Optimising Immunisation Financing Is Key to Nigeria’s Child Health Goals

Ibukun Oguntola and Sheriff Gbadamosi (Lead writers)

“I believe the children are our future.” This iconic lyric, immortalised by Whitney Houston, resonates deeply for Nigeria, a country where nearly half the population is under the age of 15. With one of the fastest-growing populations in the world, Nigeria’s future is inextricably tied to the health and wellbeing of its youngest citizens. In this context, immunisation and primary healthcare (PHC) are essential public health priorities, and as such, the foundation of a resilient, inclusive, and future-ready health system.

According to United Nations for Children’s Fund (UNICEF), Nigeria has one of the highest numbers of unvaccinated children in the world, with an estimated 2.3 million children missing out on life-saving vaccines each year. This is despite the provision in Section 5(1)(i) of the National Health Act, 2014, and Section 17(3)(d) of the 1999 Constitution which mandates the provision of adequate healthcare for all citizens including immunisation for children under five and pregnant women.

Yet, data from the Nigeria 2021 Multiple Indicator Cluster Survey (MICS) & National Immunisation Coverage Survey (NICS) revealed that only 57% of children aged 12 to 23 months received all basic vaccinations, well below the global target of 90%. Despite multiple policy frameworks, including the National Health Act and the Primary Healthcare Under One Roof strategy, the country continues to struggle with consistent vaccine financing.

Sustaining Gains with Smarter Health Investments

This chronic underfunding is not due to a lack of ambition. Nigeria’s health leaders have made repeated commitments, such as the co-financing agreement with Gavi, and the creation of the Basic Health Care Provision Fund (BHCPF). However, erratic budget releases, reliance on donor funding, and weak accountability at subnational levels have undermined the system’s ability to deliver vaccines where and when they are needed.

The urgency is growing. With Nigeria being a signatory to several international declarations and frameworks that commit the country to improving immunisation financing and coverage, including the Global Vaccine Action Plan, the Addis Declaration on Immunisation, Sustainable Development Goals (Goal 3.2), and Gavi’s planned transition by 2028, Nigeria must strengthen its domestic immunisation financing or risk reversing the fragile gains made over the past decade.

What is the vaccine financing challenge?

Nigeria’s immunisation programme is currently financed through a mix of funding sources. These include annual allocations from the government budget, support from Gavi, the Vaccine Alliance, as well as loans from mechanisms such as the World Bank’s IMPACT programme and the Vaccines Independent Initiative (VII), which also operates through loan-based financing.
Despite these funding streams, significant challenges persist such as:

1. Budget Execution Bottlenecks: According to Dr Muyi Aina, the Director General of National Primary Healthcare Development Agency (NPHCDA), in 2024, only 21% of the allocated vaccine budget was released by mid-year. Out of ₦137 billion appropriated and ₦116 billion approved, just ₦29 billion was disbursed, creating major shortfalls in vaccine procurement and delivery.
2. Currency and Inflation Pressures: Volatility in exchange rates and rising inflation continue to increase the cost of vaccines and logistics, especially those reliant on imports, disrupting procurement timelines and planning.
3. Weak Subnational Commitment: State and local governments contribute minimally to immunisation financing. Trends show that between 2021 and 2023, an average of 24%, 10%, 3.5%, and 8% of the state’s annual health budget was allocated to the state primary health care boards in Bauchi, Kano, Sokoto and Borno states respectively, undermining last-mile delivery efforts.
4. Legislative Turnover Risk: Reform efforts are vulnerable to disruption due to political turnover. Advocacy champions in the National Assembly may be lost during elections or reshuffled, threatening the continuity of vaccine financing reforms.
5. Out-of-Pocket Burden on Households: Despite immunisation being a public good, households still incur significant indirect costs, such as transportation and missed income, to access services. This creates hidden financial barriers and deepens inequities for low-income families.

Legislative initiatives for sustainable and efficient immunisation financing

At a multistakeholder workshop organised by the House of Representatives committee on healthcare services, supported by the Vaccine Network for Disease Control and the Global Health Advocacy Incubator, in July 2025, discussions took a hard look at the root causes of the country’s immunisation funding shortfall and offered new, practical strategies.
Here’s what could change:

First-Line Charge Proposal: A bold recommendation emerged to prioritise immunisation funding as a first-line charge in the national budget, ensuring vaccine financing and procurement is protected from fiscal shocks, political changes or delays in appropriation.

• Assertive Budget Appropriation: Legislative committees to push for health allocations that reflect the economic benefits in reduced illness and productivity loss and ensure that appropriated funds are timely and fully released.
• Enhanced Oversight: Strengthened oversight function to be elevated through quarterly briefings from implementing agencies like the NPHCDA and Federal Ministry of Health and Social Welfare and should be backed by data dashboards that track allocations, releases, utilisation, and outcomes.
• Legislative Advocacy: Lawmakers, backed by data from civil society organisations (CSOs) proposed amending the National Health Act to enshrine vaccine financing in law, shifting it from discretionary to statutory funding.
• BHCPF Expansion: There was a strong call to increase the BHCPF allocation from 1% to 2% of the Consolidated Revenue Fund. Participants argued that this would strengthen primary health care and ensure dedicated resources for immunisation at the community level.
• State Co-Financing Innovations: With only 3% of current immunisation financing coming from states, new subnational mechanisms were discussed, including earmarking deductions from the Federation Account Allocation Committee (FAAC) and introducing “health taxes” on tobacco and alcohol.
• Leveraging the Private Sector: Public-private partnerships, corporate social responsibility (CSR) contributions, and domestic vaccine production were highlighted as long-term solutions to reduce donor dependence and build resilience.

A political turning point

A significant outcome of the workshop was the formal launch of the Parliamentary Caucus on Immunisation and Primary Health Care Financing. This 13-member group, composed of legislators from both chambers of the National Assembly, is united by a shared mission: to secure and oversee sustainable domestic funding for immunisation and primary health care.

The Caucus is chaired by Hon. Amos Magaji, who also heads the House Committee on Health. Its creation aligns with growing global momentum to strengthen parliamentary leadership in health financing. In April 2025, the Global Health Advocacy Incubator (GHAI), with support from Gavi, convened 21 parliamentarians from 10 countries in Istanbul. That meeting produced the Istanbul Parliamentary Call to Action, a declaration urging governments to prioritise immunisation financing as a pillar of health security.

Nigeria’s new caucus is the sixth national parliamentary platform to emerge from this initiative, joining those in Cameroon, Côte d’Ivoire, Madagascar, Sierra Leone, and Zambia.

The future of immunisation in Nigeria will not be determined solely by the procurement of vaccines, but by the political will to fund them, the systems to deliver them, and the accountability to sustain them. It requires bold policy reforms, legislative vigilance, and the courage to build domestic vaccine manufacturing capacity.