No child should die from any vaccine-preventable disease, especially when the cost is much lower than the cost of treating a sick child or fighting an outbreak. ADETOLA BADEMOSI, in the first edition of this two-part report, writes on how children miss out on important vaccines and the irregularities between public and private hospitals routine immunisation schedules.

AT nine months, Moyinoluwa James contracted the chickenpox virus. The infection had caused itchy rashes with small, fluid-filled blisters that disfigured her entire skin. It started with a slight fever that made her restless and irritated. In about 48 hours, rashes had formed on her face, spreading quickly to other parts of the body.

“It was a sordid experience,” says Mrs Anike James, Moyinoluwa’s mother. Considering her tender age, Moyinoluwa would often cry helplessly, rubbing her tiny hands over her body in an attempt to scratch the blisters. The situation worsened due to erratic power supply, in a densely packed one-bedroom apartment, in one of Nigeria’s populated cities: Abuja.

With eyes filled with tears, her mother wished she could fight off the virus that had befallen her daughter. This was five years ago. Moyinoluwa has healed, but sadly, she still bears obvious dark marks in some parts of her body.

“She had chickenpox before her due time to take the vaccine,” says Mrs. Anike James. “In fact, if you look at her closely, you will see some of the marks. As she is growing, the marks are fading,” she pointed out with a smile.

Ironically, Mrs. James currently lives with a disability caused by poliomyelitis (polio). She became paralysed, not because her parents did not get her immunised against the virus, but because children who had reportedly received the vaccine at the period were given expired shots.

“When I grew up, I questioned my mum why she chose not to get me particularly vaccinated against polio among her five other children, but she said she did! And even showed me my card. I later found out through an investigation I carried out with some friends that the polio vaccine given to children at the time had expired,” she told Nigerian Tribune.

Globally, early childhood vaccines are made compulsory for children/infants to help protect them against preventable diseases. Infants from birth are introduced to a national immunisation schedule which varies by country. Some of these key vaccines are Bacillus Calmette–Guérin(BCG), OPV (polio), Hepatitis A and B, Measles, Diptheria, Tetanus Toxoids and Pertussis (DPT), Pneumococcal, Meningitis, Penta, among others. These vaccines have undoubtedly helped prevent life-threatening ailments that may affect children’s health in later years.

The World Health Organisation (WHO) 2020 fact sheet on immunisation coverage says vaccination currently prevents two-three million deaths annually. But despite the numerous benefits, some children in Nigeria are losing out on important routine vaccines due to poor functional vaccination system, high cost and parents’ ignorance.

In Nigeria, for instance, it is widely believed that about 18 northern states are performing poorly in terms of immunisation coverage, with those in the south doing better with a great margin. But a brief on the National Immunisation Coverage Indicators (NICI) 2016/2017 states that only one in four children received all recommended vaccines.

It says more children are fully immunised in the South-South, South-West and South-East zones, but noted that lack of awareness was the main reason children are not fully vaccinated.

However, investigations carried out in the North-Central and South-West, for instance, revealed that some important vaccines are left out of the national immunisation schedule either deliberately or otherwise, leaving parents with the belief that their children or wards have been fully vaccinated. This is peculiar with public health institutions across the places visited.

In other cases, parents who lack the financial resources coupled with the challenge of a proper monitoring system will ensure children are compulsorily vaccinated.

The public healthcare centres do not entirely specify all required vaccines in the immunisation cards given to parents. This was later discovered to be due to the costs of vaccines, which the government does not subsidise. Examples of these vaccines are rotavirus, chickenpox, hepatitis A, MMR, cholera, and typhoid.

In the case of Mrs. James, Moyinoluwa’s mother, she said as of 2017, she was asked to pay for chickenpox, measles, mumps and rubella (MMR) and pneumococcal vaccines.

“I paid for MMR, chickenpox and even pneumococcal. During postnatal, they will tell you these vaccines are not compulsory but are necessary, in the sense that if you don’t have them, it’s nobody’s business, but they are necessary. If you need it, then you pay for it,” Mrs. James explains.

