Vaccines bring us closer to a better world
Every year, the last week of April marks World Immunization Week, a chance to recognize the tremendous impact that vaccines—one of the greatest scientific innovations of all time—have had on our collective health and well-being. Like many Africans, I have seen firsthand the powerful difference that vaccines make for public health and how they bring our communities closer together.
Growing up in a rural part of northern Nigeria, my first awareness of vaccines was health workers visiting our school for vaccination campaigns and seeing people’s “BCG scar”: the slightly raised indentation, usually on the upper arm, that was left by the Bacillus Calmette-Guérin vaccine used to fight tuberculosis. (Later on, as a public health worker going house to house, I would look for this scar, among other evidence, to identify who had been immunized.) But many other vaccines now taken for granted were simply not available when I was younger, especially in rural areas. As a result, measles, diarrhea, and whooping cough swept through parts of Nigeria every year and resulted in many, many deaths. Because most people were not vaccinated, this was just considered normal, and that’s the way things were.
I will never forget a conversation I had with a mother of eight children several years later, after I had finished nursing training and started working in the health sector. To break the ice, I teased her about why she had had so many children. She shrugged and said, matter-of-factly, “Measles will take its own, diarrhea will take its own.” She took it as a given that these sadly ubiquitous—and vaccine-preventable!—diseases would claim some of her children. Her answer haunted me and has reinforced my commitment to advance immunization throughout Nigeria, Africa, and the world ever since.
While West Africa still has some of the lowest vaccine rates in the world and there is clearly much more work to do, I have seen amazing progress during my time in public health. At the health facility in Sokoto, Nigeria, that I often visit, children from rural areas are vaccinated every week, and the huge annual tolls of mortality and illness from measles and whooping cough have receded considerably. In 2017, for example, 4.7 million children in northeast Nigeria were vaccinated against measles in just two weeks. When I interact now with families who remember how much death there used to be from these preventable illnesses, there is so much relief and satisfaction to see only mild symptoms and significant reduction in the loss of young lives. Children do not need to perish or suffer needlessly; these diseases can be beaten, thanks to vaccines.
In fact, vaccines have helped cut child deaths around the world by more than half in just 30 years, and they have protected people from dozens of diseases, ranging from measles to cervical cancer to Ebola. They have had a tremendous impact over the last decade in improving health and quality of life for millions of people across Africa. And now, in the face of the biggest global public health crisis in a century, vaccines give us all hope that we will defeat COVID-19 worldwide and will be able to come together as families and communities once again.
Campaigns across a continent
Last summer, even as the COVID-19 pandemic took an enormous toll on families’ health and livelihoods, the world received a wonderful bit of news. On August 25, four years after the last known case had been found in northeast Nigeria, the World Health Organization (WHO) certified that the African region was now free of wild poliovirus. “This is one of the greatest achievements in public health history,” declared WHO’s chief, Tedros Adhanom Ghebreyesus. For the thousands of vaccinators, volunteers, community leaders, and public health advocates who had worked tirelessly for years to immunize every child in Africa against this crippling disease, it was a hard-won moment of jubilation (though, due to COVID-19, the celebrations primarily happened on Zoom). Twenty-four years earlier, poliomyelitis still paralyzed more than 75,000 children across Africa annually. Now, thanks to vaccines, hard work, and constant vigilance, wild polio is gone from Africa, joining smallpox as the second virus to be eradicated from the continent—a key step toward a truly polio-free Africa and, hopefully soon, a polio-free world.
Wiping out wild polio is just one of the many success stories in Nigeria over the last decade. Another was the arrival of MenAfriVac, an affordable meningitis A vaccine that was also the first-ever vaccine developed specifically for Africa. Before MenAfriVac, bacterial meningitis killed tens of thousands of infants, children, and young adults in sub-Saharan Africa. But in 2010, and thanks to a partnership that included PATH, WHO, the Serum Institute of India, the Bill & Melinda Gates Foundation, and countless public health workers and volunteers on the ground, 20 million people in Burkina Faso, Mali, and Niger were vaccinated against meningitis A. During peak season that year, not a single case was reported in those three countries. For the next six years, the MenAfriVac vaccination campaign continued across Africa, protecting an estimated 400 million people and preventing an estimated 1 million meningitis A cases and 150,000 deaths in 2020 alone.
