Incentive payments to encourage health workers to get involved in the polio vaccination campaign in Nigeria appear to have had unforeseen consequences. Nigeria has one of the world's biggest populations of children but is lagging behind dramatically in immunisation.
It is one of only three countries where polio is still endemic – the others are Afghanistan and Pakistan. In spite of huge efforts to reach every child, there were 108 cases last year – the year in which India managed to become polio-free. And shockingly, fewer than half of its babies receive the routine and absolutely vital basic immunisation. Only 47% now get the DTP jabs, protecting them against diphtheria, tetanus and whooping cough. In a world where immunisation has risen right up the agenda and is considered a major tool in the fight to save more children's lives, the DTP vaccination rate in Nigeria has actually dropped.
Why is this? Dr David Olayemi, senior programme adviser at Save the Children in Abuja, Nigeria, says part of the story is the unforeseen and unfortunate consequence of the mammoth effort under way to eradicate polio.
Centres are deserted and some children miss out on other immunisations that they need. But there is another problem too, said Dr Olayemi, which one could perhaps call vaccination fatigue. TThe vaccination strategy has to change, he says, to strengthen the primary healthcare system. The Gavi Alliance appears to think this is the way forward too – at a board meeting it agreed to get involved in the polio eradication effort, with a focus on integrating polio vaccination into the general baby vaccination programme and strengthening health systems to do that.
Dr Olayemi was speaking at the launch of a Save the Children report, which calls on Gavi to step up efforts to reach the last 20% of children across the developing world who are not getting routine immunisation. There has been impressive progress in reducing child mortality (12 million in 1990 to fewer than 7 million in 2011), which immunisation has helped to drive, it says. But the 20% left behind are the poorest, most marginalised and hardest to reach, it says, and new strategies are needed. Vaccination services need to be part of a package of healthcare interventions within strengthened primary care centres – and also taken to the children through outreach clinics.
The polio vaccination campaign is a response to what the WHO declared is a global emergency, but routine vaccination has to be a part of normal life.