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Magdalene Odunvbun, Consultant Pediatrician/Senior Lecturer, University of Benin/University of Benin Teaching Hospital shares with Kemi Ajumobi on the importance of vaccination, its relevance and the need for better intervention by the government. Excerpts.
Awareness of vaccination in Nigeria
Vaccines are the most inexpensive ways of improving health and reducing death and diseases caused by infectious organisms however, there are several bottle necks and barriers to routine immunization in Nigeria. The political will to drive immunisation in Nigeria is very poor. Waisbord and Larson (2005) identified 4 major reasons why children do not get vaccinated. Children don’t get vaccinated if:
1. Caregivers don’t know the value of immunisation, when the children should receive it and where they can receive it.
2. The caregivers live in communities that are excluded and beyond the reach of immunization services.
3. The caregivers don’t trust the safety of the vaccines
4. The vaccines are not available.
Nigeria operates a 3 tier system of government and each tier of government has its own role in immunization. The Federal Government is solely for procuring vaccines and providing technical support. Adequate budgets must be made at this level to buy vaccines and this can only be achieved if the government considers immunization a priority. Primary health care and immunisation are the responsibility of the Local governments. Funds are usually not available to drive an effective immunization programme. The fund constraints identified were due to failure to expand than failure to budget. There are federal and state budgets for routine immunization, but the release of this fund is neither guaranteed nor timely. The same occurs at the Local Government Areas, provisions are made but funding disbursement are not made. The end result is that immunisation program are poorly conducted because the program managers and health care workers complain of lack of funds to fuel their vehicles to go to the state or LGA stores to collect vaccines, they are unable to power their generators to maintain the cold chain necessary to preserve the vaccines.
Common misconceptions that deter caregivers from giving their children immunisation
1. Fear of the safety of the vaccines- fear that the vaccines will harm their children
2. That vaccines are unnatural, and it is better for the child to experience the real disease before treatment.
3. Giving vaccines to a young child can overload the child’s immune system
4. Misinformation, myths/superstition that vaccination reduces fertility later in life
5. Fear of needles- that injection causes paralysis in the child
6. Religious taboo, some people believe that disease are an act of God , thus vaccination to prevent them will anger the “gods”
7. Influence of religious leaders, especially those in Northern Nigeria, that there is a hidden agenda by the donors of vaccines to control their population
8. Vaccines will make children dependent on Western medicine instead of our local herbs for cure
9. Some believe that vaccines are curative and since their children are health they do not need to be cured of any ailment
Solution to increasing awareness
Public awareness of the benefits of immunization is low. The high level of illiteracy in Nigeria is largely responsible for this. There is an urgent need to increase public awareness about the importance of vaccination through better communication strategies. This is better done at the community level involving major stake holders in such communities like the religious leaders, market women leaders, traditional birth attendants etc.
Involving communities in immunization programs has helped to build trust and acceptance of vaccines. Locally adapted and appropriate communication strategies are needed to address socio-cultural and political influences that impact immunization behavior in communities. Communities should be active in planning and carrying outreach services and they can also participate in monitoring immunization within their villages.
There is need for increase political will to fund immunization programs. The government must realize that immunization is actually the cheapest way to protect the health and wellbeing of their populace and should therefore invest more on it instead of waiting for international donors. Financial guarantee and flexible funding will improve the likelihood that funds budgeted for vaccines are used solely for that purpose. The government should provide legislation, build national capacities, improve monitoring and data quality, improve vaccine management, safety and regulation, research and innovation. They should strengthen the immunization system through adequate staffing, adequate resources, and adequate supply of vaccines. Scaling up immunization coverage to 90% will avert $17billion in economic losses and will save more than 600,000 lives over the next 10 years.
For the Health workers, they must administer the vaccines properly and safely. Their services must be accessible and appealing to ensure that caregivers bring back their children for immunization. They should avoid turning parents away when they see that not enough children are present for them to open a new vial of vaccine. It is better to open a new vial for a child and discard the unused portion, than to send away the children because you don’t want to waste the vaccine. The parents may never bring back that child for immunization, and that becomes a missed-opportunity.
