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Reaching every zero-dose child in Nigeria

The hurdles. The hopes. The happiness.


Sometime last year there was a swirl of a excitement among Save the Children colleagues in a field office in north-western Nigeria. The excitement that comes with news of a potential new project. A proposal had been submitted for a new health project.

Excitement soon gave way to questions. What will be the focus of the new project? Who is the donor? How long is it for?

To find answers, I put a call to our Advocacy and Policy Manager for our Survive Breakthrough. He dropped a phrase I hadn’t heard before: zero-dose children.

In an era of buzzwords, fuzzwords and frequently emerging phrases in the development and humanitarian space, I scratched my head at this one. Then I did some quick research.

Definitions vary. One group of authors defines zero-dose children as children aged 12–23 months who have survived but did not receive the first dose of the diphtheria, tetanus, and pertussis containing vaccine (DTP-1). Another study defines zero-dose children as children not receiving DTP-1 who are aged less than 12 months. Another definition refers to the non-receipt of the four basic vaccines (BCG, polio, DPT and meningococcal) in children aged 12–23 months.

The common denominator in the different definitions is evident. Despite progress in increasing access to immunisation, many children are without basic, routine vaccines. The theme of this year’s celebration of the World Immunization Week is Long Life for All. That begins with working towards the survival of children. It calls for attention and action to ensure we reach every zero-dose child.

Unfortunately, we didn’t win the proposal. But it won’t dampen our global ambitions and breakthroughs for children – in this case, that no child dies from preventable causes before their fifth birthday. Zero-dose children fall within this category.

But there are many hurdles along the jagged road to reaching zero-dose children. Overcoming these hurdles brings us closer to our hopes and happiness for a long life for all.


A strategic priority of the World Health Organization’s Immunization Agenda 2030 is to reach out to zero-dose children. The target is to see a reduction of 50% number of zero-dose children by 2030. This is a tall target for Nigeria to meet – given health systems challenges and hurdles in the immunisation landscape.

Nigeria has an unenviable record on zero-dose children. For example, in 2020 it was reported that 35% of infants failed to receive diphtheria-tetanus-pertussis (DTP1); a vast number of these zero-dose children in the northern part of the country.

Why are more children not vaccinated in this part of Nigeria? Studies, including those conducted by Save the Children, indicate multiple reasons or factors. These factors can be grouped under:

  • awareness and demand
  • access
  • facility readiness.

At local and community levels, there is lack of knowledge and awareness on the part of parents and caregivers about the value of immunization. This lack of awareness, coupled with low trust in governments and vaccines generally, is partly responsible for hesitancy. Add in attitudes and beliefs, poor treatment melted to mothers by health workers, and low confidence arising from immediate adverse events following immunization, and you get the picture.

In terms of the capacity of health facilities to provide immunisation services, there are shortages and low capacity of health workers, unavailable vaccines, and vaccine cold chain problems.

One hurdle we cannot miss is the Coronavirus pandemic. With the outbreak, Nigeria went into a national lockdown. This caused disruption in routine immunisation, limiting progress towards reaching zero-dose children.   


Concerted action gives us hopes that reaching zero-dose children can become a reality. Organisations like Save the Children aim to do things differently, trying new approaches and learning from previous ones. The quest is to leave no one behind, including zero-dose children.

Save the Children is pushing for primary health system reforms in Nigeria. Such reforms can help in identifying children who are missing out and in bridging the immunisation gap in rural and remote communities with little coverage. Steps include strengthening immunisation programmes by targeting low-coverage areas and missed communities, including zero-dose children.

A range of immunisation activities can help here. For example, through social mobilisation, men and women in community groups are supporting local efforts to encourage parents and caregivers to present their kids for immunisation. And through advocacy, we are looking to help shape the immunisation policy agenda, by influencing increased investment in immunisation and calling for action to improve coverage of vaccines, especially among poor and marginalised children.


In 2021, the World Health Organization released guidance for strategies to reduce gaps in immunisation and to plan and implement catch-up vaccination. The guidance is meant to refine national and local vaccination policies and schedules, to make sure people who have missed out – including children – are identified and vaccinated, and to lay plans for continuous implementation of catch-up vaccination as part of the health system.

Seeing this guidance through in very practical ways is the first step towards making everyone riotously happy on the road to reach every last zero-child. 

every zero-dose child