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How Immunisation Saved Nigeria

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Vanguard (Lagos)

OPINION
January 28, 2003
Posted to the web January 28, 2003

Sola Ogundipe
 

AT inception, one of the cardinal objectives of the present administration was to eradicate, eliminate and control childhood and other vaccine preventable diseases through adequate routine immunization activities; and the attainment of self-reliance in vaccines and biologicals production. Several arguments could be put forward for this desired objective.

For a country like Nigeria, with a fast growing population, it was clear that addressing issues of affordable disease control programmed is of utmost importance. Gains of the last two to three decades in the area of healthcare delivery had been seriously eroded by the increase in cases of vaccine preventable diseases such as yellow fever, Cerebrospinal Meningitis (CSM), measles and tuberculosis. These diseases had continued to occur in epidemic proportion with great and devastating impact on lives of the people. Between 1987 and the year 1994, Nigeria experienced about 17 outbreaks of severe yellow fever epidemics. There were four serious outbreaks of cerebrospinal meningitis of which the 1996/97 episode was the largest recorded so far in history.

Emergence and re-emergence of diseases such cholera, HIV/AIDS. Lassa fever amongst others was equally worrisome. Cholera outbreaks were recorded between 1996/97 affecting more than 18 States and claiming over10,000 lives. Most worrying however, has been the speed with which HIV/AIDS has spread among the population to the extent that Nigeria is now in the epidemic phase of the epidemic.

Some endemic diseases have also continued to defy control measures. These include malaria, typhoid fever, and tuberculosis. The increase in cases of drugs resistant malaria and cerebral malaria is among the most serious public health any country can face. Demographic transition, coupled with changing life styles and deplorable environmental sanitation, hygiene, degradation and disasters have combined to compound our difficulties in effective control of communicable diseases.

These factors have also led to the increase in non-communicable diseases, such as diabetes, hypertension, etc.

It is no longer news that the on-going campaign against vaccine-preventable diseases through the National Programme on Immunization (NPI) has achieved tremendous successes, both in terms of resource mobilization from Federal government and international agencies, and an overall improvement in the immunization coverage for children and women.

What may not be immediately obvious is the way these improvements in national immunization levels were achieved. The driving force began from the quarterly distribution of routine vaccines with corresponding auto-destruct syringes to states and LGAs, along with boosting of routine immunization through multi-antigen campaigns in 19 States.

Over the last couple of years or so, there were series of landmark achievements in reduction of vaccine preventable diseases nationwide. In this regard, polio takes centrestage. First was the initiation of massive anti-polio activities that would result in the elimination of wild polio virus (WPV) transmission in the Federation towards the December 2002 target; then the establishment and commissioning of the National Strategic Cold Store in Abuja, and the provision of zonal cold stores; and sub-zonal "cold-rooms" coupled with receipt of European Union and GAVI funds, leading to improved resources mobilization.

The success of National Immunisation Days (NIDs) and Sub-National Immunisation Days (SNIDs) was unprecedented. But this was hardly surprising, afterall, Nigeria was the first African country to implement the house-to-house immunization strategy in 1999. There was also a successful synchronization of NIDs in West

Africa, involving six countries, and Presdient Olusegun Obasanjo played a leadership role in ensuring cross-border immunization and increase regional collaboration in immunization activities. Specific targets deemed necessary to achieve the eradication, elimination and control of childhood and other vaccine preventable diseases through adequate routine immunization activities, included strengthening of routine immunization services; advocacy for nationwide political commitment; involvement of private practitioners in the provision of immunization services achieved; introduction and use of new vaccines and achievement of adequate quantity and quality of vaccines.

One of the key areas of progress was in the drive towards self-sufficiency in vaccines through the National Institute for Production of Vaccines and Biologicals. At inception, it was the objective of the present administration to achieve self-sufficiency in vaccines to assure long-term sustenance of national immunization goals and efforts. To facilitate this, the Federal Executive Council approved the establishment of the National Institute for the Production of Vaccines and Biologicals, and committed funds and appointed a Consultant for the recommencement of the production of yellow fever and other vaccines at the Institute.

Expectations are that production would commence after delivery and installation of key equipment and with the completion of the monkey colony building, and breeding of monkeys. In addition, reputable WHO-certified vaccine - manufacturing companies notably Aventis Pasteur of France; Green Cross of Korea; and Vaccine Production Institute of China made presentations to the Ministry of Health for collaboration in the areas of vaccine production. These presentations are being examined in the context of government policy on private-sector participation in commercial/manufacturing ventures, and long-term profitability.

All in all, adequate funding remains the key for the success of the control activities. This in addition to encouraging local production of requirements for control activities are expected to greatly enhance affordability and self-sufficiency. For instance, the completion of Yaba Federal Vaccine Production Laboratory is believed to be able to save the country millions of Naira and make the immunization programme affordable.

Establishment of a National Center for Disease Control, Prevention and Eradication, fashioned after the US Center for Disease Control and Prevention, in Atlanta, may not be possible at the moment. But as part of the overall institutional response to sustainable disease control and prevention programme, it remains the ultimate desire.

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