From Fred Ezeh, Abuja
United Nations Children’s Fund (UNICEF) recently celebrated the 50 years of Expanded Programme on Immunization (EPI), highlighting the gains thereof.
UNICEF’s chief of health, Dr. Eduardo Celades, in an interview with Daily Sun on the sidelines of a two-day media dialogue in Kano, highlighted the impacts of the EPI to mankind viz how it has improved the quality of health of Nigerians and beyond.
What has been the impact of 50 years of EPI to the health population of Nigerians?
EPI has been of great service to Nigerians and beyond. With the significant improvement and expansion in immunization in Nigeria, millions of lives have been saved, as well as the quality that has been added to the people due to the efficient and expanded EPI programne in Nigeria and beyond.
What’s the state of immunization in Nigeria?
I may not have the complete details but there are about eight vaccines that are administered to children in Nigeria as they grow and develop. These include Penta 1-3, measles, BCG, tetanus, Rota, HPV, and several other vaccines, including the malaria vaccine that might be introduced soon. Nevertheless, there has been significant improvement and progress as regards immunization services in Nigeria. Kudos to the people and government, led by National Primary Health Care Development Agency (NPHCDA) and other stakeholders, including the traditional and religious leaders. However, there are more gaps to close, and I think all the stakeholders have worked it on. For instance, recent data from UNICEF indicated that 30 per cent of Nigerian children have zero-dose immunization. This is a big threat to herd-immunity and the population in general. The data also indicated that before COVID-19 outbreak, there was 79 per cent confidence in vaccines, but, surprisingly, there’s decline in that confidence as indicated by the data.
Is there any empirical evidence that EPI has been effective to human lives?
It’s there for all to see. It’s evident in the quality of health and life of the people, as well as the life expectancy, which has improved significantly as a result of improved immunization. Vaccines save lives and we have strong evidence to prove that. At UNICEF, we are celebrating 50 years since the EPI programme started in Nigeria and Africa. Recent studies show that EPI has saved over 150 million lives. This means 10 billion years for the humanity that has been saved. So, this is a massive achievement, especially against deadly measles and other vaccine-preventable diseases.
Is there still a case of vaccine hesitancy?
There are still pockets of that. But like I said earlier, we have noticed that interest in immunization has dropped in Nigeria, and this could be attributed to vaccine hesitancy. Sadly, we still have a lot of children who have not had the opportunity to be immunized at all. These are people we refer to as the zero-dose children community. These children are so vulnerable to disease attacks because they have no defence (immunity).
How scary or otherwise is the figure?
Yes, it’s there for all to see. For instance, here in Nigeria, we have more than two million zero-dose children. This is a big threat to the herd-immunity. Michael Banda, officer-in-charge, UNICEF Kano Field Office, told us recently that there are 556,750 children in Kano, Jigawa and Katsina states who have not received a single dose of vaccination (zero-dose) in their life. Such zero-dose communities are dangerous to the health of the community (herd immunity), as they can be the gateway to outbreak of communicable diseases such as polio, diphtheria, measles and several other vaccine-preventable diseases. But we must note that vaccine hesitancy is not a Nigerian challenge alone but a global one. So, it’s important that quick actions are taken to change the narrative. We need to address vaccine hesitancy so we can have a realistic solution in the next 10 years.
What has been the effect of myths and misconceptions?
That has been a big challenge to us. There is a need to address the issue of misinformation and disinformation among the people, especially the ones that come from “ignorant” people who, unfortunately, command massive loyalty and followership. Such is one of the most limiting factors for immunization in the next five to 10 years in Nigeria. We have more functional health facilities and services, as well as more vaccines available. So, the challenge is not going to be the issue of supply but the issue of demand. So, there’s a need for all stakeholders to join hands to solve the issues that might affect the successes recorded as regards immunization.
Do you suggest legislation against people who peddle false information on vaccines?
I may not make a categorical statement on this. However, we have noticed that there are lots of misinformation and disinformation from a lot of people that have massive followers. Some of them are religious leaders while others are influencers. From UNICEF’s perspective, the best way to respond to that is fact-checking. This will help to prove them wrong or otherwise. For instance, there is misinformation in the public that the HPV vaccine affects the fertility of women. This is not correct. At UNICEF, what we do in such situations is to put the facts before the public and allow them to make choices. But the most important thing is to let the public know that HPV prevents cervical cancer, which is one of most killers for women. So, I will suggest that people respond to rumours with facts instead of legislation.
How precarious is the situation to Nigeria’s posterity?
Zero-dose children are a big threat to the health of the people. Last year, there was an outbreak of diphtheria in some parts of the country, particularly in Kano State. Over 10, 000 children were affected in that outbreak. That was a setback to us. The only way to stop such outbreaks in the future is by prevention, which is better than cure. Two things are required to achieve that. First, we have to strengthen our PHC system by making available, adequate number of health care workers to offer services to the people. And we are glad that the government is already taking care of that. The second one is the vaccine. More people need to be reached with routine immunization services. If we fail to do that, we would continue to record regular outbreaks of vaccine-preventable diseases. We need to move to a situation where we have strong herd immunity, in which more than 80 per cent of children are vaccinated. That will go a long way in giving protection to our communities and improving the life expectancy in Nigeria. Nevertheless, we are on the right track, but we need to do more. We have a working relationship with traditional and religious leaders, and that has been helpful in achieving the needed results.
You were in Kano recently. What was your assessment of the vaccination situation in Kano?
Kano is one of the most populated states in Nigeria. If Nigeria wants to achieve its target as a country as regards immunization, we need to see significant progress in Kano. Aside from the diphtheria outbreak in Kano last year, there was an outbreak of measles in nearby states, Jigawa and Katsina, which predisposes children in Kano to similar health threats. Nevertheless, there are some positives in Kano and beyond, but are they fast enough and sustainable? We need to strengthen our health care system, by first improving the health workforce in the system.
Of what importance is mobilization in rural communities?
Mobilizations at rural communities are critical to whatever success we desire. Sadly, we have cases of unvaccinated children in several remote communities in Kano state, which was responsible for the diphtheria outbreak last year. What we need is a change in strategies to achieve that. We need local influencers to help achieve that. At UNICEF, we have some respected celebrities who are UNICEF champions. In our recent engagements in Kano, we deployed the services of Ali Nuhu, a popular Hausa moviemaker, and we saw the result thereafter. But Ali Nuhu cannot be everywhere. So, we need to deploy the services of other reliable local influencers to do the mobilization.
Tell us about the catch-up efforts being done by UNICEF and the federal government as regards immunization.
One of the big issues we are facing is how to restore the immunity that was lost during the COVID-19 pandemic. Like I said, we have over 2 million zero-dose children. If the figure is added to the ones of 2021, 2022 and 2023, that will be a huge number and disastrous. As a result, the government, in collaboration with partners, is planning a huge measles campaign towards the end of the year. The campaign might be expanded as the need arises.
As UNICEF chief of health, what’s your assessment of the minister of health so far?
Obviously, the minister has some ambitious plans to reform the health sector in Nigeria, and he is taking the right steps. The National Health Sector Renewal Initiative was articulated in a sector-wide approach.
The compact for the implementation of that was signed in December last year by all stakeholders and the implementation is ongoing.
Did UNICEF sign the compact?
Yes, we did. We signed the compact because we believe that it’s the right vision for Nigeria’s health sector. It’s about reducing fragmentation and having a strong PHC system that will provide quality health care and provide health security. UNICEF is part of the technical working group and others. We believe in the tools that the Minister is using to implement the policy. Tools like: pool-funding, technical assistance, capacity building, and adequate supervision, among others. We expect progress soon.
