GAVI and Vaccination – Joy for African countries, Saddness for Nigeria


Press reports out of Nigeria

March 29 2008…Measles Outbreak in Katsina

March 28 2008…Cholera Outbreak in Benue

December 14 2007…Measles outbreak in Kano


Probably no medical intervention has saved more lives than VACCINATION….and definitely nothing as efficiently and effectively.

It ranks with antibiotics as the two interventions that have had the most profound effect on medical practice.

New vaccines are being developed rapidly. In 2006 a new vaccine for pneumococcal infections was introduced in the UK after being a huge success in the USA. Most of the “developed” world is revelling in the introduction of the first mass vaccination initiative for a vaccine against Human Papiloma Virus (HPV)…the primary causative agent of Cervical Cancer. A vaccine for the rota virus, one of the major causative agents for diarrhoeal illness is in advanced stages.

In our beloved country Nigeria, we have found it impossible to raise vaccination coverage in for our routine EPI diseases in childhood. Every day we read about huge outbreaks of vaccine preventable diseases in pages of the newspapers.

Why is there no outcry by members of the public?

Why do we accept that children should die from measles, a disease for which a vaccine costs less than a bottle of coke, while members of our parliament spend N10,000,000 on a retreat to discuss our health?

Now read this…The introduction of the Hib vaccine to Uganda has resulted in the elimination of deadly Hib meningitis in children under five, according to an independent study published in The Bulletin of the World Health Organization. Uganda was one of the first GAVI-eligible countries to adopt Hib vaccine and their results in disease control are similar to those seen in Bangladesh, Kenya, Chile, the Gambia, the United Kingdom and the United States.

The GAVI Alliance was launched in 2000 to improve access to immunisation for children in developing countries and is sourcing huge amounts of funding from private and public sectors.It has raised over USD 1 billion to support vaccination in developing countries, USD750 million coming from the Bill and Melinda gates Foundation. Read an excellent summary of their work here.

For the really interesting stuff from Nigeria read the annual country report for 2006 here. Abstracts below…

Delays in accessing the fund was experienced in some States and LGAs due to their inability to open dedicated accounts with authorised signatories. GAVI fund utilization at the State level was poor due to the 10% counterpart funds required by States to provide for ownership.

From GAVI alone for our “poor” country…we recieved:

2006 = US$ 2,292,176
2007 = US$ 2,060,306

Total expenditure on Vaccination activities in Nigeria are estimated as

2006 = US$ 267,385,480
2007 = US$ 213,915,811

Yet an immunsation coverage survey GAVI carried out in 2006 showed these shocking results…

Fully Immunized child -18.1%
BCG – 40.5%
DPT3 – 36.3%
Measles – 32.7%

Something isn’t right here!

If your really want to feel bad…click here to see how other other African countries are doing in saving the lives of their children.

Most of these funds are spent on “vaccination campaigns”..the latest model is “Immunization Plus”. This involves the delivery of vaccines in addition to commodities such as Insecticide Treated Nets (ITNs), de-worming tablets, paracetamol syrup, soap etc as primarily from door to door by health care workers.

Most Nigerians can see why this will be attractive…someone will have to “supply” the commodities!

But we know that while these periodic, intensive campaigns to vaccinate a entire populations over s few days are attractive and maybe effective as a short term response to outbreaks, eradication initiatives etc….They are not economically sustainable….and from the constant flow of reports of measles outbreaks…are not working.

Every country needs a strong routine vaccination services! This requires forward planning, supply chain management, organisation, systems, skilled leadership etc. These areas challenge us badly…not for their non-existence but their non-utilisation in appropriate roles.

We have had an entire agency responsible for this for several years…the National Programme for Immunisation (NPI. In the later years of the Obasanjo regime, this was subsumed by the National Primary Health Care Development Agency..and is presently managed by Chief Adelekan. Nothing is heard from this agency…not in the national press…not through their website. Not a word…not even in response to the outbreaks!!!

Why is no one complaining? Why are no questions being asked? Where is the National Primary Health Care Development Agency?

To end on a positive note…a story about the “Nigerian spirit“…the one thing that keeps most of us going…

Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead

Chikwe Ihekweazu is an epidemiologist and consultant public health physician. He is the Editor of Nigeria Health Watch, and the Managing Partner of EpiAfric (, which provides expertise in public health research and advisory services, health communication and professional development. He previously held leadership roles at the South African National Institute for Communicable Diseases and the UK's Health Protection Agency. Chikwe has undertaken several short term consultancies for the World Health Organisation, mainly in response to major outbreaks. He is a TED Fellow and co-curator of TEDxEuston.

Discussion2 Comments

  1. To add to the joy…

    In this week’s WHO’s Weekly Epidemiological Record Bulletin
    Full Issues available at: Epidemiological report:

    1. Somalia is again polio-free

    2. Validation of neonatal tetanus elimination in Zambia by lot quality-assurance cluster sampling

    while we stuggle with a,b,c in Nigeria…”Giant of Africa”

  2. i’m highly frustrated reading this blog on Nigeria heealth. it is all about blames, accusations and finger pointing – absolutely no solutions. Can we step back a little and blog about solutions ?

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