‘Nigeria has secured enough vaccines for 2016, 2017’

Dr. Ado Gana Muhammad is the Chief Executive Officer (CEO)/Executive Director of the body in-charge of immunization in Nigeria, the National Primary Health Care Development Agency (NPHCDA). Muhammad in this exclusive interview with The Guardian to mark the World Immunisation Week, April 24 to April 30, said among other things that despite perceived shortfall in budgetary allocation to health, the Agency has secured all the country’s vaccines for both Routine Immunization and campaigns for polio and others. Muhammad also said that the Agency is focusing now on Primary Health Care (PHC) which as a main change mantra for health by the President Muhammadu Buhari-led administration. To ensure sustainable financing of immunization beyond just government support, the country last week hosted the Anglophone countries in Abuja to develop collective strategies and initiatives towards having country level structure primarily for sustainable immunization financing. Muhammad said Nigeria already has a National Immunization Financing Task Team in place that aims amongst others of pushing for evidenced based government increase in budgetary allocation and appropriations for immunizations, exploring alternative sources of vaccine financing and proposing the most appropriate and sustainable co-funding mechanism between governments at all levels. He said the country, for 2016, has secured adequate funding for all vaccines targeting over seven million children and about nine million pregnant women and government contribution is captured in the 2016 budget under consideration. Muhammad said the federal government plans to introduce more new vaccines into the routine immunization schedule of the country for Meningitis A vaccine in 2017, Rotavirus vaccine for diarhoea in 2018 and Human Papilloma Vaccine (HPV) vaccines for cervical cancer demo in 2017 and 2018 and into the Routine Immunisation (RI) schedule in 2019. The NPHCDA boss said that the plan in the next four years is to have at least one functional PHC per ward in all 10,000 wards in Nigeria that is able to provide basic PHC services, immunization inclusive, on a 24 hour per day basis, using a responsive and resilient human resources and activities linked properly and tailored to community needs and expectations. He said the overall objective is to provide universal care to about 100 million Nigerians. “Between June and August, we intend to deliver on 111 at one per senatorial district as a proof of concept for the Universal Health Coverage (UHC) PHC agenda. CHUKWUMA MUANYA, Assistant Editor (Head Insight Team, Science and Technology) writes. Excerpts:

There are reports that the country may experience and some states are already experiencing shortage of some essential vaccines?
No state has experienced any stock out since 2013 but we need to sustain the zero stock out level achieved. Our initial problem was not in-country supplies but delays in distribution along the supply chain. To address this, we established a simple but impactful vaccine stock dashboard board, which gives us weekly visibility of all vaccines stocks at National, zonal, State, Local Government Area (LGA)§ and even some heath facilities for informed decision. We push to States and also ensure that States push these vaccines to all LGAs and Health Facilities (HFs) based on the status of stock on a week-by-week basis. For us to sustain this momentum, means that Executive budgetary provision for vaccines is retained and more funding made available as we transit from donor vaccine support eligible country due to rebasing of the economy. Nigerian Government fully pays for all traditional vaccines and commodities and enjoys additional support from GAVI on new vaccines (based on co-financing arrangement). GAVI, the Vaccine Alliance is a public-private global health partnership committed to increasing access to immunisation in poor countries. For 2016 we have secured adequate funding for all our vaccines targeting over seven million children and about nine million pregnant women and government contribution is captured in the 2016 budget under consideration.

Considering the obvious shortfall in the national budget on health, what is NPHCDA doing to ensure you are still able to meet your mandate in terms of vaccination against preventable diseases?
NPHCDA continues to engage both executive, through the Federal Ministry of Health (FMoH) and the legislature the values of vaccination for security of the nation and our economic prosperity. The current efforts we deploy to ensure we secure all our vaccines for both Routine Immunization (RI) and campaigns, polio and others, is to draw from Federal Government through regular budget and other commitments, from GAVI co-financing support- for new and underutilized vaccines- and in using the World Bank draw down facility for polio campaign vaccines. These arrangements have helped us secure all our needs for 2016 and 2017. The current Country Multi-Year Plan (2016 – 2020) clear indicates how much we need in the future and we have gone further to develop a Case Investment plan for Immunization.

