Overlooking routine immunisation in northern Nigeria
Authors: Ahmad Abdulwahab, Ben Anyene, Anne McArthur-Lloyd
Journal: The Lancet Global Health (2014)

Tara Mangal and colleagues1Mangal TD Aylward RB Mwanza M et al.Key issues in the persistence of poliomyelitis in Nigeria: a case-control study.Lancet Glob Health. 2014; 2: e90-e97Summary Full Text Full Text PDF Scopus (38) Google Scholar document the struggle to eliminate polio in northern Nigeria. However, they overlook the importance of routine immunisation to polio eradication efforts.2Global Polio Eradication InitiativePolio eradication and endgame strategic plan 2013–2018.http://www.polioeradication.org/Resourcelibrary/Strategyandwork.aspxGoogle ScholarThe investigators identified an association between the risk of contracting polio and oral polio vaccine unavailability. Systemic problems with routine immunisation distribution, supply chain, and staffing result in missed immunisation opportunities and, as findings from their study show, can lead to increases in the prevalence of polio. Nigeria launched its routine immunisation strategic plan in 2013, but will need sustained funding and vaccine availability to reach its goals.3Federal Ministry of Health of NigeriaNational Primary Health Care Development AgencyNational Routine Immunization Strategic Plan 2013–2014. Federal Ministry of Health, National Primary Health Care Development Agency, Nigeria2013Google ScholarTo increase population immunity, Mangal and colleagues recommend more polio doses for northern Nigerian children. In 2013, even after 13 rounds of polio immunisation, thousands of children were missed. The Independent Monitoring Board of the Global Polio Eradication Initiative recommended strengthening campaign management to improve coverage.4Independent Monitoring Board of the Global Polio Eradication InitiativeEighth report.http://www.polioeradication.org/Portals/0/Document/Aboutus/Governance/IMB/9IMBMeeting/9IMB_Report_EN.pdfDate: October 2013Google Scholar Our experience indicates that better health education, community engagement, and robust routine immunisation will effectively reach missed children and thereby increase coverage.5Partnership for Reviving Routine Immunization in Northern Nigeria; Maternal Newborn and Child Health Initiative (PRRINN-MNCH)Improving routine Immunization in northern Nigeria.http://www.prrinn-mnch.org/resources-factsheets.htmlGoogle ScholarRefusal of polio vaccination remains a problem in northern Nigeria. We agree that community engagement will strengthen demand. In view of the high level of distrust, face-to-face discussions are recommended to help caregivers better understand and accept immunisation. People's fears and beliefs cannot always be assuaged by mass communication.In a setting where DPT3 coverage is below 30%, northern Nigerians have received polio campaigns for 18 years, while their need for routine immunisation has been largely unmet.6National Population CommissionNigerian demographic health survey 2013: preliminary report.http://dhsprogram.com/pubs/pdf/PR41/PR41.pdfGoogle Scholar Long-term efforts to strengthen routine immunisation remain elusive. The people of northern Nigeria deserve investment in routine immunisation to ensure service for all as well as polio eradication.We declare no competing interests. Tara Mangal and colleagues1Mangal TD Aylward RB Mwanza M et al.Key issues in the persistence of poliomyelitis in Nigeria: a case-control study.Lancet Glob Health. 2014; 2: e90-e97Summary Full Text Full Text PDF Scopus (38) Google Scholar document the struggle to eliminate polio in northern Nigeria. However, they overlook the importance of routine immunisation to polio eradication efforts.2Global Polio Eradication InitiativePolio eradication and endgame strategic plan 2013–2018.http://www.polioeradication.org/Resourcelibrary/Strategyandwork.aspxGoogle Scholar The investigators identified an association between the risk of contracting polio and oral polio vaccine unavailability. Systemic problems with routine immunisation distribution, supply chain, and staffing result in missed immunisation opportunities and, as findings from their study show, can lead to increases in the prevalence of polio. Nigeria launched its routine immunisation strategic plan in 2013, but will need sustained funding and vaccine availability to reach its goals.3Federal Ministry of Health of NigeriaNational Primary Health Care Development AgencyNational Routine Immunization Strategic Plan 2013–2014. Federal Ministry of Health, National Primary Health Care Development Agency, Nigeria2013Google Scholar To increase population immunity, Mangal and colleagues recommend more polio doses for northern Nigerian children. In 2013, even after 13 rounds of polio immunisation, thousands of children were missed. The Independent Monitoring Board of the Global Polio Eradication Initiative recommended strengthening campaign management to improve coverage.4Independent Monitoring Board of the Global Polio Eradication InitiativeEighth report.http://www.polioeradication.org/Portals/0/Document/Aboutus/Governance/IMB/9IMBMeeting/9IMB_Report_EN.pdfDate: October 2013Google Scholar Our experience indicates that better health education, community engagement, and robust routine immunisation will effectively reach missed children and thereby increase coverage.5Partnership for Reviving Routine Immunization in Northern Nigeria; Maternal Newborn and Child Health Initiative (PRRINN-MNCH)Improving routine Immunization in northern Nigeria.http://www.prrinn-mnch.org/resources-factsheets.htmlGoogle Scholar Refusal of polio vaccination remains a problem in northern Nigeria. We agree that community engagement will strengthen demand. In view of the high level of distrust, face-to-face discussions are recommended to help caregivers better understand and accept immunisation. People's fears and beliefs cannot always be assuaged by mass communication. In a setting where DPT3 coverage is below 30%, northern Nigerians have received polio campaigns for 18 years, while their need for routine immunisation has been largely unmet.6National Population CommissionNigerian demographic health survey 2013: preliminary report.http://dhsprogram.com/pubs/pdf/PR41/PR41.pdfGoogle Scholar Long-term efforts to strengthen routine immunisation remain elusive. The people of northern Nigeria deserve investment in routine immunisation to ensure service for all as well as polio eradication. We declare no competing interests. Key issues in the persistence of poliomyelitis in Nigeria: a case-control studyAlthough high refusal rates, low OPV campaign awareness, and heterogeneous population immunity continued to support poliomyelitis transmission in Nigeria at the end of 2012, overall population immunity had improved due to new OPV formulations and improvements in programme delivery. Full-Text PDF Open Access