Dr Emmanuel Abanida before his retirement was Director Disease Control and Immunisation at the National Primary Health Care Development Agency (NPHCDA), but now a health activist with the Health Sector Reform Foundation of Nigeria (HERFON), he is passionate about the responsiveness of the Nigerian government to immunisation of the nation’s children. To end infant mortality in Nigeria, in an interview with Ndidi Chukwu of Health Reporters Abanida recommends prioritization by Nigerian government.
There is an assertion that the Federal Government of Nigeria will not be able to fund vaccine and vaccination by 2022, when the Global Alliance for Vaccine Initiative (GAVI) finally stops its 50% financial support for immunisation in Nigeria, what challenges do you for see when this happens?
The assertion that the federal government of Nigeria will not be able to fund vaccines is totally false. There may be challenges but a determined government would provide the basic minimum care for the children. We are talking about the lives of the children that are our future, the leaders of tomorrow. It is true that following the rebasing of the GDP in Nigeria we will be graduating from GAVI’s low income to medium income category. For our graduation process we are supposed to be totally off GAVI’s direct support by the year 2022 seven years from now which is a lot of opportunity. There are challenges on the issue of vaccination. I will classify them into three; one is the vaccine as a commodity, two, vaccine devices or injectable materials, three, human resources and the health facilities. For vaccines we presently have about ten vaccines in our national schedule that we give to children below the age of one year. The latest addition which you have heard is the Pentavalent vaccine a 5 in 1 vaccine introduced in 2012, which is now rolled out in 36 states plus FCT. Last year we added pneumococcal conjugate vaccine that will prevent pneumonia infections and other diseases. This is going to be scaled up in the whole states. We also have IPV which is injectable polio vaccine that is supposed to be endgame changer for the polio eradication going on in the world and in Nigeria too. In 2011 we also introduced meningitis vaccine that is supposed to take care of the greatest burden of meningitis by 2014; we had gone through all 36 states of the country for vaccination.
What is the cost of Vaccination annually?
The cost of vaccination in the country per annum is estimated to be about 12-15 billion naira, it is expected that the federal government will put in maximum of 5 billion naira invariably the remaining parts are taken care of by our partners especially GAVI but we also have partners like UNICEF, WHO, DFID, USIAD, Japanese Government, Norwegian Government all of them make good contributions and we put it together to get these vaccines and vaccination done.
What mechanism is Nigeria going to put in place to fill the gap when GAVI stops funding?
We must understand that we now have a national health act that would provide resources especially for vaccination. Part 2 of the national health act did say certain percentage of money will go to basic health care including drugs and vaccines. My estimate I feel vaccines and vaccination will be taking close to 10 billion plus or minus 1 million from the National Health Act which will go a long way. If you add it now to what we are getting from GAVI definitely we have increased government’s contribution if we begin to implement the national health act. This will not totally solve our problem, by 2017 we plan to include about four new vaccines to our national programme.
Nigeria will be needing close to 60 billion naira every year for vaccine, where do we go from there?
That is the reason why a lot of streams of activities and discussions are going on and one of it is the National Immunisation Task Fund. We have thought of the various possibilities and dimensions to take and set up a trust fund and have people help us to see where vaccination is important and the fund that will come out from there will be put as a trust. We are looking at utilisation tax, like the tobacco tax, alcohol tax, entertainment tax and any other option we can think about. We are also thinking that it is possible for the States to co-finance. As we are talking now the essential vaccines are all paid for by the federal government, states are not contributing, but the 1st section of the Act on the immunisation programme in the country says the federal government will provide vaccine free for every eligible person, many states are hiding under that, but we know it cannot be business as usual. So much have to change, they have to contribute to take care of their children. In our investment case plan 2015-2020, we have expanded it to include what states can do and we have worked out different scenario so that it will be justifiable, equitable and ensure that states buying into that and that money if possible should be taken from source. One thing we are thinking of is the issue of local vaccine production, we are not saying Nigeria can produce all the 10 vaccines, even if it is 1 or 2, it will be very good.
Is there a plan for local vaccine production and what are the expectations?
A meeting was held last year, we had various stakeholders in the production of vaccine, both the academia, programmers, virologists, pharmaceutical manufacturers, and government officials, and the resolution that was made is to have a plan between now and 2020 a kind of a work plan and identify all the stakeholders that have been into this process. The key element of the outcome of that meeting was that government will not go into vaccine production, but will provide a good policy platform for whoever wants to produce vaccine in the country. It is a process and I want to believe that they are doing that. There is no minister of health yet perhaps that could be one of the reasons for the delay. Secondly vaccine production has to follow a business model, and being a business model means that it is not going to be all philanthropic, manufacturers are not philanthropists they are in it for business to make gains, so it is going to be a bit difficult to have a sustainable vaccine production outfit.
To be continued