By Uwais Abbubakar Idris
Paradigm News International, having closely followed the evolution of Africa’s health systems — particularly the Africa Centres for Disease Control and Prevention (Africa CDC) — brings you this exclusive development report. Over the years, Africa CDC has demonstrated exceptional leadership in public health response, performance monitoring, and resource mobilization, notably during the COVID-19 pandemic, where it played a pivotal role in coordination, prevention, and driving up vaccination rates across the continent.
In this exclusive report, Paradigm News International presents new insights into Africa CDC’s strategic initiatives, partnerships, and its growing influence in strengthening health security architecture across Africa.
Nigeria has struggled for many years to attain sufficient coverage of routine immunisation (RI), a problem worsened by the coronavirus, otherwise known as the COVID‐19 pandemic. The difficulties affecting RI include inefficient supply chains, subpar service provision, insufficient human capital, low demand as a result of unfavourable opinions, cultural and religious influences, disparities in finances, problems with accountability, inadequate governance, and low‐quality data.
The Multiple Indicator Cluster Survey (MICS) shows that immunisation coverage in Nigeria is below the Global Vaccine Action Plan (GVAP) goals. The situation is putting a substantial number of children at risk of vaccine-preventable diseases, with about 1 in 10 children in Nigeria dying before their 5th birthday.
Findings of the 2021 Nigeria Multiple Indicator Cluster Survey (MICS) & National Immunization Coverage Survey (NICS) carried out by the NBS as part of the global MICS program, show that the infant mortality rate is 63 deaths per 1,000 live births for the 5 years preceding the survey, while the under-5 mortality rate (U5MR) for the same period is 102 deaths per 1,000 live births.
Before the COVID-19 vaccine arrived in Nigeria, the country had reported a significant number of COVID-19 cases and deaths. As of March 28, 2021, Nigeria had cumulatively established 162,593 cases of COVID-19, ranking 5th among the most affected countries in Africa and 77th globally. The cumulative deaths reported in Nigeria were 2,048. The government and health authorities were working to contain the spread of the virus through various interventions.
COVID-19 vaccination in Nigeria started in March 2021, intending to vaccinate 40% and 70% of the population by the end of 2021 and 2022, respectively. However, the country faced challenges in achieving these targets. As of September 21, 2022, only 15% of the eligible population had been fully vaccinated, with over 31 million people vaccinated. By March 2023, Nigeria had administered over 111 million vaccine doses, with a range of ~40-59 total doses administered per 100 people. A national survey conducted in 2022 found that only 32.8% of respondents had been vaccinated against COVID-19, with higher vaccination uptake in urban areas (34.4%) compared to rural areas (30.9%).
The survey also revealed that older adults, public servants, and those who obtained vaccine information from health workers, government, and mass media were more likely to be vaccinated.
Nigeria’s COVID-19 vaccination efforts before the Africa CDC and Mastercard Saving Lives and Livelihoods (SLL) program intervention faced significant challenges. The country had set ambitious targets to vaccinate 40% of its population by the end of 2021 and 70% by the end of 2022, which translates to approximately 111.8 million people.
However, the initial supply of vaccines received through the COVAX facility in March 2021 was suboptimal, limiting the quantity available to meet demand. As of June 2021, only 3% of the eligible population had received at least one dose of the vaccine. By September 2021, around 5.8 million people had received the first dose, while 3.1 million had been fully vaccinated.
The vaccination efforts were hindered by challenges such as limited funding, inadequate vaccine supply, poor cold-chain management, government distrust, and communication failures. Vaccine hesitancy was also a significant issue, driven by concerns about vaccine safety, potential reactions, and limited knowledge about COVID-19.
Despite these challenges, Nigeria made progress. By September 2022, more than 31 million people had been fully vaccinated, accounting for around 15% of the entire population. Additionally, by April 2022, 17.3% of the eligible population had received at least one dose of the vaccine, while 11.5% had received two doses.
Through the Saving Lives and Livelihoods (SLL) program, the Africa Centres for Disease Control and Prevention (Africa CDC) partnered with the United Nations Children’s Fund (UNICEF) to strengthen immunisation systems in Nigeria.
According to Dr Shaikh Kabir, UNICEF Health Manager for Immunisations/Vaccine Management & Logistics, the program aims to improve vaccine availability and accessibility across the country. Kabir said the SLL program focuses on rehabilitating and strengthening Nigeria’s immunisation supply chain by equipping health facilities with energy-efficient equipment, such as solar direct drive refrigerators and freezers.
