Leveraging religious, traditional institutions to escalate immunisation coverage

Under-five mortality remains high in sub-Saharan Africa in spite of the global decline. A 2021 UNICEF report says that it is as high as one death in every 14 children.
In Nigeria, the figure is staggering, standing at 56.220 deaths per 1000 live births, according to UNICEF 2022 report.
Although his figure is 2.57 per cent decline from 57.701 deaths per 1000 live births, this is still unacceptable compared to statistics from other developing countries.
In Ghana for instance, the figure stood at 31.768 deaths per 1000 live births in 2022, a decline of 2.9 per cent from the 32.735 deaths per 1000 live births recorded in 2021.
Paediatricians say one-quarter of these deaths are preventable through interventions such as immunisation.
According to the experts, the risk of children being incompletely immunised in Nigeria is usually influenced by not only individual factors but also a community and state-level factors.

Fuleke Adeniran, a 23 year-old woman, at the Asiwaju Bola Ahmed Tinubu Comprehensive Health Centre in Lagos state, gave birth to her daughter, where she received a dose of Bacille Calmette-Guérin (BCG), the vaccine that protects against tuberculosis.
Four months later, her daughter had not received any vaccines.
Like Adeniran’s daughter, the majority of zero-dose children in the country are born to poor struggling families.
Adeniran said she had to wait for four months before going to vaccinate her daughter because she could not afford N400 transport fare to health facility.

The World Health Organisation (WHO) says vaccines are one of the most successful and cost-effective health investments with wider benefits that cut across a lifetime.
Nigeria’s immunisation programme recognises the following for the routine immunisation of children in the country: Bacili Calmette Guerin (BBG), a vaccine against tuberculosis; Oral Polio Vaccine (OPV), a vaccine against poliomyelitis.

It also includes DPT combination vaccine against diphtheria, pertussis, tetanus; Hepatitis; vaccine for hepatitis A and B; measles vaccine; yellow fever vaccine and supplemental vitamin A.
According to the National Primary Health Care Development Agency, (NPHCDA), the child is only considered fully vaccinated when they have received the aforementioned on schedule.
The State of the World Children Report, says that Nigeria is home to the second-largest number of zero-dose children in the world.

According to the report, Vaccine confidence is volatile and time specific.
According to the report, 67 million children missed out on vaccinations between 2019 and 2021, with vaccination coverage levels decreasing in 112 countries.
“Children born just before or during the COVID-19 pandemic are now moving past the age when they would normally be vaccinated, underscoring the need for urgent action to catch up on those who were missed and prevent deadly disease outbreaks.

“As of the end of 2021, India and Nigeria (both countries with very large birth cohorts) had the largest numbers of zero-dose children, with Nigeria having 2 million zero-dose children,”’ the report said.
Dr Seth Berkley, CEO, Vaccine Alliance (Gavi), said that there were signs of hope and progress.
“Identifying and reaching zero dose children is a central focus for Gavi’s work with Alliance partners.
“Zero-dose children do not receive even the first dose of the DPT-containing vaccine”, Berkley said in one of his verified social media accounts.
Lack of confidence in the vaccines, fuelled by religious and traditional beliefs have also led to immunisation apathy and rejection in some quarters.

The Chief of Health in Nigeria, UNICEF, Dr Eduardo Celades, said at a news conference to unveil the 2023 edition of State of the World Children Report that it’s essential to build confidence in vaccines in the country.
According to him, if we’re going to boost global vaccination rates, understanding specific attitudes towards the safety and value of vaccination in any given community is critical.
He said this required strengthened engagement and leaning on interventions designed and delivered by trusted community members such as health workers and religious leaders
“These individuals often enjoy high levels of trust in their community. Therefore, they must be empowered to counter misinformation and promote the value of vaccination.
“When these trusted individuals engage in dialogue, they allow people to share their feelings and concerns and can help foster confidence in vaccines,” he said.
“No child should be denied the right to a lifesaving vaccine. We must quickly find and vaccinate children who missed vaccines,” he said.
Prof Oyewale Tomori, Chairman, BIOVACCINE Nigeria Limited (BVNL), said that the country needs to strengthen routine immunisation systems and services is critical to achieving high coverage and reaching states’ disease-eliminating targets.

Tomori, who is also the former vice-chancellor of the Redeemer’s University, Ede, said that community engagement strategies that reach beyond traditional health systems may reduce dropout and increase coverage in immunisation
He said community-related causes of low demand for child Immunisation include: Poor community involvement in the planning and implementation of routine immunisation services, and social and cultural barriers to access.
He said that lack of knowledge about the potential benefits of vaccinations, a lack of accountability and a weak governance system for routine immunisation, poor service delivery, missed opportunities at health facilities and weak sustainability of planned interventions.

Mrs Chika Offor, founder, Vaccine Network for Disease Control (VNDC), said that an effective Primary Health Care (PHC) system was vital to delivering vaccines to all children.
“Efforts to empower, train and retain health workers will need to be scaled up and extended to community health workers (CHWs), the backbone of PHC”, she told the News Agency of Nigeria (NAN).
According to her, to make these changes sustainable, the government needs to continuously evaluate and consolidate relevant policies in the system.
“Initiatives such as developing and adopting community engagement charters are essential to enhance demand creation and promote community involvement and trust”, she said.
Increasing immunisation coverage in Nigeria is a prerequisite if every child within immnisation range will be fully vaccinated.
It is incumbent on policy makers, civil society organisations, donor agencies and health workers, traditional and religious leaders; and other stakeholders to intensify their commitment to immunisation.
Abujah Racheal writes from News Agency of Nigeria