Amina Aminu Dorayi and Mahmud Mustafa
Nigeria’s successful rollout of the Measles-Rubella (MR) and Human Papillomavirus (HPV) vaccines marks more than a public health milestone. It demonstrated the country’s ability to harness and strengthen routine immunisation systems to deliver campaign success, even in the face of persistent challenges.
For decades, measles has remained a leading cause of preventable illness and death among children, while Rubella poses severe risks to pregnant women and their unborn babies. At the same time, cervical cancer, primarily caused by HPV, continues to claim thousands of Nigerian women each year. Introducing MR and HPV vaccines represents a decisive step towards addressing these long-standing public health challenges with proven, life-saving solutions.
Importantly, these rollouts demonstrate that Nigeria is not starting from scratch. Years of investment in primary healthcare and routine immunisation systems, ranging from microplanning and cold chain expansion to workforce development and real-time data systems, have laid a solid foundation for success. Community sensitisation increased awareness of MR and HPV diseases, increased demand and uptake of vaccines.
Progress came with real constraints
Despite this progress, the journey has not been without obstacles. At the outset, awareness of both MR and HPV vaccines was low. A NOIPolls survey in April 2025 found that only 7 per cent of Nigerians were aware of the MR vaccine. Vaccine hesitancy, competing priorities, and limited political visibility in some areas further complicated early efforts. The impact of advocacy was measurable and progressive. Awareness increased from 7 per cent at baseline (March 2025) to 24 per cent by June 2025 following early advocacy efforts. In high-priority local government areas (LGAs), awareness increased further during implementation, rising by 13 per cent by September 2025. A post-campaign survey conducted in March 2026 recorded a 61 per cent increase in awareness, confirming the effectiveness of advocacy in driving vaccine uptake.
Operationally, gaps in data management also affected the consistency and visibility of progress. Healthcare workers have faced challenges in accurately recording vaccination data, while monitoring and evaluation officers encountered difficulties uploading information to the District Health Information Software 2 (DHIS2). These issues contributed to underreporting and limited the ability to track performance effectively.
Service delivery has also been constrained by weak linkages between schools, health facilities, and community structures, leading to missed opportunities to reach eligible populations. The limited inclusion of outreach activities in Reach-Every-Ward (REW) microplans, alongside the absence of dedicated vaccination teams in some facilities, further affected coverage.
In addition, community engagement efforts declined after the initial mass campaigns, underscoring the need for sustained demand generation. For HPV vaccination, ensuring consistent uptake among adolescent girls requires ongoing awareness, access, and trust-building.
What this experience revealed
Campaigns are only as strong as the systems that underpin them. Nigeria’s MR and HPV experience revealed both the power of coordinated leadership and the vulnerabilities of weak linkages. These lessons must now inform how the country builds a more resilient routine immunisation system, with MR and HPV integrated.
During introduction, strong leadership and coordination across federal, state and local levels anchored implementation, with governors, first ladies, and health commissioners providing visible support. Advocacy was not an afterthought but a driver of delivery, as Pathfinder and C-WINS worked closely with the National Primary Health Care Development Agency (NPHCDA), civil society organisations and community leaders. By strengthening and working through Advocacy, Communication and Social Mobilisation (ACSM) working groups, impact was achieved at scale.
The campaigns reached an estimated 58 million people and mobilised more than 1,300 champions. In Lagos alone, 150,656 girls were vaccinated – 76% of the annual HPV target – and 96% MR coverage was achieved among targeted children. Post-campaign surveys confirmed high acceptance and understanding of vaccines, with most respondents willing not only to vaccinate but also to advocate for immunisation within their communities.
Alongside these successes, the campaigns exposed challenges that must be addressed if routine coverage is to be strengthened. Low baseline awareness and pockets of vaccine hesitancy underscored the need for sustained demand generation, including continuous community education, rather than one-off mobilisation. Service delivery barriers highlighted the importance of building stronger linkages between schools, health facilities, and community structures, so that no eligible child is missed. Data and reporting weaknesses revealed the urgency of investing in systems like DHIS2 and NHMIS, ensuring records are consistent and uploads reliable, so that decision-makers have the visibility they need to target resources effectively.
What comes next
What happens after the success of mass campaigns is critical. It is important for a next phase to focus on integration, embedding MR and HPV vaccines fully within routine immunisation systems to ensure sustained and equitable access. This inevitably requires a focus on key priorities:
1. Strengthening routine immunisation integration
The gains from mass campaigns must transition into strong routine systems. Integrating HPV vaccination into primary healthcare services and aligning it with platforms such as Maternal, Newborn and Child Health (MNCH) weeks, polio campaigns, and other outreach initiatives will be essential.
2. Investing in data systems and capacity
Targeted training for healthcare workers on National Health Management Information System (NHMIS) tools, alongside refresher support for monitoring and evaluation personnel, will improve data quality, visibility and decision-making.
3. Expanding service delivery channels
Dedicated vaccination teams and stronger school-health facility linkages can help reach more adolescents consistently. Schools, churches and madrasas offer critical platforms for both awareness and service delivery.
4. Sustaining community engagement
Demand generation must remain continuous. Empowering adolescent girls through school-based education and extracurricular engagement will not only improve uptake but also create champions for vaccination within communities. Sustaining the momentum of the coalition support groups- the women leaders, social media influencers, and traditional leaders to continue advocacy at community levels.
5. Deepening partnerships
The coalition built during these introductions should be sustained and expanded. This is critical as the continued collaboration between the government, civil society and development partners will be key to maintaining progress and addressing emerging challenges.
To protect the gains already made, Nigeria must act decisively. MR and HPV vaccines should be fully integrated into routine immunisation, backed by stronger data systems and trained staff who can turn information into action. Dedicated vaccination teams, tighter school-health linkages, and faith-based platforms must expand the reach. Communities must remain engaged through education, adolescent champions, and active coalitions that keep trust alive. Above all, government, civil society, and donors must deepen collaboration to guarantee resources and accountability. The choice is clear: sustain momentum now, or risk losing the progress that millions of children and adolescents depend on.
* Dr. Dorayi, the Regional Portfolio Director, West and Central Africa, Pathfinder International, is a physician and public health professional with more than two decades of extensive experience in designing and managing health systems and sustainable development programmes aimed at improving the health and well-being of women, girls and communities.
* Dr. Mustafa, Head of Mission at the Centre for Well-Being and Integrated Nutrition Solutions (C-WINS), with over 30 years of experience in immunisation and health systems, provides strategic leadership for public health advocacy and systems strengthening initiatives in Nigeria.
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