Overlooking routine immunisation in northern Nigeria.

Tara Mangal and colleagues document the struggle to eliminate polio in northern Nigeria. However, they overlook the importance of routine immunisation to polio eradication eff orts. The investigators identified an association between the risk of contracting polio and oral polio vaccine unavailability. Systemic problems with routine immunisation distribution, supply chain, and staffi ng result in missed immunisation opportunities and, as findings from their study show, can lead to increases in the prevalence of polio. Nigeria launched its routine immunisation strategic plan in 2013, but will need sustained funding and vaccine availability to reach its goals. To increase population immunity, Mangal and colleagues recommend more polio doses for northern Nigerian children. In 2013, even after 13 rounds of polio immunisation, thousands of children were missed. The Independent Monitoring Board of the Global Polio Eradication Initiative recommended strengthening campaign management to improve coverage. Our experience indicates that better health education, community engagement, and robust routine immunisation will eff ectively reach missed children and thereby increase coverage. Refusal of polio vaccination remains a problem in northern Nigeria. We agree that community engagement will strengthen demand. In view of the high level of distrust, face-to-face discussions are recommended to help caregivers better understand and accept immunisation. People’s fears and beliefs cannot always be assuaged by mass communication. In a setting where DPT3 coverage is below 30%, northern Nigerians have received polio campaigns for 18 years, while their need for routine immunisation has been largely unmet. Long-term eff orts to strengthen routine immunisation remain elusive. The people of northern Nigeria deserve investment in routine immunisation to ensure service for all as well as polio eradication.