As part of the comprehensive strategy to Eliminate Yellow Fever Epidemics (EYE) by 2026, more than 25 million Nigerians will be protected in different parts of country in 2018 and the immunization efforts will continue over the following years.
Nigeria is conducting its largest ever yellow fever mass campaign which is steered by WHO, Gavi, and UNICEF.
The vaccination campaign is in response to the yellow fever cases reported in Nigeria since September 2017, when the first case was confirmed in Kwara State. Since then, 41 cases have been confirmed in 7 states, and more than 1700 suspected cases have been reported from all states of the country.
However, in Borno State, where millions of people are in need of humanitarian assistance, no case of yellow fever has been confirmed so far; but the presumptive positive case of the disease (which was not confirmed) highlighted the importance of protecting the highly vulnerable population against yellow fever in this extremely fragile area.
Since the humanitarian crisis unfolded in northeast Nigeria and the rise of Boko Haram in the region depriving people of their lives, including their right to health, Borno has been one of the most affected areas.
With the partial or complete destruction of more than two-thirds of health facilities in the state, remaining functional health infrastructure is limited to respond to the healthcare needs of the population, including outbreak response.
Hence, in February 2018, health authorities in Borno, in collaboration with WHO and partners, preventively vaccinated more than 2 million people in internally displaced people (IDPs) camps and surrounding host communities.
The reach of the health service delivery established for yellow fever vaccination in the IDPs can serve as a backbone for delivery of other vaccines and indeed more diverse health services and strengthen the routine immunization delivery system.
According to Dr Wondimagegnehu Alemu, WHO Nigeria Representative, “vaccinating internally displaced people in Borno state is crucial because protecting vulnerable populations living in high-risk conditions will prevent the spread of yellow fever if an outbreak occurs.”
He added that, conducting a mass vaccination campaign during an ongoing humanitarian crisis, when reaching people is difficult, but also dangerous, presents several challenges. For this reason, Nigeria has chosen a tailored approach, which takes into account the accessibility component, to protect population in Borno.
Meanwhile, Dr Jorge Castilla, Senior Emergency Officer, at WHO, in Geneva said the main difficulties regarding the implementation of vaccination campaigns in humanitarian settings are related to the limitation of access to people in need of assistance.
His words: ” Within the EYE Strategy framework, the prioritization of areas that will implement vaccination campaigns take into account, among other things, immunization coverage, levels of risk, and population vulnerability, as these factors directly affect the ability of communities and health systems to detect, confirm, and respond to yellow fever epidemics in a timely manner.
“In the conflict-affected area, vaccination has to add the dimension of access and feasibility, and when a window opens that allows vaccinating a low coverage area, that window of opportunity must be taken whenever it is possible”, Dr Castilla said.
Similarly, the Borno state Health Commissioner, Dr Haruna Mshelia said population mobility and accessibility to health facilities is also crucial to ensure a successful immunization campaign.
According to him, the availability of polio infrastructure made planning and implementation a lot more feasible. “The existence of polio infrastructure, health personnel and expertise with years of experience in vaccination campaigns enabled the rapid development of strategic plans, definition, and prioritization of most-at-risk populations based on available micro plans, implementation, and monitoring using a standard checklist to ensure a high-quality campaign.”