Nigeria Steps Up Vaccination Campaign After Lapse

When Lola Atiku brought her oldest son to the neighborhood clinic five years ago for routine immunizations, government health workers repeatedly turned her away, saying they had run out of needles or vaccine.

This week, as Atiku carried her youngest boy to the market, volunteers literally pulled her in off the street to administer the 15-month-old child’s first measles shot and a polio booster. The boy, Basit, wailed from the sting, but his mother was impressed.

“They’re making it a lot easier nowadays,” said Atiku, 30, rocking the child.

Nigeria, Africa’s most populous country, is in the midst of an aggressive campaign to recover from a prolonged breakdown in its public health system that has triggered an alarming increase in deadly yet easily preventable diseases over the last two years.

As the rest of the world, including many African nations, made progress in eradicating polio and measles, Nigeria reported 837 polio cases through September, according to figures from the World Health Organization, or WHO. That’s nearly 70% of the world’s polio cases this year.

Measles, which was eradicated in developed nations decades ago, is still one of Nigeria’s leading causes of death among children, claiming several hundred victims a year, according to the Health Ministry. (Exact figures are not known because of poor data collection.) Most worrisome, Nigeria’s routine immunization coverage, including protection against childhood diseases such as polio, measles, whooping cough, diphtheria and tetanus, is among the lowest in the world. Last year, routine immunization coverage was only 35%, according to the WHO.

In Africa, where most other nations report coverage rates of more than 80%, the only country that performed worse than Nigeria was Somalia, which has lacked a functioning central government for 15 years.

“We’re trying to catch up,” said Tola Kasali, the health commissioner of Lagos state, after kicking off the government’s latest measles vaccination drive this week.

Officials blame myriad factors for Nigeria’s lapse. Despite oil reserves that make this one of the continent’s richest nations, government funding for public health has evaporated over the last decade.

State-run clinics ran out of vaccines or syringes. Workers went unpaid. Sometimes vaccines were available at regional centers but could not be distributed to local clinics because government vehicles had no gasoline, said Chris Kamugisha, the WHO medical officer in charge of immunizations in Abuja, the capital.

“It was mostly a government issue,” he said. “Facilities didn’t have the vaccine or they weren’t reaching the [local] wards.”

In Lagos, one of the most populous states, federal funding for health programs fell victim to a power struggle between the state and national governments, said Adetoun Agbe-Davies, head of family medicine in the state. The funding was cut off in 2004 and only recently resumed.

“It’s all because of the usual politics,” she said.

At first, international health groups tried to fill in the gap by focusing on delivering polio vaccines in Nigeria. Health officials feared that the country’s lapse in healthcare would endanger a long-standing goal of eradicating the crippling disease worldwide by 2005.

But house-to-house polio vaccination campaigns in 2003 backfired in Nigeria’s Muslim-dominated north, where anti-Western sentiments were already high because of the U.S.-led invasion of Iraq that year.

“People became suspicious,” Kamugisha said. “They started asking, ‘Why do you keep coming to my house, but you only give the polio vaccine? What about measles? What about diphtheria?’ ”

Muslim leaders in the north organized a boycott against the campaign, accusing the West of secretly contaminating the polio vaccine with the AIDS virus or infertility drugs in an attempt to wipe out Muslims. Parents hid their children during the immunization efforts. Health workers were harassed or threatened.

In 2003, the government suspended polio immunizations and ordered testing on the vaccine. Officials declared the vaccine safe and resumed the program the next year. President Olusegun Obasanjo personally delivered a vaccine to a child in an effort to calm public fears.

But the damage was already done, and Nigeria’s polio cases soared last year.

Kasali, the Lagos health commissioner, blamed misinformation rather than government inaction.

“We offered a lot of routine immunizations, but people just didn’t take advantage of it,” he said.

Now the national government and international humanitarian groups, including the WHO, UNICEF and Rotary International, have made impressive progress in reversing Nigeria’s negative trends. They have spent more than $70 million on several vaccination campaigns, focusing chiefly on the north, where polio cases are concentrated.

This week, a government-led effort launched a major measles and polio vaccination campaign in the south, aiming to reach 30 million children in 10 days. A similar program was completed in the north last December.

To address lingering distrust among Muslims, who make up half of Nigeria’s population, health workers in spring began combining polio vaccines with immunizations for other childhood diseases and vitamin A shots. As an additional incentive, participants received free mosquito nets, soap or deworming tablets.

Coverage rates for routine immunization in northern states skyrocketed. In Kano state, where many families once refused the polio vaccine, immunization coverage among children rose to 96% from 26%, according to the WHO.

That’s helped increase the national immunization rate among children to 60%. Measles cases are estimated to have fallen this year by 90%, the group said.

Polio remains a pressing problem, with cases still on the rise compared with last year. But so far, the epidemic in Nigeria is limited to northern regions, said Mike Mwanza, a WHO employee who monitors statistics.

“We have it geographically restricted,” he said. “That’s a good sign.”

edmund.sanders@latimes.com