In 2021, the Africa Centre for Disease Control and Prevention (CDC) published the Partnerships for African Vaccine Manufacturing (PAVM) Framework for Action, calling for 60% of vaccines required by Africans to be made in Africa by 2040 -- which is up to 1.7 billion doses annually.
Currently, Africa produces only 0.1% of the world's total vaccine supply, and many African countries, including Nigeria, are faced with the dual challenge of ensuring widespread immunisation coverage, while navigating the intricacies of funding these programmes.
Nigeria has maintained a two-part financing mechanism for routine immunisation and vaccine coverage. The federal government is solely responsible for the cost of routine immunisations. Routine immunisation programmes are funded at the federal, state, and local government levels. This ensures a cooperative and shared financial strategy by co-financing vaccines sponsored by Gavi, The Vaccine Alliance, via the National Primary Health Care Development Agency (NPHCDA).. While this external assistance has been key to improving vaccination uptake and mitigating preventable diseases, it has also created a dependency that puts the country's long-term health security at risk.
With the increased burden on the global community by evolving health crises, there is uncertainty around the availability and sustainability of international aid. Shifts in donor priorities, economic downturns, and geopolitical tensions all impact the flow of funds from external sources. This dependency makes Nigeria's immunisation programmes vulnerable to disruptions, which can have grave consequences on public health, particularly in the face of new and emerging health threats due to climate change.
The Abidjan Declaration
Vaccines provide a cost-effective prevention to most diseases. Vaccine-preventable diseases, such as measles, chicken pox and HPV are still a major public health issue in many parts of the world and account for approximately 25% of the 5 million deaths of children under five years. However, despite efforts put in place to improve vaccine coverage over time, inequalities remain especially in countries like Nigeria with 2.1 million zero-dose children, the highest in the world.
The recent Abidjan Declaration, signed by health ministers from nine African countries -Including Nigeria -- marked a significant commitment to self-sufficiency in vaccine financing. These countries have pledged to bear the full costs of their immunisation programmes from their national budgets, thereby taking control of their healthcare futures.
Gavi was set up as a global health partnership in 2000 with the goal of creating equal access to new and underused vaccines for children living in the world's poorest countries. A core element of Gavi's current development model is to work together with these countries to transition them from Gavi's support and scaling up domestically funded immunisation efforts.
As these countries' economies strengthen, Gavi requires them to take on more of the costs for vaccine procurement until they transition fully out of the alliance's support. So far, only 19 countries have transitioned away from Gavi's support since 2000 and Nigeria is expected to become fully self-financing for immunisation programmes by 2028.
With only four years to go, the Abidjan Declaration emphasises the need for sustainable domestic financing to ensure that immunisation programmes are not overly reliant on external donors and can be maintained and scaled up to meet the health needs of the population.
What does this mean for Nigeria?
For Nigeria, this huge commitment will require the allocation of more of its national budget to immunisation programmes. Despite the Abuja declaration in 2001, which committed to allocating at least 15% of the annual budget to healthcare, Nigeria's expenditure on health has remained very low. Therefore, meeting this commitment will require prioritising health in national, state and more recently the local government budgets.
While increased allocation is great, disbursement should also be prioritised. Nigeria may need to implement policy changes to ensure that immunisation is adequately funded and that funds are fully disbursed as and when due.
If the Abuja Declaration revealed anything, it is that meeting such commitments is not always an easy journey. However, although, the country does not have 23 years to achieve "drop by drop progress", Nigeria may need to develop new partnerships with private sector entities, civil society organisations, and other stakeholders to mobilise resources and support for immunisation programmes. In order to more domestic resources, especially from state health budgets. Developing strategies to ensure that all areas including procurement, cold chain storage and immunisation campaigns are all sustainably financed.
Nigeria currently faces a funding gap of $430 million, with Gavi, UNICEF and other international donors contributing $230 million toward the total cost. Given that Gavi, UNICEF and the Bill & Melinda Gates Foundation are also addressing other global health challenges, the question arises: where will Nigeria find the remaining $200 million?
This question raises concerns, especially when the highest federal budget allocation to health was a mere 5.95% in 2012 and has dropped in the subsequent years, falling short of the pledged target of at least 15% of the annual budget to healthcare . Even worse, despite significant increased budget allocation for immunisation in the past two years, there was no record of expenditure or release in 2023.
The legislative's role in boosting domestic financing
All hope may not be lost yet. Recent development efforts are being made to secure a dedicated funding stream for immunisation in Nigeria, with the federal government initiating the process of establishing a specific budget line item for immunisations under the Service Wide Vote, managed by the Federal Ministry of Budget and National Planning.
This fund will be allocated to NPHCDA and will aim to increase annually to meet co-financing obligations for vaccine procurement, ensuring reliable and timely funding for vaccines and immunisation programmes.
During economic crises, a country's legislature can play a crucial role in resolving issues through targeted legislation. One effective measure could be to mandate that the public sector achieves self-sufficiency in production, storage, and distribution logistics. This approach not only strengthens the economy but also ensures a more stable supply chain during challenging times.
However, to further prioritise vaccine financing, it is important for the legislature to pass legislation making vaccine financing a first-line charge item in the budget to ensure consistent and predictable funding; conduct regular oversight and monitoring of vaccine financing to ensure transparency and accountability, while working with the Executive arm of government to ensure alignment and effective implementation of vaccine financing plans.
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Vaccine manufacturing and Nigeria's future.
Nigeria is at a critical juncture in its immunisation efforts, as it prepares to transaction from Gavi's support by 2028. It is, therefore, imperative to develop a comprehensive strategy to mobilise domestic resources and sustain routine immunisation programmes. With the transition process already underway, Nigeria has entered the accelerated phase, comprising four stages, which demands a robust plan to ensure a seamless shift towards self-sufficiency.
Nigeria's Presidential Initiative on Unlocking Healthcare Value Chains (PVAC), which encourages private sector participation in the country's vaccine and medical product industry, may be a significant factor in leveraging African Vaccine Manufacturing Accelerator (AVMA) funds -- a financing instrument that will make up to accelerate the expansion of commercially viable vaccine manufacturing in Africa. The initiative can also assist in market shaping to assure sustainable local and international demands.
Investing in vaccine production, distribution, and delivery should be the top priority for the Nigerian government to guarantee pandemic readiness and universal health coverage.
Regulatory frameworks, health systems, supply chain management, and sustainable funding methods must be prioritised in place of aid dependence, particularly in situations where local production of countermeasures is practical. A more equitable future for Africa awaits those who can make the decisions necessary to transition to self- while Nigeria covers 200M.
