PT Health Watch: How Nigeria can reach zero-dose children, tackle vaccine-derived polio- Expert

Reaching every unvaccinated child and preventing the spread of circulating vaccine-derived poliovirus type 2 (cVDPV2) remains a persistent challenge for Nigeria’s health system.

Despite years of interventions, gaps in routine immunisation coverage persist, especially among “zero-dose” children who have never received a single vaccine.

According to the United Nations Children’s Fund (UNICEF), Nigeria currently has the world’s highest number of unvaccinated children. An estimated 2.1 million Nigerian children under the age of one, representing 24 per cent of the country’s 8.7 million under-one population, have not received any routine vaccines.

Speaking with PT Health Watch, Christiana Fashola, a global digital health and vaccine expert with experience across Africa, Central Asia, and Latin America, said Nigeria must evolve its immunisation strategy to close coverage gaps and protect more children from preventable diseases.

Lessons from other regions

Ms Fashola explained that the most effective immunisation strategies are context-specific, tailored to a country’s disease burden, health infrastructure, and target groups.

She said that while mass campaigns, routine outreach, and scheduled immunisation days have helped Nigeria expand coverage, these tools are no longer enough.

“There’s a growing need to expand beyond these traditional strategies by leveraging community-based service delivery models,” she said.

Globally, she noted that integrating community pharmacies and pharmacists into vaccine delivery has boosted access, particularly in hard-to-reach areas where they are often the first point of care.

She said their inclusion enhances accessibility and enables a life-course approach to vaccination, reaching not only children but also adolescents and adults.

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Ms Fashola also highlighted the importance of intersectoral collaboration across health, education, and social services, an approach that proved effective during the COVID-19 and HPV vaccine rollouts.

Local influencers, mobile teams, and community health workers, she added, remain essential to reaching underserved populations.

She said that trust-building through culturally sensitive communication must remain a pillar. “If people don’t trust the system, they won’t take the vaccines,” she said.

Why cVDPV2 is spreading

Recent outbreaks of cVDPV2 reveal systemic weaknesses in Nigeria’s vaccine distribution, especially in conflict-affected and remote areas.

Ms Fashola cited low coverage, poor sanitation, limited health personnel, and vaccine hesitancy as key factors fueling the virus’ spread.

One of the biggest challenges, she said, is the country’s inadequate health workforce.

“Nigeria’s health workforce density is critically low, with only 1.83 skilled health workers per 1,000 people, far below the WHO-recommended threshold of 4.45 per 1,000,” she said.

“To tackle this, there is a need to increase the health workforce through training and deploying more healthcare personnel, as well as utilising community health workers to strengthen local immunisation efforts.”

She added that poor water and sanitation infrastructure also play a major role in cVDPV2 transmission.

“Inadequate water, sanitation, and hygiene infrastructure further complicate the situation. Improving these conditions, alongside vaccination efforts, is crucial to reducing the transmission risk of the virus,” she noted.

Reaching zero-dose children

As the World Health Organisation (WHO) marks 50 years of the Expanded Programme on Immunisation (EPI), experts are reflecting on both progress and the gaps that remain. In Nigeria, many children, especially in the North, still miss out due to insecurity, limited access, and misinformation.

Ms Fashola acknowledged efforts such as mobile outreach to nomadic populations and the engagement of traditional leaders to identify zero-dose children, but said more must be done.

“There’s still a long way to go,” Ms Fashola said. “We need stronger data systems to track and reach these children, improved healthcare infrastructure, and prompt release of immunisation funds to sustain activities.”

She pointed out that digital tools like geospatial mapping have proven effective in improving vaccine delivery precision, but these innovations must be scaled nationally.

What Nigeria must do next

To build a resilient immunisation system, Ms Fashola stressed the need for increased investment in health personnel, especially in hard-to-reach communities.

This includes recruiting, training, and equitably deploying workers to areas most in need.

“Nigeria has successfully integrated global immunisation strategies through collaborative efforts with Gavi, WHO, UNICEF and other partners, adapting proven approaches to its local context,” she said.

She added that to further strengthen progress, Nigeria must prioritise knowledge sharing, local adaptation of best practices, sustainable financing, domestic resource mobilisation, and improved monitoring and evaluation systems.