National Emergency Routine Immunization Coordinating Centre an emergency response to address routine immunization gaps in Nigeria: a mixed-method retrospective study
This mixed-method retrospective study demonstrates that the establishment of Nigeria's National Emergency Routine Immunization Coordination Center (NERICC) significantly improved routine immunization coverage, evidenced by a 51% increase in average Penta3 coverage across prioritized states between 2016 and 2021, highlighting the critical role of coordinated, evidence-based interventions in strengthening health systems.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Imagine Nigeria's routine immunization program as a massive, nationwide game of "Catch the Ball," where the ball is a life-saving vaccine and the players are millions of children. For a long time, the game was stalling. In 2016, the scoreboard showed a troubling reality: despite having plenty of vaccines in the locker room, over 4.3 million children had never touched the ball. In some areas, the game was barely being played at all; for instance, in Sokoto state, only 3% of children had received their third dose of the Penta vaccine (a key shot against five diseases).
The government realized that just having the ball wasn't enough; they needed a new coach and a new playbook. In July 2017, they declared a "state of emergency" for routine immunization and launched a new team called NERICC (National Emergency Routine Immunization Coordination Center). Think of NERICC not just as a coach, but as a high-tech command center with a direct hotline to every local field. Before this, the teams were playing in silos, often missing the ball or dropping it. NERICC was built to be the central hub that connects the national level down to the smallest local government areas, ensuring no child is left on the sidelines.
The New Playbook: How They Changed the Game
NERICC didn't just shout instructions; they rewrote the rules of engagement with a "Theory of Change" that focused on six key areas. Here is how they played:
- The Command Center: They set up similar command centers at the state and local levels (SERICC and LERICC). It's like having a head coach, assistant coaches, and team captains all talking on the same walkie-talkie. They met daily to fix problems immediately.
- Bringing the Game to the People: Instead of waiting for kids to come to the clinic, they brought the clinic to the kids. They launched "Optimized Integrated Routine Immunization Sessions" (OIRIS), which meant clinics stayed open late into the evening and on weekends. They even combined vaccines with other health services, like nutrition checks, so one trip solved multiple problems.
- The "Last Mile" Delivery: They fixed the supply chain, which is the conveyor belt that moves vaccines from the warehouse to the village. They introduced a "Three-Hub" storage system and better tracking tools so vaccines never ran out or spoiled.
- The "Zero-Dose" Hunt: They used data like a treasure map to find the "Zero-Dose" children—those who had received zero shots. They deployed special teams for "Integrated Medical Outreach Programs" (IMOP) to hit 333 local areas hard, especially after the pandemic disrupted normal services. In just the first week of one IMOP push in October 2020, they managed to reach 70% of the target children in those areas.
- The Referees: They sent out "Supportive Supervision" teams. These weren't just inspectors looking for mistakes; they were mentors who went to the fields, fixed problems on the spot, and made sure the data being reported was real. They also started using SMS (text messages) to report data in real-time, making the scoreboard much more accurate.
- Training the Team: They built an "Immunization Academy" to train health workers, ensuring everyone knew the latest moves.
The Scoreboard: Did It Work?
The paper looks at the results between 2016 (before the new coach) and 2021 (after the new strategies were in place). The data suggests a massive turnaround.
In the 18 states that were struggling the most (the "low-performing" states), the average coverage for the third Penta shot jumped from 24% in 2016 to 54% in 2021. That is a 51% increase in the average coverage.
The paper breaks down the wins even further:
- 94% of these 18 states saw their coverage go up by at least 20%.
- 44% of the states saw their coverage skyrocket by 50% or more.
For example, Yobe state went from 9% coverage in 2016 to 65% in 2021, and Jigawa jumped from 7% to 49%. However, the paper notes that not every single team won; Borno state actually saw a decline in coverage during this period, dropping from 48% to 33%. This suggests that while the new playbook worked wonders for most, some areas still faced unique, stubborn challenges.
What the Paper Says (and Doesn't Say)
The authors are careful to say that NERICC could have contributed to these gains. They highlight a strong correlation between the establishment of NERICC and the rise in numbers, suggesting that this coordinated, emergency-style approach helped address the gaps. They do not claim to have definitively proven that the old, fragmented way of doing things was ineffective, but rather that the new model provided a powerful framework that aligned with significant improvements in coverage.
The paper also clarifies that while the numbers look great, the job isn't finished. They state that sustaining these gains will require continued investment in leadership, money, and data. They don't claim the problem is "solved," but rather that a powerful new engine has been installed that is driving the car in the right direction.
In short, by turning immunization into a coordinated emergency response with a clear command structure, better data, and a relentless focus on reaching the hardest-to-reach kids, Nigeria managed to turn a failing game into a winning one for millions of children. The scoreboard shows a clear upward trend, proving that when you coordinate the team and bring the ball to the players, the game changes.
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