Nigeria’s COVID-19 vaccination campaign is not a competition and there are no prizes for the state that successfully vaccinates all of its eligible population first, but the fact that Nasarawa State has vaccinated over 70% of its eligible population, putting it ahead of all but one of its neighbouring states, is a commendable feat.
In 2021, Nigeria set a target to achieve 70% coverage for COVID-19 vaccines by the end of 2022, but data from the National Primary Health Care Development Agency (NPHCDA) revealed that as of 1 June, 2022, 24.1% and 16.9% of Nigeria’s eligible population had been partially and fully vaccinated against COVID-19, respectively. The country is behind schedule and must intensify efforts if this goal must be met by the end of the year.
How it all began
In February 2022, the NPHCDA revealed that Nasarawa State topped the list of five best performing states in the COVID-19 vaccination campaign. As of 27 February, at least four in every 10 eligible persons in the state had been fully vaccinated. To achieve this feat, Nasarawa leveraged on learnings from past vaccination campaigns, clearly employing an old strategy to a new public health issue.
The state adopted the target set by the NPHCDA to vaccinate 50%, 70%, and 100% of its population by March, June and December 2022. They hit the 70% mark in February — ahead of schedule — and by 31 May, 2022, had fully vaccinated 1,444,272 and partially vaccinated 1,322,013 of its estimated 2,523,400 population.
According to Mr Ayuba Ismaila Oko, project manager, State Emergency Routine Immunisation Coordination Centre and the Deputy Director, Routine Immunisation Unit, “the Executive Secretary of the state set up a committee to develop the strategy that helped increase the number of vaccinated persons in the state”. The committee was made up of officials of the NPHCDA, health officers from all 13 Local Government Areas (LGA) in the state and selected officers from some Primary Health Centers (PHC). Leaders of Civil Society Organisations (CSOs), government agencies, including the State Security Service, private organisations and various other stakeholders were also part of the committee.
The state launched its Mass Vaccination Campaign in November 2021 with a public education campaign to increase public confidence in and uptake of COVID-19 vaccines. Information, Education and Communication (IEC) materials were distributed statewide, and jingles were produced in English and translated into the seven local languages. To ensure that the campaign reached every corner of the state, purposeful effort was made to reach members of communities and associations through their leaders. Rallies during which comedians used local languages to create awareness were organised across each LGA, at motor parks, markets, health facilities, shopping malls, markets, and schools.
Dr Stephen Iliya Sasetu, Director Planning, Research and Statistics Nasarawa State Primary Health Care Development Agency revealed that members of the committee also “met with Fulani leaders, market leaders, leaders of drivers and motorcycle riders’ associations, and various other traditional and group leaders. After the visits, a lot of them got vaccinated and then with evidence to show, they helped to mobilise their people”. He added that the campaign achieved a heightened awareness of the importance of the COVID-19 vaccination which translated into behavioural change as, without being pushed, community dwellers now visit facilities to receive the COVID-19 vaccine.
For the next phase of the vaccination campaign, teams made up of vaccinators, recorders, and mobilisers were assembled, trained and sent out to communities. The communications campaign had paved the way for them, and so they went to areas where the rallies had mobilised people, as well as other public areas where people were most likely to converge, including public health facilities, designated private facilities, the state secretariat, among others. There, they sensitised and vaccinated people simultaneously.
Umra Abdulahi Aliu, a recorder with the vaccination team at Bukan Sidi Primary Health centre said they also took advantage of seasonal gatherings, “During Joint Admissions and Matriculations Board (JAMB) exam registration and other such registration exercises, people are asked if they have gotten vaccination and if not, they are encouraged to get vaccinated at the nearest centre.”
To stay up to date with the campaign, virtual meetings were organised every day, where all the teams met to debrief, trouble shoot on any issues encountered and share key information on next steps of action. The state health secretary, some NPHCDA staff and LGA team leads were always present at the meetings.
Motivating the frontline workers
Health workers were a great asset to the exercise. Besides their direct involvement in the campaign, they were also among the first set of people to get vaccinated and therefore convinced people to get vaccinated by sharing their own experiences. The state in turn motivated the health workers by paying them a fee for their services. “This is a proven strategy in the moment of emergency, team members who meet up their targets were rewarded more,” said Dr Sasetu.
There were concerns about the state’s ability to sustain the extra payment being made to health workers. But Oko thinks it must be sustained because “you don’t just sit and expect people to mobilise, there has to be a good reward system”. He revealed that the state recently got approval for a fund from UNICEF to help ensure that the practice is sustained.
According to Ms Eunice Damisa, Director of Advocacy and Communication, NPHCDA, vaccine availability and accessibility used to be a major issue, “but this has been resolved because the country now has enough vaccines in stock and the logistics and supply chain system have been strengthened more.” Misinformation about COVID-19 and the COVID-19 vaccine hesitancy was an issue but this is being tackled with the ongoing communications campaign which will continue to run as long as the COVID-19 vaccine campaign is a priority.
Oko said that a man was reported to have been selling COVID-19 vaccine cards to people who had not been vaccinated. The committee involved the Department of State Services (DSS) and other security bodies in the state. “Because there was an accountability framework and involvement of security groups, the culprit was punished accordingly,” he said.
In a chart outlining African countries and the percentage of fully vaccinated populations per country, Nigeria ranks 42nd having fully vaccinated only 6% of her eligible population.
Although the numbers vary by state, ranging from over 3 million fully vaccinated in Kano to over 26,000 in Bayelsa, it is encouraging to see that every state in Nigeria is committed to ensuring that its citizens receive the COVID-19 vaccine. However, all states — particularly those with the lowest numbers — must heighten efforts to increase their numbers.
Long dependent on wealthy nations for its vaccine supplies, Nigeria is building its own vaccine manufacturing capacity as revealed by President Buhari in January 2022. COVID-19 vaccine inequity, one of the fallouts of the pandemic, has shown that countries will take care of their people first and Africa needs to be able to do the same. Great strides will be made into ensuring that Nigeria fully vaccinates most of her population if the nation is able to push from both fronts — continue to leverage on lessons learned from polio and other immunisation campaigns to increase coverage, as well as ensure vaccine availability.