Another parent, Mrs. Oluwatoyin Igbinlola, expressed dismay after telling her four-year-old child might have skipped some vaccines. “That is not possible,” she exclaimed. “I can show you his card. He got all the vaccines except for this (pointing at the omitted rotavirus section).” A check at the child’s immunisation card showed he had taken other vaccines except for rotavirus. MMR, chickenpox, among others, were not included in the card.

Also, Mrs. Faith Oloyede, a Lagos State resident, had strongly argued her daughter was fully vaccinated. She thought that any vaccine not administered to her child was probably not necessary or important.

“Maybe they are not important because I don’t see why the hospital will not include it in the card if they are so important. They told me her immunisation was complete, but they did not give us this rota and I didn’t ask why,” she complained.

The reporter met with at least five other mothers who had similar experiences.

Copies of immunisation hand-cards gotten from both private and public hospitals revealed notable differences. For instance, a comparison between the immunisation schedule cards obtained from private hospitals within the Federal Capital Territory (FCT) and Lagos State showed that compared with public hospitals, the child vaccines schedule is listed to include: rotavirus, MMR, chickenpox, typhoid fever, hepatitis A, pneumococcal conjugate (IV) and cholera were included.

But for public health care providers, the schedule only includes BCG, hepatitis B, oral polio1-3, pneumococcal conjugate (PCV) 1-3, Penta 1-3, injectable polio vaccine (IPV), measles1 and 2, yellow fever and meningitis.

Health practitioners share diverse views

To further authenticate these findings, over 10 public and private hospitals were visited in the Federal Capital Territory (FCT), Abuja and Lagos state.

The reporter visited hospitals in six local government areas (LGAs) in Lagos State, Nigeria’s largest and most populous city with a landmass of 999.6 km,

At the Ifako-Ijaiye LGA, Primary Healthcare Centre, College Road, Lagos, the nurse in charge of immunisation whose name was displayed on her (Identity withheld) spoke on why vaccines such as hepatitis A, chickenpox, MMR, PCV (IV) were not given. She said such vaccines were not necessary.

She argued that they are only listed in cards given in private hospitals to swindle parents. “The child does not need rotavirus, chickenpox, MMR and others that you mentioned. These vaccines are listed in the immunisation cards given in private hospitals to obtain money,” She disclosed.

She explained that the pentavalent injection, which comes in four doses, is a five-in-one vaccine. As a result, apart from DTP, chickenpox and Hepatitis are included in the Penta vaccine.

“This means that the child has collected four times. Penta is five in one, in the injection, chickenpox is also included, diphtheria is included, tetanus is included,” she noted.

The nurse who seemingly found the enquiries hilarious not only noted that there is no known vaccine for typhoid, she also claimed pharmaceutical companies no longer produce the rotavirus vaccines.

Also, at the Ifako-Ijaiye General Hospital, the nurse on duty, who was administering vaccines to children at the time of visit, outrightly told this reporter that the set of vaccines in question were not available.

Later, the nurse, identified as Mrs. Salawu, further stressed that such vaccines were not given as they are not included in the schedule. “We don’t have chickenpox and MMR. Government hospitals don’t give because it is not in the schedule, except you go to private hospitals,” she said.

“We are cautious in suggesting such vaccines to parents that do not know because this is a rural area,” said Mrs. Eunice Adepoju, another nurse at Ikola Primary Health Centre, Agbado Oke-Odo LCDA, Alimosho Local Government Area of Lagos. “Most of these parents will come to you and ask if you could help them buy and we did that before but not again.”

According to her, the shots were as important as others but asking parents to pay for them generated serious controversies in the past, hence the need to stop suggesting such.

While stressing the importance of these vaccines, she, however, noted: “I cannot go about preaching to parents on the importance of these vaccines. What a qualified nurse will only say is that they have not introduced these into their schedule. Once they do, we will start administering them.”

Similarly, an unidentified nurse at the Baruwa PHC, Ayobo, Ipaja, Lagos, said these vaccines are not given in any government hospital as they are not necessary.

While stressing that the chickenpox virus has been eradicated, there was no need to administer the shot on children. She said giving a child the Hepatitis A vaccine was also not necessary.

“As time goes on, even the polio vaccine will no longer be administered to children once it has been eradicated,” she stressed.

