In a small, isolated fishing community in Eastern Obolo, Akwa Ibom State in Nigeria's south-south region, Ekong Asuquo, a resident of the community sits by the river, her eyes distant and heavy with grief. It has been a year since she lost two of her children to a measles outbreak that swept through their coastal village. "I remember their tiny bodies burning with fever," Asuquo explained.
There are no roads leading to Asuquo's village and the only way to reach the mainland is by boat. Asuquo said that by the time the outbreak reached her home, there was nothing she could do. " I still wonder, if we had vaccines here, will they [my children] still be with me?"
In many floating or semi-permanent settlements, there is a general lack of access. In most cases only canoes and boats are the method of transportation. This leaves children vulnerable, often suffering from a lack of basic healthcare infrastructure and services. "We were trapped, unable to get help in time" Asuquo noted.
Immunisation remains the cornerstone for preserving children's health. According to the Nigeria Strategy for Immunisation and PHC System Strengthening (NSIPSS), the country has 4.3 million unvaccinated children, the highest number in the world.
In a Multiple Indicator Cluster Survey (MICS) conducted in 2016/2017, 77% of children aged 12-23 months did not receive any vaccine at all. This highlights the need for governments and stakeholders to implement strategies to boost immunisation coverage and uptake. Efforts to make vaccination available to hard-to-reach communities are critical in leaving no one behind, as these areas often face significant barriers such as geographic isolation, limited healthcare infrastructure, and socio-economic challenges.
Recognising the urgent need to address the lack of access to vaccines in such communities, the Akwa Ibom State Primary Healthcare Development Agency (ASPHCDA) devised an innovative solution to ensure that no child is left behind by launching the Mid-Sea Vaccination programme.
The programme takes into consideration geographic access as a limitation to vaccine coverage and recognises that traditional healthcare service delivery methods will not be effective in providing this essential requirement. Hence, vaccine delivery is distributed through speedboats instead of waiting for the people to come to the mainlands to access these vaccines.
Mid-Sea Vaccination programme
Nigeria still remains the host to the second largest number of zero-dose children in the world, with millions of children having never received or facing formidable barriers to accessing essential healthcare services, including vaccines.
The state agency explored the strategy of using speed boats and equipping health workers with tools such as life jackets, enabling them to navigate the rivers safely to take vaccines to the coastal communities.
However, the strategy is not just about delivering vaccines, they also engaged the community members, educating them about the importance of immunisation, and ensuring that every child, no matter how remote their location is, has access to life-saving vaccines.
"When they told us the health workers were coming, I couldn't believe it," says Emem Udoh, a resident of Eastern Obolo LGA and a mother of three. "I have always worried about my children getting sick, especially with all the talk of diseases we don't even know about. But now with the vaccines, I feel like they are safe. It's one less thing to worry about."
According to Dr. Eno Attah, the Executive Secretary of ASPHCDA, the Mid-Sea Vaccination programme is aimed to support the coastal communities in strengthening Routine Immunisation structures and improving the immunisation outcomes in the state.
"Vaccinating children in mid-sea communities isn't just about protecting them from diseases; it's about making sure they aren't forgotten." she added. "
'For years we felt forgotten'
The success of this approach has broader implications. It highlights the importance of tailored healthcare solutions that consider the unique needs and lifestyles of different communities. For Akwa Ibom's riverine populations, the boat has become a symbol of hope -- a vessel that carries not just vaccines, but the promise of a healthier future.
"The boat coming to our village was like a miracle," says Chief Inyang Otu, a community leader in one of these riverine settlements. "For years we felt forgotten but now we know we are not alone. The children in our community can now be safe from diseases we thought we couldn't prevent."
For others, the initiative has brought a renewed sense of community and trust in the healthcare system. "We've seen the health workers come before, but this time it feels different," says Etebong Akpan, a fisherman in Eastern Obolo. "They made the effort to come all the way to us. It shows that they care. I made sure my children got their shots because I don't want them to suffer from diseases we can prevent."
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Misinformation poses a barrier
According to Antatica Ukoimam, the Health Promotion Officer in Eastern Obolo LGA, the process of delivering and administering vaccines to communities include more than just logistical difficulties. She noted that one of the challengs is "combating misinformation, which often discourages community members from trusting vaccines.
"It is sometime so bad that before we get there with the vaccines, misinformation has gotten there." However, the agency has strategically leveraged the influence of community leaders, traditional rulers, and key stakeholders to build trust within these communities.
Through this collaborative effort, they have been able to sensitise community members about the importance of vaccines and health programmes, ensuring that vital health services reach even the most isolated populations.
Ensuring that every child in Nigeria receives life-saving vaccines, regardless of where they live, is a mission that requires innovative thinking, collaboration, and exceptional commitment. By leveraging mobile vaccination boats, forming partnerships with local fishermen, empowering community health workers, and improving maritime infrastructure, healthcare agencies are breaking down barriers and bringing hope to coastal communities in Akwa Ibom.
