Looking Beyond the Money: Crucial Steps to Getting Vaccines to Children

Without money, many nations can’t afford to tackle health care issues and introduce the life-saving vaccines that are critical to child survival in the developing world.  But even after a vaccine is introduced and money has been spent, some children never see even the first dose.  With so much investment and effort, you wonder — how can that be?

Take Nigeria, the country with the second largest number of child deaths globally.  Over the past few years, they’ve raised vaccine coverage in many parts of the country to nearly 70%.  But progress is fragile, and results uneven.  Some areas have coverage rates above 80%; others are barely providing any vaccine.  Economic status and presence or absence of donor funding don’t fully explain the disparities. It’s not just the money – there must be something more.

To find out, a team led by Dr. Chizoba Wonodi at our International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public Health, worked with the government of Nigeria to interview 126 stakeholders in 8 states that best exemplify the successes and challenges in immunization coverage.   Dr. Wonodi’s team found that often, it’s not the amount of money that’s the problem – it’s getting that money to the right places at the right times, from the federal government all the way down to the community level. When that doesn’t happen, children go unvaccinated. Conversely, innovative mechanisms can lead to success stories. In one northern state, Zamfara, leaders used a “basket fund” to pool funds at the state and local level, ensuring that resources go where they are needed.

Other non-monetary issues were important as well. Inadequate transportation was cited in the study as a near universal barrier to vaccine delivery. Transportation contracts are one solution—these contracts could even be preferentially awarded to female-owned business, empowering women while improving service delivery (I really like this one!).

Inadequate cold chain, or the refrigeration required from ‘lab to jab’ to keep a vaccine viable, is another frequently cited barrier. Nigeria has invested in cold chain, and when I visited in July I saw what can be done and, unfortunately, what can sometimes prevent great ideas from being implemented.  They have lots of solar fridges, for example, but I learned that without a system to ensure regular repairs, that vital equipment can sit idly.  I can go on and on about what we found, but I suggest you read the brief report to get a better understanding of what is both most impactful and feasible.

The good news is that the government and many other stakeholders are fully committed to making a difference.  In fact, Nigeria is holding its first National Vaccine Summit, and I’m honored to be a participant.  The summit shows impressive commitment from the highest level, from the President, Vice-President, ministers, senators, and first ladies, right on down to the local governments.  The summit is also bringing in the private sector and other non-health groups even the Minister of Power is engaged to help ensure no interruption in those fridges!  It’s a huge effort, but one that will bear fruit in the coming months when a new pentavalent (Diphtheria, Tetanus, Pertussis, Hepatitis B, Hib) vaccine is introduced.

Investment in vaccines makes sense, and saving lives is well worth this effort.  The scaling up of new vaccines to 90% coverage is projected to save over $300M in direct health costs and add up to $17B to the economy in increased productivity!  That’s an investment worth making.