1.

1 Background Information

Immunization remains one of the most cost-effective and impactful public health
interventions, playing a crucial role in the prevention and control of infectious
diseases. By stimulating the immune system to recognize and combat pathogens,
vaccines not only protect individuals but also contribute to broader community
immunity, reducing the spread of diseases and protecting vulnerable populations
(World Health Organization [WHO], 2021). Since the introduction of vaccines,
diseases such as smallpox have been eradicated, while others, including polio,
measles, and tetanus, have seen significant declines in incidence (Centers for Disease
Control and Prevention [CDC], 2022).

Global Impact of Immunization

Globally, immunization prevents an estimated 4–5 million deaths annually, making it

one of the most effective tools for safeguarding public health (WHO, 2021).
Vaccination programs have significantly reduced the global burden of vaccine-
preventable diseases (VPDs), including diphtheria, pertussis, and hepatitis B. For
instance, between 2000 and 2018, global measles vaccination efforts averted over 23
million deaths, with the largest gains observed in low-income countries (UNICEF,
2020).

Despite these successes, approximately 25 million children under the age of one failed
to receive basic vaccines in 2021, largely due to disruptions caused by the COVID-19
pandemic, misinformation, and structural challenges within healthcare systems
(WHO, 2022). In low- and middle-income countries (LMICs), factors such as
poverty, inadequate healthcare infrastructure, and limited access to vaccines continue
to impede immunization efforts, contributing to preventable morbidity and mortality
(Gavi, the Vaccine Alliance, 2022).

Immunization in Africa

In Africa, vaccination campaigns have made remarkable progress, particularly in

tackling diseases like polio and measles. Polio, which once paralyzed thousands of
children annually, is now on the brink of eradication across the continent. This
success is attributed to sustained efforts by governments, international organizations,
and community health workers (Gavi, 2022). For instance, Nigeria, once considered
the global epicenter of polio, was declared wild poliovirus-free in 2020 after years of
intensive immunization campaigns and surveillance (National Primary Health Care
Development Agency [NPHCDA], 2021).

However, routine immunization coverage across Africa remains suboptimal. WHO

estimates indicate that only 70% of children in Africa receive all recommended
vaccines, leaving millions vulnerable to diseases like measles, tetanus, and pneumonia
(WHO, 2022). The COVID-19 pandemic exacerbated this issue, with many African
countries experiencing significant disruptions in immunization services. For example,
measles outbreaks were reported in over 24 African countries in 2021, underscoring
the urgent need to strengthen routine vaccination programs (UNICEF, 2022).

The Nigerian Context

In Nigeria, immunization coverage is approximately 57%, far below the WHO-
recommended target of 90% needed to achieve herd immunity against most vaccine-
preventable diseases (NPHCDA, 2021). The northern regions of Nigeria face the
greatest challenges due to cultural, religious, and socio-economic barriers that
contribute to vaccine hesitancy. A notable example is the resistance to polio
vaccination campaigns in northern Nigeria, which delayed global eradication efforts
(Gavi, 2022).

In addition to vaccine hesitancy, systemic challenges such as inadequate cold chain

systems, poor access to healthcare in rural areas, and insufficient funding hinder
immunization programs. A report by UNICEF (2020) highlights that only 30% of
Nigerian healthcare facilities have functional cold chain equipment, which is critical
for vaccine storage and distribution. Furthermore, misinformation about vaccines,
fueled by social media and community myths, continues to undermine immunization
efforts, particularly in marginalized communities (UNICEF, 2022).

Renewed Focus on Immunization

To address these challenges, there is a growing need for renewed focus on

strengthening immunization programs, particularly in LMICs like Nigeria. Key
strategies include:

1. Strengthening Healthcare Systems: Investments in healthcare infrastructure,

particularly in rural areas, are essential to improving vaccine accessibility and
delivery (WHO, 2021).
2. Addressing Vaccine Hesitancy: Community engagement, public health
education, and transparent communication about vaccine safety and efficacy
can help build trust and dispel myths (CDC, 2022).
3. Leveraging Technology: The use of digital tools, such as electronic
immunization registries and mobile health (mHealth) applications, can
improve vaccine coverage and track defaulters effectively (UNICEF, 2020).
4. Global and Local Partnerships: Collaboration between governments,
international organizations, and community stakeholders is critical to
mobilizing resources and implementing targeted vaccination campaigns (Gavi,
2022).

In conclusion, immunization is a cornerstone of public health, with the potential to

save millions of lives annually. While significant progress has been made, particularly
in regions like Africa, challenges such as vaccine hesitancy, misinformation, and
inadequate infrastructure must be addressed to ensure equitable health outcomes.
Strengthening immunization systems and promoting widespread vaccine acceptance
remain crucial for achieving global health security.
1.2 Objectives

General Objective:

 To examine the role of immunization in enhancing public health and reducing

the burden of vaccine-preventable diseases.

Specific Objectives:

1. To analyze the historical impact of immunization on global health outcomes.

2. To assess the current challenges hindering immunization efforts in low- and
middle-income countries.
3. To evaluate strategies to improve vaccine coverage and overcome barriers to
immunization.
4. To highlight the role of community engagement and public health policies in
promoting immunization programs.
1.3 Statement of Problem

Despite the remarkable achievements of immunization in reducing the global burden

of infectious diseases, substantial challenges persist in achieving universal vaccine
coverage. Immunization programs have saved an estimated 4–5 million lives annually
worldwide, but gaps in vaccine coverage remain significant, particularly in low- and
middle-income countries (World Health Organization [WHO], 2021). In 2021,
approximately 25 million children globally did not receive basic vaccines,
representing the highest number since 2009. Alarmingly, 60% of these children live in
just ten countries, most of which are in Africa and South Asia (WHO, 2021).