“We don’t give MMR, and all these are no more existing. Once a child is given measles 2 vaccination and booster, it is okay. Private hospitals are only using it to swindle parents,” she said.

What about the Hepatitis A vaccine? The reporter queried. “They are not necessary!” The nurse answered. “Like Hepatitis A vaccine, you will only find these in private hospitals; we don’t give it because it is not necessary,” she added.

“There is nothing like chickenpox again, for the MMR, it has been included in the Penta vaccine – don’t mind the card. You follow whatever is stated in the card. Don’t stress yourself; the Measles II has replaced MMR,” another nurse at the Alausa Health Centre alluded.

Also, at the Ikeja Primary Health Centre, the nurses on duty explained that such vaccines were not administered in government hospitals. Children are considered okay once they get the measles and yellow fever vaccine.

The officer-in-charge (OIC), whose identity could not be ascertained at the time of visit, said against beliefs, the set of vaccines was as important as others but for the cost.

“As a parent, if you feel you can afford to get it for your child, please do. I will advise you to get them for your children. I also got them for my children,” she reiterated.

Nigeria’s largest slum lacks  functional health care facility

At Makoko community, Yaba, Lagos, the case is slightly different. As of the time of visit, there was no functional Primary Health Centre. Residents disclosed that the newly-built health facility was yet to be commissioned.

However, Mrs. Julianah Okimiji expressed disappointment that there were vaccines for diarrhoea, vomiting or cholera in children.

Makoko is recognised as Nigeria’s largest slum, where thousands of people reside on water. They lack basic amenities, sanitation facilities and often time access to drinkable water is a great challenge. As such, residents, including children, are susceptible to infections.

“When they are teething normally, they experience vomiting and stooling. I don’t know there is a vaccine that works against that one. If not that you are saying it now. When such a thing happens, the normal thing I do is to use a measurement of salt and water in clean water and give the child,” Mrs. Okimiji said.

Another resident, Mrs. Omolola Omole, a mother of two, said. However, not everyone can afford to pay such huge amounts on the vaccine; parents should be given opportunity to make their decisions.

“Although I am not happy that my child skipped these vaccines, we, the poor masses, not all of us, can afford to pay that huge amount to get these vaccines. They are supposed to be in public hospitals and if at all they are not available, they should indicate and advise us to get them,” she stated.

Mrs. Abigail Jackson, a caregiver, said in her submission that the government could not be totally blamed for not including these vaccines in the cards as Nigerians, in her words, “like free things a lot. Everything is not free, but then knowledge is power.”

In her opinion, she said both free and non-free vaccines should rather be listed out for parents to decide.

“They should tell us this is free and this is to be paid for, but they don’t tell. What will be beneficial to a child’s health, they won’t say. There are lots of children here in Makoko with cases of diarrhoea even vomiting. You will even pity their parents,” noted Mrs. Jackson.

Meanwhile, at the Federal Capital Territory (FCT), most public hospitals visited do not give vaccine shots beyond nine months.

At the Lugbe PHC, under the Abuja Municipal Area Council (AMAC), the nurses on duty said apart from those stated in the cards, they do not give the ones being enquired about.

Despite being listed in the vaccination cards, the rotavirus vaccine is not administered to children. This is not, however, peculiar to FCT alone but to other hospitals visited in Lagos.

Fatima Yahaya, a mother, enquired about the rationale for their decision, but the woman (nurse) she met on duty just told her, “they don’t have it.”

Unlike Mrs. Yahaya, Evelyn Kadiri, a mother of two, was not financially privileged to get her children immunized for the “non-free” vaccines at the National Hospital, Abuja.

She watched in obvious confusion as a nurse, after administering her son’s ninth-month vaccines, told her:”…Madam, you come prepared from one year.”

Apparently, vaccines taken beyond nine months in this hospital are paid for.

Government hospitals like Gwarinpa, Federal Medical Centre, Jabi, Kuchingoro Primary Health Centre, Airport road, among other hospitals, had similar responses to every enquiry on these vaccines.

This report was done with the support of Wits Journalism and the African Investigative Journalism Conference.