‘Vaccine is most powerful historical tool to reduce child mortality’

New reports have shown that global number of maternal deaths fell from around 446, 000 in 2000 to around 287,000 in 2020, which represents a 36 per cent decrease. However, in Nigeria, it is estimated that eight million children are born every year with seven million pregnant women at any moment, with the country’s poor state of healthcare.
Eduardo
Eduardo

New reports have shown that global number of maternal deaths fell from around 446, 000 in 2000 to around 287,000 in 2020, which represents a 36 per cent decrease. However, in Nigeria, it is estimated that eight million children are born every year with seven million pregnant women at any moment, with the country’s poor state of healthcare. There is need to ensure quality and adequate healthcare for the vulnerable, especially in rural communities. The United Nations International Children’s Emergency Fund (UNICEF), Nigeria Chief of Health, Eduardo Celades spoke to IJEOMA THOMAS-ODIA on the organisation’s interventions to improve upon the services of primary healthcare centres across the nation.

In your current report on trends in maternal mortality from 2000 to 2020, what are some of the issues as they relate to Nigeria?
Nigeria is one of the most complex nations in the world in terms of the public health issues that it is facing. It has the second highest number of unvaccinated children in the world. It is also a nation with a high maternal mortality. Last year, we had the biggest outbreak of Measles in the world. It is a country with extremely weak health systems, so we are trying to think from different angles. We, as UNICEF and the UN, cannot work alone, we need the government, and we also need to work with journalists and social media influencers to make the change that is needed.
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What are some of the vaccine-preventable children diseases?
We have a big range of vaccines. At this moment, we have about 18 antigens in the country on the routine immunisation scale. Starting from Rotavirus for Diarrhoea, Pneumococcal vaccine for Pneumonia and vaccines for Measles, Diphtheria, Tetanus and so on. We know that the vaccines work and we know that it is one of the most powerful historical tools to reduce child mortality. The challenge becomes ensuring that all the children who need it have access to it.

Sustainable Development Goal (SDG) three is focused on health and well being for all, including a bold commitment to end the epidemics and other communicable diseases by 2030. How well has Nigeria progressed to achieving this goal?
The analysis from the data tells us that Nigeria is progressing towards the SDG 3. However, this progress is insufficient to reach the targets. The country has been able to go through the COVID-19 pandemic and still progress. For example, we saw how routine immunisation coverage increased. Very few countries managed to pull it off and Nigeria did it. We have seen how child mortality has been reduced over the last few years, but it is insufficient because, for example, neonatal mortality is not going down, and with maternal mortality, it is the same. We are seeing that it has reduced by 12 per cent in the last 20 years, but that is not enough if we want to reach our targets. From UNICEF’s side, our main approach is to try to accelerate interventions to make an impact. We are only seven years away from 2030. If we continue at this rate, it is not going to be enough. Some donors will leave the country in a few years. Now we have a window of opportunity, if we work together, mobilize resources and the government is committed, we can achieve our targets.

How much of a concern is this?
It is not a concern, it is a reality. In Nigeria, it is estimated that eight million children are born every year. There are seven million pregnant women at any moment. The key question is how we can ensure that these women and children can survive, how we can reduce child mortality, especially new born children and how we can ensure that no woman dies because she is pregnant. And our recent reports tell us that there is still a large number of women that die because of pregnancy related causes, which is about 82,000 every year. What we are trying to do as UNICEF and with the government is to strengthen the primary healthcare, to have enough human resources, commodities, deliveries, abundance of resources and good data to be able to bend the curve and accelerate progress.
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What is the call to action with respect to the latest maternal mortality report 2000-2020?
Our call to action has three main aspects. The first is the need to increase effective investments in primary healthcare at the state level, and also the basic health care provision. Without investments and addressing of the right priorities we are not going to be able to bend the curve. The second is to get Universal Health Coverage and to reduce mortality through the availability of the national health insurance. Our second appeal is to expand the national health insurance as much as we can, to invest in the most vulnerable so they have access to national health insurance. We are appealing to the state governments to allocate resources to that and donors as well. Our third call to action is to target the most vulnerable – the women who do not have access, in the most inaccessible areas.

What are your plans in ensuring that states take primary healthcare concerns seriously?
UNICEF in collaboration with the Nigerian Governors Forum and other key partners launched the Primary Healthcare Leadership Challenge. The idea is to recognise and award the state governments who are really investing not just resources, but time and effort in primary healthcare. The award is going to be given by an independent judging panel based on data. We are going to provide 13 awards in the six geo-political zones to the best state and the most improved as well as one national champion. We believe that this is a great opportunity to provide incentives for state governors to invest in primary healthcare.

Also, Nigeria is set to introduce a new vaccine this year to routine immunization, the Human Papilloma Virus (HPV) vaccine. It will prevent young girls from getting cervical cancer. This is a great opportunity and we expect that the vaccines will be in the country and ready to be delivered by November this year, which is in about six months. For the targets, we expect that if everyone goes well and the vaccines are successfully delivered, the drug will be one single shot. We are targeting at least 1.6 million girls in school and three million girls out of school this year.

How would you say the COVID-19 vaccine has affected immunisation of children and what lessons can we take from it?
We have a high number of pseudo-dosed children – Children who were not vaccinated at all during COVID-19 in these last couple of years. We estimated that in Nigeria in this moment, there are 2.2 million children with no vaccines at all. There has been decrease in immunisation for children, likely because of the bandwidth of the governments to deliver these services. Nigeria has been an exception. Nigeria has been able to progress despite COVID-19.
However, the progress was slowed down and at this moment, we have a big issue in our opinion.
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Hence, our priority for this year in collaboration with the Federal Ministry of Health and the National Primary Health Care Development Agency (NPHCDA) is catch up and recovery. Trying to get to these children that we lost over the last couple of years and trying to ensure that there are no more zero-dosed children. We are working with all our partners to reach out to all these children.

Will this process be a backlog or a similar procedure for children of all ages?
With the current coverage, we define zero-dosed children as the ones who don’t have Penta 1 and the coverage of Penta 1 is 70 per cent based on the last few weeks. Which means that 30 per cent – which is three out of ten children are zero-dosed. We have been conducting an analysis to find out where they are, and our priority this year is to get these pockets of children who are not vaccinated. Some of them couldn’t get these vaccines because these services were not available. This is not only in the North like in Sokoto and Zamfara, but as well in Lagos, in places like Alimosho. There are many children who are not vaccinated.

Regionally, a huge number of zero-dosed children are predominantly found in what areas?
It is predominant in the North but it is also all across Nigeria. When we look to the 100 priority local councils with many zero-dosed children, numbers are more in the North, but we have two in Lagos – one being in Alimosho, we have one in Ogun, we also have some in Plateau, Bauchi, Nassarawa statesss. We have them in 18 states across the federation.
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