As my colleague Solomon Zewdu recently noted, many other rapid and transformative vaccination campaigns have been implemented across Africa in the past few years. In 2016, 14 million people in Angola and the Democratic Republic of the Congo (DRC) were vaccinated against yellow fever in a remarkable 10-day campaign that enlisted 41,000 health workers. From 2018 to 2020, more than 300,000 people were vaccinated against Ebola across the DRC, proving that ultra-cold vaccines could be transported to remote areas in need. And last year, even as COVID-19 hindered many vaccination efforts, Ethiopia immunized nearly 15 million children against measles and nearly 2 million children against cholera.
The contributions of these vaccines to fighting deadly diseases are amazing enough, but they have also helped serve as the entry point to better primary health care across Africa. As immunizations have become more routine and more people have experienced the tremendous benefits they bring, vaccine clinics in remote areas have become trusted sources of other basic and necessary health services, such as prenatal and infant care and treatment for illnesses such as diarrhea, pneumonia, malaria, and HIV. Building out access to these key primary health resources as part of regular vaccination campaigns arguably saves as many lives as the vaccines themselves.
Trust and verify
Of course, building trust is never easy. An essential part of any successful vaccination campaign is listening to the concerns the community may have and providing forthright information that addresses the issues directly and empowers parents to act for the benefit of their children’s health. Nigeria’s polio campaigns, for example, would not have succeeded if vaccinators had not worked closely with local and traditional leaders and encouraged them to get involved, including by demonstrating to everyone else that the vaccine was beneficial.
Good data are also critical to shaping effective immunization efforts. This is true both on the ground—in counting people to ensure that everyone is vaccinated—and for all of the strategic and logistical decision-making that must go into a quality campaign, from tracking doses to training volunteers to ensuring equitable coverage across a multitude of rural, remote, and sometimes security-challenged areas. Similarly, a lack of reliable, actionable data can hinder vaccination efforts from the start; this is part of the reason that ending polio in Nigeria took more than 200 campaigns. Diligent efforts by a variety of partners to improve health data, often using new digital tools such as mobile phones, has significantly improved outcomes as well as our understanding of where further changes are needed.
Finally, there is no substitute for sheer hard work on the ground. Every immunization campaign relies on the talent and determination of frontline health workers and volunteers who, with great effort and sometimes the risk of violence or even death, deliver these life-saving innovations to all of the places they need to go and ensure that people have the chance to use them. Unfortunately, and especially in the early months of the pandemic last year, COVID-19 prevented many opportunities to deliver basic vaccines and health care services to all the places where they were needed. As a result, just as we were starting to see real momentum build in public health, 2020 marked a major step backward. Worldwide, as the foundation’s 2020 Goalkeepers report noted last October, we might well have lost 25 years of progress on vaccine coverage in just 25 weeks.
The challenge of COVID-19
The COVID-19 pandemic has undercut immunization campaigns all over the world even as it has reminded all nations of how truly miraculous vaccines can be. In more prosperous countries where COVID-19 vaccines are becoming widely available, families, friends, and coworkers isolated during the pandemic are starting to reunite, with appropriate precautions. Postponed weddings and parties are being planned anew, and senior citizens can feel safe seeing and hugging their grandchildren again. U.S. and European social media are now filled with post-vaccination selfies, pictures of joyful reunions, and stories of people crying with relief and happiness after receiving their “jab.”
But here in Nigeria, as in many nations around the world, a frustrating wait still lies ahead before everyone will be protected against this pandemic. While Nigeria received nearly 4 million doses of vaccine through the COVAX initiative in March, many people may not be able to get vaccinated until 2022 or later. Thankfully, we are already seeing some signs of a welcome rebound in other immunization efforts. For example, immunizations with pentavalent and pneumococcal conjugate vaccines in Nigeria are returning to pre-2020 levels and the introduction of the rotavirus vaccine, delayed by the pandemic, is set to begin soon. But until coronavirus vaccinations ramp up across the continent, COVID-19 will continue to be an imposing obstacle to reaching every child with the immunizations and health care they need to grow into healthy adults.
This pandemic has shown us all once again how vaccines can transform lives for the better. Let us recommit to expanding access to these tremendous, life-giving innovations so every child has a chance to thrive and so we can end COVID-19 and all of the readily preventable diseases that have afflicted us for far too long.