He noted that this is crucial, as many health facilities in Nigeria struggle with grid electricity connections, making alternative energy solutions essential for vaccine storage. The program also includes the distribution of vaccine carriers and temperature monitoring devices to ensure vaccines are stored and transported safely.
In addition to improving infrastructure, the SLL program includes capacity building for healthcare workers. Over 300 staff members in 40 vaccine stores received training on vaccine management and logistics to enhance their skills. This training enabled them to effectively manage vaccine warehouses and ensure that vaccines are properly stored and distributed.
Kabir disclosed that the entire 8 million children will benefit through 40 vaccine store capacity building and distribution of vaccines to all 37 states. The SLL program is being implemented in two phases, with the first phase focusing on rehabilitating and expanding cold chain equipment and improving waste management efficiency in selected states. The second phase, set to be completed by 2025, will focus on decommissioning obsolete equipment and enhancing logistics support for vaccine delivery across all 37 states.
Also, the Sydani Group Project Officer, Dr Al-Mustapha Muktar, said the efforts to strengthen Nigeria’s health system through the integration of life-course vaccines into routine immunisation were successfully implemented across 10 states, adding that activities were centred on capacity building and service delivery.
The project, which was part of the Saving Lives and Livelihoods (SLL) Phase 2 initiative, aimed to protect healthcare workers, strengthen pandemic preparedness, and integrate life-course vaccines into routine immunisation. Through the project, over 107,710 individuals were reached with vaccination outreach services, with 48% receiving adult vaccinations. Additionally, about 1,400 health workers received formal training opportunities.
The project successfully strengthened health systems and improved vaccine access and uptake in Nigeria, ultimately contributing to the country’s pandemic preparedness and response efforts. With the support of the Africa CDC and other partners, the project team made a lasting impact on the health and well-being of Nigerians.
The National Primary Health Care Development Agency (NPHCDA) Saving Lives and Livelihoods (SLL) program Health Expert, Dr Adejoke Oladele, explained that the program has made significant progress in improving COVID-19 vaccination efforts in Nigeria.
Oladele said that although the program faced challenges, effective strategies have been implemented to address vaccine hesitancy and improve uptake. To build trust and confidence in the COVID-19 vaccine, NPHCDA implemented several strategies, including regular media briefings, social media campaigns, and community outreach programs.
The NPHCDA also engaged traditional leaders, religious leaders, and professional groups to disseminate information and address concerns. The program’s efforts have helped improve vaccine uptake, particularly when health workers are empowered to communicate effectively with the community.
The APIN Principal Investigator and Country Scientist for the Pharmacovigilance Project, Dr Segun Showande, said the project has made significant progress, including establishing PV committees and conducting meetings. He highlighted the collaboration between academia and policymakers, which enhanced health security and promoted real-time policy translation.
NAFDAC Deputy Director, Pharmacovigilance Office, Dr Kalat Musa, described the structure of adverse event reporting and emphasised the importance of collaboration and community engagement in pharmacovigilance. He said the agency has seen an increase in reporting due to awareness efforts and engagement with media and healthcare workers.
Dr Mannir Jega, Director of Program and Operations, Nigeria Red Cross Society, reflected on their experience with the Africa CDC SLL project, underscoring the importance of clear communication, coordination, and engagement with both government and community.
Dr Olawunmi Adeoye, AFENET SLL Project Coordinator, noted that AFENET supported the training of health personnel across 10 states and 774 LGAs, vaccinating over 9 million people. Despite challenges, she described the program as a valuable and impactful experience.
Residents such as Ibrahim Mohammed Lawal and District Head of Karishi, Alhaji Ahmed Duka, testified to the success of the vaccination program, attributing it to trust, leadership, and effective community engagement.
Niger State Immunisation Officer, Abubakar Usman Kpantu, and Kogi State representative, Enoch Eghe, also shared success stories of how the SLL project improved outreach, training, logistics, and solar-powered vaccine storage, helping to sustain immunisation coverage even in hard-to-reach areas.
The SLL initiative has become a model for strengthening health systems and promoting vaccination in Nigeria, bridging gaps in access, communication, and capacity to achieve lasting public health impact.
