified life-threatening diseases.
For instance, statistics from global partners revealed that despite the critical progress made over the years, Nigeria still contributes 30 per cent of the global number of unimmunised children between the ages of 0 and 5.
Drop in immunisation
They added that Nigeria is currently facing a critical moment of choice, to either protect children from a host of preventable diseases to avert uncertain future and dire health prospects as a result of the alarming decline in global vaccine coverage due to the COVID-19 pandemic.
Worse still, scary figures from UNICEF which showed an alarming decline in immunisation coverage worldwide revealed that the chances of a child born today being fully vaccinated by the time he or she is 5, is less than 20 per cent.
In the UN analysis, in 2019, nearly 14 million children did not receive any of the life-saving vaccines such as measles, diphtheria, tetanus or pertussis and two-thirds of these children are concentrated in 10 countries of Nigeria, India, the DRC, Pakistan, Philippines, Ethiopia, Brazil, Indonesia, Angola and Mexico.
According to the global vaccination coverage rate, with the third dose of the vaccine against diphtheria, tetanus and pertussis (DTP3) plateau at 85 per cent since 2010, in Nigeria, numbers show that routine immunisations in the first six months of 2020 dropped compared to the same period in 2019 – indicating deterioration in important routine vaccination coverage, due to COVID-19.
To reach every child with vaccination and avert the resurgence of diseases like the Wild Polio Virus, WHO says countries need to address the challenges of inadequate infrastructure, transport and power supply, limited frontline healthcare workers, and stock-outs of vaccines and other essentials, like syringes.
Benefits of routine immunisation
According to UNICEF, vaccines are among the greatest advances in global health and development. For over two centuries, vaccines have safely reduced the scourge of diseases like polio, measles and smallpox, helping children grow up healthy and happy. They save more than five lives every minute – preventing up to three million deaths a year, even before the arrival of COVID-19.
Thanks to immunisation efforts worldwide, children are able to walk, play, dance and learn. Vaccinated children do better at school, with economic benefits that ripple across their communities. Today, vaccines are estimated to be one of the most cost-effective means of advancing global welfare.
In a chat with Good Health Weekly, the Coordinator for COVID-19 vaccination in Adamawa State, National Primary Health Care Development Agency, NPHCDA, Abba Muhammad Isawa who said that Nigeria immunization coverage was hovering around 70 to 80 per cent said despite the high coverage many Nigerian children under the age of 5 were still unimmunised.
Isawa stated that although Nigeria has been polio-free if the country did not continue to give routine immunisation to eligible children, polio may resurface.
“Most of the reasons why Nigeria has low coverage was due to lack of awareness and the lack of involvement of the people at the community level.
Corroborating his views on the possible resurgence of poliovirus in Nigeria, the Communication for Development Specialist, UNICEF, Mrs Elizabeth Onitolo, said: “No child must die of polio again in Nigeria.”
In her presentation at a media dialogue in Yola, Onitolo said the Nigeria certification for polio calls for cautious as the success recorded was still fragile because immunization coverage was still low.
“Many parents are still not compliant while many children have not been vaccinated. Environmental Sanitation and personal hygiene in the communities are still very low, providing possible grounds for outbreaks. Poliovirus transmits from person to person or from wastewater to person. Children are especially vulnerable because their immune system is weak. Polio has no cure, only prevention through vaccination.
“The only way to keep children safe is through vaccination. We need to act now to protect our children from getting the poliovirus; we need to maintain ‘herd immunity. This means every child must complete routine immunisation so that the virus will not have a window to re-enter our communities, she noted.
She said if all children are fully vaccinated, the virus would not find a window to enter. “Immunisation is the best way to secure the future of our children. It is safe, effective, free, and available at all government health centres. Children up to 5 years of age are most at risk from Polio. And repeated vaccines increase the capacity of a child to resist the disease. In addition, IPV boosts immunity through blood, whereas OPV works through the stomach. Both vaccines are needed to maximise immunity”.
However, health watchers are of the opinion that policymakers must quickly identify robust and context-specific strategies to rapidly scale up routine immunisation in order to mitigate the impact of COVID-19 on their national immunisation performance.
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