Amina is a young mother from one of the rural communities of the Federal Capital Territory (FCT) who gave birth about six weeks ago. Her son, Hamidu, has gone through the initial vaccination and is due for the next round. She is now faced with the hurdle of transportation due to the lockdown and fear that she and her son may contact the dreaded COVID-19, if they go to the Primary Health Care centres; there is also the issue of no funds for transportation.
Alysa, a sickle cell survivor, gave birth about ten weeks ago in one of the medical centres in the city of Abuja. Her daughter has gone through the first two rounds of vaccination and is due to take the third. Alysa also needs to access family planning services as her condition makes it imperative. She is scared to go to the hospital because of her underlying condition and the rumour that the possibility of contacting COVID-19 is higher in health facilities. This is the reality of the times.
COVID-19 has brought the world to its knees and Nigeria is no exception. Today, Nigeria has over one thousand five hundred cases and the numbers are still rising. This pandemic has greatly disrupted immunisation services as we know it. Vaccines save lives and money only if those that need these essential vaccines have access to them. Globally, immunisation prevents two to three million deaths every year (immunisation coverage- World Health Organization, 2019) and in Nigeria, between years 2016 and 2018, vaccine coverage increased from thirty-three percent to fifty percent (NICS/MICS survey, 2016-2018). This improvement is not the desirable, but these gains can be lost due to the effects of COVID-19 on the already weak health systems. In Nigeria, nearly eight million children are born every year and about four million of these children remain under vaccinated, while another one million five hundred thousand have zero vaccination. Layer this on top of the COVID-19 pandemic and its own effect, and it becomes catastrophic. Let us not forget that Lassa fever has killed more in Nigeria than COVID-19. At present, the death toll for COVID-19 in Nigeria is 40, while Lassa fever is 188. Yet, immunisation and other epidemics have to fight for attention as COVID-19 has the pride of place.
Nigeria is currently polio free and the transition plan for polio has been the house -to-house campaign/routine immunisation and surveillance. The polio campaign (house-to-house) has been paused for now as it negates one of the preventive measures of COVID-19 which is social/physical distancing. Again, layer this on top of the fear by care givers to access the Primary health care centres due to the pandemic, challenges due to lockdown such as logistics limitation, increased poverty (especially for those that feed through daily pay), increased gender based violence in communities, information overload, inadequate personal protective equipment (PPE) for health workers in the Primary Health Care centres, and you have a resultant national emergency. This disruption of immunisation services due to the present realities, therefore, results in reduced demand for routine immunisation. It is worthy of note that routine immunisation in fixed health facilities is the only safe approved immunisation strategy during the COVID-19 period.
All is not lost. I believe that COVID-19 and its attendant issues will soon come to an end as its vaccine is being developed with ongoing trials. Going forward, strategies are already in place to try to sustain the gains of immunisation coverage as much as possible- the WHO has developed guiding principles for immunisation programmes during the COVID-19 pandemic. Subsequently, the National Primary Health Care Development Agency (NPHCDA) has also developed immunisation response strategy during using the WHO guidance to be domesticated to states. It includes pausing of mass vaccine campaigns, delay of introduction of new vaccines, safety for health workers and caregivers and children, social/physical distancing, wearing PPE’s, handwashing/sanitiser. Use of adequate PPE gears, practice of hygiene and training of health workers on how to cope with the new realities cannot be overemphasised. However, despite these strategies, the current immunisation state is not yet “Uhuru.”
The civil Societies, government and communities have their parts to play to manage the fears, stigmatisation, gender-based violence and create demand for immunisation services so that the gains are not lost. The civil societies should also support government response and community gate keepers should use noninvasive approaches to create demand during the COVID-19 era like town criers.
When this COVID-19 saga is laid to rest, all hands must be on deck to aggressively respond to immunisation. The come back strategy for coverage should be stronger and more aggressive in other to regain lost ground. New strategies to reposition the value of vaccines to its pride of place should be in the making now! I believe that immunisation coverage will indeed take a new look post-COVID-19. We as civil societies will be part of that journey.
Chika Offor is the CEO, Vaccine Network for Disease Control and member, FCT PHCB COVID response.