When Okorie Nneoma, a mother of three, first heard about a vaccination outreach near her community in Nsukka, Enugu, she initially hesitated. She, like many mothers in her village, had reservations about vaccinations and their relevance, fueled by years of misinformation, and cultural and religious beliefs. "I was scared about vaccines because I heard bad things about it. I didn't know it was to protect my kids' [health]," she explained.
Nneoma, along with many others, was invited to attend the session which promised to provide accurate, reliable information about vaccinations and the Expanded Programme on Immunisation (EPI) schedule. Nneoma, unsure but curious, chose to attend, driven by mixed concern for her daughter's well-being.
At the event, Nneoma was greeted by healthcare workers who didn't just lecture her but took the time to listen to the mothers' concerns. They responded to their questions, dispelled myths, and addressed their concerns individually.
By the end of the session, she understood that the vaccines could protect her children from life-threatening diseases like measles, hepatitis, and tuberculosis. Encouraged, she enrolled her child in the immunisation program and received a vaccination schedule to follow. "The nurses collected our numbers and called to remind us of the next vaccination date. If we miss it, they followed up to find out why," Nneoma explained.
Limited information continues to be a barrier to vaccine coverage
Vaccines and immunisations play a key role in the primary prevention of infectious diseases, providing a safe and cost-effective defence, especially for infants and young children. However, children across sub-Saharan Africa bear the brunt of vaccine hesitancy stemming from parent's mistrust in the vaccination process.
Despite significant progress in reducing under-five deaths from 12.6 million in 1990 to 5.3 million in 2018 -- thanks to the introduction of the EPI schedule -- the region still accounts for 58% of all under-five deaths worldwide, with one in every 14 children dying from preventable infectious diseases that can be effectively addressed through immunisation.
Nneoma's account of her hesitancy to vaccines is only one of many stories that contribute to larger issues plaguing Nigeria's vaccine coverage. According to Dr Ephrem T. Lemango, UNICEF's Associate Director of Immunisation, parents would become hesitant if they don't have enough information on the benefits and side effects of vaccines, which requires engagement with health workers and someone explaining the importance of vaccines.
AfriVacx's presence in Nigeria's six geopolitical zones, aims to contribute to increased vaccine coverage among mothers and children. According to Bethel Okeke, the founder of AfriVacx, since the organisation's inception in October 2023, it has focused on maternal education and awareness and ensuring the complete vaccination of over 200 children.
A community pharmacy approach.
Identifying under-vaccinated and zero-dose children in rural and hard-to-reach areas, requires proactive community engagement and location-specific outreaches, that address underlying healthcare access and immunisation challenges.
Bethel Okeke noted some key initiatives undertaken by the NGO including expanding vaccine access, promoting public awareness and education, optimising vaccine supply chain management, and partnership with focal person in the community.
Pharmacy Model
AfriVacx also makes strategic use of the broad presence of community pharmacies, locally referred to as 'Chemists', in rural areas, recognising their role as an immediate healthcare resource, readily accessible to residents. "Establishing vaccination points in pharmacy outlets increases convenience for people to receive their vaccines, which ultimately helps improve vaccination rates and protects the population from preventable diseases," Bethel explained.
He went on to say that Nigeria has over 1,000 healthcare centres, "but many of them aren't very functional. Most pharmacies, which are usually the first point of call for patients are always open. If we can mitigate this gap by forming strategic partnerships across these community pharmacy outlets, then vaccination will be at the doorstep of everyone."
Bethel believes that local pharmacists can play a crucial role in enhancing vaccine coverage. As trustworthy healthcare professionals, especially in rural areas, they can provide not only vaccinations, but also critical information and education about vaccine safety and efficacy. According to studies, around one-third of parents who initially refuse vaccines change their minds after receiving proper education.
Midwives as vaccine agents
AfriVacx recognises midwives' importance in advising expectant parents about childhood immunisation and invests in education and training for future healthcare professionals. "Nurses and midwives are the first point of contact for pregnant women and young mother," Nnamdi Okoli, AfriVacx's Northwest Zone Director noted, "and their knowledge is crucial to dispelling the strong misconceptions these women have about vaccination.
Their commitment to educating nurses and midwives was evident during the recent Vaccine Seminar at Hill College of Nursing and Midwifery, Jos, Plateau State, where over 70 final-year nursing students received in-depth training on vaccination protocols, public health importance, and effective administration practices.
Gladwin Pat-Enike, a critical care nurse manager at Zenith Medical and Kidney Centre, noted that, "in an ideal system, when administering vaccines, we should educate and talk to patients in details about the medications, how they would feel after taking it and what it does. If we do more around awareness, we might be able to tackle vaccine hesitancy amongst these women and have more children completing their doses."
Looking ahead: A future free from Zero-Dose children
AfriVacx's innovative and community-centred approach has reached over 5,000 women across Nigeria, according to Bethel. He explained that through a variety of initiatives, and by meeting people where they are -- whether in a community health centre, a pharmacy, or an IDP camp -- the organisation is addressing the challenge of reducing the number of zero-dose and combating vaccine hesitancy in Nigeria.
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Despite progress, significant obstacles hinder the attainment of these objectives, notably the limited educational attainment of many of the women, which limits their understanding of essential health practices, including the benefits of vaccination and effective childcare. "Many of these women start but don't complete their immunisation dosage and it's always an issue to get them to complete it but we have seen a 65% increase in these women coming back," Chioma, a nurse at New Haven Healthcare Centre explained.
Research also reveals a strong relationship between parental education level and immunisation skeptism. Notably, parents with lower educational attainment and socioeconomic status showed greater hesitancy towards vaccination, even when educated about the benefits.
Another challenge that interpreters need to address, is the communication barriers that exist due to language differences. To bridge this gap, health workers who are fluent in the communities' local languages are receiving training ensuring more effective engagement with the community.
For mothers like Nneoma, the difference is clear. "Before, I was afraid of vaccines but now I know they will protect my children and I tell my neighbours to take their children too," she noted.