To ensure sustainable financing of immunization beyond just government support, the country last week hosted the Anglophone countries in Abuja to develop collective strategies and initiatives towards having country level structure primarily for sustainable Immunization financing. We already have a National Immunization Financing Task Team in place that aims amongst others of pushing for evidenced based Government increase in budgetary allocation and appropriations for Immunizations, Exploring alternative sources of vaccine financing and proposing the most appropriate and sustainable co-funding mechanism between governments at all levels- federal, State and LGAs.

No state has experienced any stock out since 2013 but we need to sustain the zero stock out level achieved. Our initial problem was not in-country supplies but delays in distribution along the supply chain. To address this, we established a simple but impactful vaccine stock dashboard board, which gives us weekly visibility of all vaccines stocks at National, zonal, State, LGA and even some heath facilities for informed decision. We push to States and also ensure that States push these vaccines to all LGAs and HFs based on the status of stock on a week-by-week basis. For us to sustain this momentum, means that Executive budgetary provision for vaccines is retained and more funding made available as we transit from donor vaccine support eligible country due to rebasing of the economy. Nigerian government fully pays for all traditional vaccines and commodities and enjoys additional support from GAVI on new vaccines, based on co-financing arrangement. For 2016 we have secured adequate funding for all our vaccines targeting over seven million children and about nine million pregnant women and government contribution is captured in the 2016 budget under consideration.

What has been the situation of routine immunization in the country? What is the percentage, challenges and what are we doing to improve the coverage?
Nigeria has maintained sustained increase in the national immunization coverage, DPT3 and other antigens at over administrative 80 per cent, since 2013. DPT refers to a class of combination vaccines against three infectious diseases in humans: diphtheria, pertussis (whooping cough), and tetanus. There has also been 31 per cent reduction in the number of un-immunized children in the country in 2015 compared to same period in 2014. This has contributed to the reduction in morbidity and mortality of infants in Nigeria. For example, the Nigeria infant mortality rates dropped from 97/1000 live births, based on 2008 National Demographic Health Survey (NDHS) to 69/1000 live births, according to the 2013 NDHS report. The remaining weaknesses, which the current PHC System reform is addressing, include: inadequate human resources for RI, poor infrastructure, especially in the rural / semi-urban areas, insecurity in most regions- Boko Haram in the North East (NE) and militancy / kidnapping in South South (SS) / South East (SE), and quality of data: denominator issues and also significant and inadequate support for implementation of identified functional innovations / interventions

We are focusing now on PHC which as a main change mantra for health by this administration. We will continue to sustain advocacy at all levels, most especially to State Governors, to key into this PHC agenda and ensure quicker replication of the approach. We are building on the gains of polio eradication to strengthen RI, including lessons learnt from demand creation. On data, the priority is to accelerate scale up of DHIS 2 roll out to all states, in 2016 / 2017. Health worker capacity will continue to be strengthened using innovative approach that will allow health workers to provide quality services in an integrated manner to be supported by supportive Supervision at all levels. We will ensure strict implementation of priority activities in the national comprehensive multi-year strategic plans (cMYP) for immunization 2016 to 2020.

How far with plans to introduce new vaccines?
Before 2013, our Routine immunization schedule involves administration of six traditional vaccines- BCG, Oral Polio Vaccine (OPV), DPT, measles, Yellow fever and hepatitis B- to children to prevent the childhood killer diseases. Bacillus Calmette–Guérin (BCG) vaccine is a vaccine primarily used against tuberculosis.

In addition, tetanus toxoid vaccine is given to women of childbearing age and meningitis vaccine to the high-risk groups.
Between 2013 to date, three new vaccines- Pentavalent, Pneumococal Conjugate Vaccine (PCV) and Injectable Polio Vaccine (IPV) have been introduced into the RI schedule. These new vaccines remain very vital to achieving our collective goal of preventing death and morbidity amongst children, especially infants. A classic example is PCV used against Pneumococcal disease, pneumonia, which is reported to cause death in over 177,000 children in Nigeria annually, which represents 22 per cent of the global burden. Consistent with the government policy of protecting lives, we have plans to introduce more new vaccines into the routine immunization schedule of the country for Meningitis A vaccine in 2017, Rotavirus vaccine in 2018 and Human papillomavirus (HPV) vaccines demo in 2017 and 2018 and into the RI schedule in 2019.

