500,000 Vaccines After the Outbreak: Why Not Before?

I have written about vaccination before. More than once. In fact, I have written about vaccine hesitancy, about the misinformation that makes parents suspicious of perfectly safe vaccines, and about the devastating consequences of children missing vaccines that have been available for decades. I have written, advocated and screamed myself hoarse: vaccinate our children!

But do we listen? No!

Lately, the Federal Government’s latest response to Nigeria’s diphtheria outbreak is to deploy five hundred thousand doses of vaccine to Kano and Katsina. An emergency task force has been activated, and treatment annexes are being established across Katsina’s three senatorial districts, and additional support, including diphtheria antitoxin, antibiotics, clinical personnel, and protective equipment, is being mobilised. These are the things the government should do during an outbreak. They are necessary, urgent and welcome.

But I can’t stop myself from asking an uncomfortable question: Why 500,000 vaccines after the outbreak? Why not before? What happened to ‘prevention is better than cure ’? Why are we reactionary rather than precautionary?

Diphtheria isn’t a new disease. It’s not an emerging virus for which scientists are still desperately searching for a vaccine. This infectious disease has been around for ages, and the vaccine has been around for decades. In Nigeria, protection against diphtheria is incorporated into the routine childhood immunisation schedule, including the pentavalent vaccine given to young children.

And yet here we are again.

The current situation isn’t confined to Kano and Katsina either. On September 1, Plateau State reported 143 suspected cases and 23 deaths within two weeks. The state said nine patients were still receiving treatment, while officials identified late presentation and difficulty obtaining diphtheria antitoxin among their major challenges. There were also difficulties obtaining the specialised containers required to collect and transport samples for laboratory confirmation.

This is how a preventable disease becomes an emergency. First, a child is missed by routine immunisation, then another, and then thousands of children remain insufficiently protected. The disease finds a susceptible population. Children become sick, some present late, hospitals become overwhelmed, and then the government mobilises emergency teams. Vaccines are rushed into communities and treatment centres are established and reinforced. The diphtheria antitoxin is mobilised. Public health officials begin telling communities what they should have known before the outbreak began.

Government will call it an outbreak response. A better term would be ‘the heavy price of prevention delayed’.

Nigeria has been here before. During the earlier diphtheria resurgence, NCDC data showed that the overwhelming majority of confirmed cases occurred among children and that historical suboptimal vaccination coverage was a major driver. A national immunity survey found that only about 42 percent of children under 15 were fully protected against diphtheria. Even more revealing is what happened during the previous emergency response. By March 2025, more than 25,000 confirmed diphtheria cases had been recorded cumulatively in the national surveillance system since 2022, with more than 1,300 deaths. Only 19.3 percent of confirmed cases were reported as fully vaccinated with a diphtheria-containing vaccine.

So when we ask why children are becoming infected, we already have part of the answer: They were not protected.

Of course, vaccination is not the only issue. We have communities that are difficult to reach, fragile primary healthcare systems, problems with vaccine access and logistics, misinformation, distrust, poverty, and families who may not understand the importance of completing a child’s vaccination schedule. Some parents are genuinely hesitant. Others may want their children vaccinated but simply cannot get to a functioning facility.

Which begs the question: what responsibility does the health system have for the children who are missed?

A zero-dose child isn’t simply a child whose parents refused a vaccine. Some children live in communities where the nearest health facility is difficult to reach. Some are born into families that move constantly. Some are never captured properly by the health system. Some visit health facilities for other reasons but leave without receiving the vaccines for which they are eligible. These children are effectively invisible until an outbreak makes them visible.

And then suddenly we know exactly where they are. We know which communities need emergency vaccination. We know which LGAs are affected. We know where children are presenting. We know which hospitals need additional capacity.

The tragedy is that much of this information could have been collected before children became sick. This is why I don’t think the current response should simply be celebrated or criticised. It should be used as a mirror. The Federal Government’s mobilisation shows that Nigeria can move quickly when an emergency is declared. The question is whether we can bring that same urgency to routine immunisation.

If 500,000 doses can be mobilised because children are now at risk, what would it cost to ensure that children receive their routine vaccines before they become at risk? If treatment annexes can be created during an outbreak, why can we not build stronger primary healthcare services that prevent children from reaching the treatment ward in the first place? If government can convene an emergency task force within days, why can’t we have an equally relentless system tracking children who have missed their routine vaccinations?

There is also a human cost that rarely appears in government situation reports. When a child dies from diphtheria, it is not simply another number added to the case-fatality statistics. There is a mother who may spend the rest of her life wondering whether she could have done something differently. There are siblings who lose a brother or sister. There is a father who loses a child. Some families may sell possessions to pay for transport and treatment, only to return home with an empty bed.

We should therefore welcome the 500,000 vaccines. We should support the emergency task force. We should applaud the effort to take treatment closer to communities. And we should demand that the antitoxin and other lifesaving treatments reach the facilities where sick children actually present. But when this outbreak eventually subsides, I hope we do not pack away the lessons along with the emergency tents.

We have the vaccine, and we know where these children are. We also know what happens when vaccination coverage falls. Therefore, we should not allow another outbreak to become necessary before we vaccinate our children.

These deaths are senseless.