An ongoing measles outbreak, which killed 36 children and infected over 4,000 in northern Nigeria between 16 February and 9 March, has been linked to a drop-off in immunizations due to vaccine shortages in regional health clinics and widespread suspicion of the vaccine, say government health officials.
Many parents have declined to vaccinate their children against measles as they believe the vaccine is harmful, according to Ado Mohammed, director-general of Nigeria's National Primary Health Care Development Agency (NPHCDA).
"Parents are largely to blame... for their refusal to have their children immunized against preventable diseases including measles due to unfounded suspicion that such vaccines are harmful to children, following persistent rumours that polio vaccine causes infertility in children," he told IRIN.
Distrust of vaccines has grown as parents often do not differentiate between the polio vaccine and other immunizations, according to Mohammed. The 12 states affected by the measles outbreak mirror those where polio is endemic and where resistance against the polio vaccine is highest.
Kano State has reported over 1,000 measles cases, and Katsina State 1,260.
Nigeria's junior health minister, Ali Pate, agrees (as did Kano State's health commissioner Abubakar Labaran Yusuf, and Katsina health commissioner Hussaini Yammama): "The measles outbreak is a direct consequence of parents refusing to immunize their children," he said, adding: "Measles is a disease that is 99 percent preventable."
Following incremental progress on reducing resistance to polio vaccine campaigns, on 8 January 2013 gunmen killed 10 polio vaccinators in separate attacks on two polio clinics in Kano two days after a radio station aired a programme which discussed suspicion of the polio vaccine.
Measles is a highly contagious viral respiratory tract infection that infects over 20 million people - most of them children - each year. It can be fatal if not treated quickly. Symptoms include high fever, coughing and skin rashes. Some 158,000 people, most of them children under five, died of measles in 2011, according to the World Health Organization (WHO).
Infants are immunized against measles for life at nine months as part of routine immunizations in hospitals and health centres. Other vaccines include yellow fever, hepatitis B, tuberculosis, diphtheria, whooping cough and tetanus.
"I don't allow my children to take any immunization because I don't believe they are safe. The West has been insisting we give polio vaccines to our children which we have refused, and now they insist we take our children for routine immunization which I see as another way of giving our children what we are trying to avoid in the polio vaccine," Shehu Gomo, a father of five, told IRIN.
Mamman Nababa, a father of three, told IRIN: "How could I be so naive as to allow my children to be given polio drops by people who go door-to-door giving the vaccine free while the government has failed to provide medication for most urgent diseases affecting us such as malaria and typhoid?... There is something sinister in the polio vaccine and this is evident from their desperation in forcing us to give the vaccine to our children.”
Health workers and parents said a shortage of vaccines has also contributed to low routine immunization coverage.
Lami Shuaibu, a nurse at a government hospital in Kano, told IRIN that many parents return to hospital week after week for routine vaccinations only to find doctors have run out of medicine. "At a certain stage they become fed up and stop going because they come to think it is a waste of time and energy," he told IRIN.
On 7 March 2013 Hajara Ibrahim's two-year-old daughter was admitted to Hasiya Bayero Paediatric hospital in Kano with measles. Ibrahim said she abandoned the idea of immunizing her child after several visits to hospital without getting the vaccines.
Mohammed blamed the local authorities that run health care centres for the lack of vaccines.
Nigeria’s Health Ministry supplies vaccines to states through NPHCDA for use in regional health centres.
"Some local governments don’t pick up the vaccine deliveries that we supply to states, which creates shortages at primary health care centres, depriving willing parents' access to such vaccines for their children," Mohammed told IRIN.
The national health authorities have procured 10 million doses from the UN Children’s Fund (UNICEF) to try to vaccinate seven million children in the affected states over the coming days as an emergency response to the outbreak.
NPHCDA will also supply solar-powered refrigerators to affected areas to stockpile vaccines.
Health officials, WHO and UNICEF were already planning a nationwide measles campaign for 33 million under-fives in June and August 2013.