Global Context

Globally, vaccine-preventable diseases remain a leading cause of morbidity and

mortality among children. For instance, measles outbreaks surged in 2022, with over
9 million reported cases and 128,000 deaths globally due to disruptions in routine
immunization services during the COVID-19 pandemic (United Nations International
Children's Emergency Fund [UNICEF], 2022). Similarly, diphtheria cases increased
by 50% between 2019 and 2021, demonstrating the vulnerability of populations in the
absence of adequate vaccination coverage (Gavi, 2022). Low vaccine coverage
disproportionately affects children in low-income countries, where only 81% of
children receive the full three doses of the diphtheria, tetanus, and pertussis (DTP)
vaccine, compared to 92% in high-income countries (WHO, 2021).

Africa's Immunization Challenges

Africa carries a disproportionate share of the global immunization gap. In 2021,

approximately 8.9 million African children were categorized as "zero-dose" children,
meaning they received no routine vaccinations at all (UNICEF, 2022). Vaccination
coverage for key vaccines, such as the measles-containing vaccine (MCV1), dropped
from 73% in 2019 to 70% in 2021 across the continent (WHO, 2022). This decline
threatens to reverse decades of progress in controlling vaccine-preventable diseases
like measles, tetanus, and polio.

The COVID-19 pandemic exacerbated these challenges, disrupting vaccination

campaigns and healthcare services. For example, 25 African countries reported
measles outbreaks in 2022, with over 35,000 cases, largely due to missed routine
immunizations during the pandemic (UNICEF, 2022). Moreover, logistical barriers
such as inadequate cold chain systems and vaccine stockouts continue to undermine
immunization efforts. Only 68% of African countries have the infrastructure required
to maintain vaccine potency throughout the cold chain, leading to significant wastage
of vaccines (Gavi, 2022).

Immunization Challenges in Nigeria

In Nigeria, immunization coverage remains alarmingly low, with only 57% of

children fully vaccinated against diphtheria, tetanus, and pertussis by their first
birthday, far below the WHO-recommended 90% target (National Primary Health
Care Development Agency [NPHCDA], 2021). Approximately 3 million Nigerian
children are categorized as zero-dose, making Nigeria one of the ten countries with
the highest number of unvaccinated children globally (WHO, 2021).

The challenges in Nigeria are multifaceted:

1. Poor Cold Chain Systems: Less than 30% of healthcare facilities in Nigeria
have functional cold chain equipment, jeopardizing the potency of vaccines
during storage and distribution (UNICEF, 2020).
2. Geographic Disparities: Rural areas, particularly in northern Nigeria, face
significant barriers to vaccination due to poor healthcare access, insecurity,
and difficult terrain (Gavi, 2022).
3. Vaccine Hesitancy: Cultural and religious misconceptions about vaccines
have fueled resistance, particularly in northern regions. For instance, in 2003,
rumors about polio vaccines containing sterilizing agents delayed
immunization campaigns for years, allowing the disease to persist (NPHCDA,
2021).

Kwara State and Ilorin Context

At the state level, Kwara State mirrors the national challenges with vaccination.
Reports from the Kwara State Ministry of Health indicate that routine immunization
coverage in the state is approximately 60%, with significant rural-urban disparities
(Kwara State Ministry of Health, 2023). In rural areas around Ilorin, logistical
challenges such as poor road infrastructure and inadequate cold chain facilities further
limit vaccine delivery. Seasonal flooding exacerbates these challenges, making it
difficult for healthcare workers to reach remote communities during immunization
campaigns.

Additionally, widespread misinformation about vaccines has undermined public trust

in immunization programs. In 2022, a state-led measles vaccination campaign in
Kwara State faced resistance in some communities due to rumors linking vaccines to
infertility (Kwara State Ministry of Health, 2023). This highlights the urgent need for
community engagement and public health education to address vaccine hesitancy.

The persistent immunization gap, from the global scale to local contexts like Kwara
State, underscores the critical need for targeted interventions. Addressing challenges
such as poor healthcare infrastructure, vaccine hesitancy, and inequitable access to
immunization services is essential to achieving universal vaccine coverage.
Strengthening immunization programs through increased funding, community
engagement, and innovative delivery strategies will be crucial to overcoming these
barriers and ensuring equitable health outcomes for all.
1.4 Definition of Terms

 Immunization: A process through which individuals are protected against

infectious diseases by administering vaccines to stimulate the immune system
to recognize and combat pathogens (WHO, 2021).
 Vaccine: A biological preparation that provides immunity to a particular
disease. Vaccines typically contain weakened or inactivated parts of a
pathogen to trigger an immune response (CDC, 2022).
 Vaccine Hesitancy: Delay in acceptance or refusal of vaccines despite
availability of vaccination services. It is influenced by factors such as
confidence, complacency, and convenience (WHO, 2019).
 Cold Chain System: A temperature-controlled supply chain used to transport
and store vaccines at optimal temperatures from the point of manufacture to
the point of administration (UNICEF, 2020).
 Vaccine-Preventable Diseases: Diseases that can be effectively prevented
through the use of vaccines, such as measles, polio, diphtheria, and hepatitis B
(CDC, 2022).