Rotavirus vaccine is a vaccine used to protect against rotavirus infections. These viruses are the leading cause of severe diarrhoea among young children.

Nigeria has made giant stride towards polio eradication by staying polio-free for a year and nine months with certification from the World Health Organisation (WHO). It is expected that if the country remains polio-free till July 2017, it would be declared polio-free by the WHO.After polio eradication what next?
Government will continue to prioritize Routine Immunization and ensure functionality of PHCs. The goal is to achieve universal health coverage through a functional PHC that will target over 70 per cent of our population and address effectively 80 per cent of our health problems. This strategy aligns very much with the health change agenda of Mr. President that focus on basic PHC. The current Strategic Implementation plan for 2016 budget has PHC reactivation as one of the 33 concrete actions to be executed for the year. Special appreciation goes to the Honourable Minister of Health (HMH) and Honourable Minister of State for Health (HMSH) for their exemplary vision, continuous support to the Agency towards achieving this important agenda.

The plan in the next four years is to have at least one functional PHC per ward in all 10,000 wards in Nigeria that is able to provide basic PHC services, immunization inclusive, on a 24 hour per day basis, using a responsive and resilient human resources and activities linked properly and tailored to community needs and expectations. The overall objective is to provide universal care to about 100 million Nigerians. Between June and August, we intend to deliver on 111 at one per senatorial district as a proof of concept for the UHC PHC agenda. We plan to engage the States for buy-in such that we are able collectively to achieve this noble objective.

How is the poor power supply affecting the cold chain systems in the country? Are the vaccines still viable considering the near total black out situation in the country?
All vaccines require to be maintained in an optimum temperature range of plus 2 to plus 8°C right from the point of manufacture till it gets to the end user (clients). It is a known fact that we are battling with electricity challenge, although quite impressive efforts are on the pipeline under this regime in tackling with the situation. From the start, WHO do recommends the type of equipment to keep our vaccines. This equipment’s must be Performance Quality and Safety (PQS) compliant, as they tend to hold cold temperature far longer than the domestic type of refrigerators, whenever there is power cut/failure. So we relied on PQS approved solar refrigerators. Before 2013, we have about 4000 refrigerators across States, but the problem then was that these solar refrigerators were battery type and batteries after two to three year tend to die and will need to be replaced. So the rate of breakdown or malfunction was a high as 50 per cent based on the 2012/13 Cold Chain Assessment report. We have a national policy of having at least one functional solar refrigerator by ward. So there is a huge gap.

Fortunately and with advancement of technology, WHO in 2013 pre-qualified first sets of solar refrigerators that do not have batteries. They are called Solar Direct Drives (SDDs). We took opportunity of the GAVI Health System Strengthening (HSS) support to procure 1656 units of 99 litres SDDs and distributed to over 1500 health facilities. In addition, using the EU Support to Immunization Governance in Nigeria (EU-SIGN) support another 757 units have been procured to be distributed to 24 EU-SIGN focal States. We supported the entire Bill and Melinda Gates Foundation (BMGF) supported RI states with technical guide and they also procured sizeable number of SDDs from their basket funding to bridge the existing gaps. For example Kano procured 208, Bauchi 162, Katsina and Zamfara 180 each while Sokoto, Borno and Yobe have plans for SDD procurement as well.

We have also procured and distributed temperature-monitoring devices that provide 24-hour information on the storage conditions of all refrigerators. At our National and zonal stores, we have advanced real-time temperature monitoring devices that sends out information though phones and mails whenever there are issues demanding immediate attention of staff. With these measures put in place and with future plans, the country is moving towards the one SDD per ward strategies, real-time storage condition information although it requires heavy investment to fully achieve.