“There is a quarterly task-force committee for PHC services, headed by the Deputy Governor […] The local government chairpersons are fully participating and providing counterpart funding to administer vaccines. All 13 local government areas ensure that all eligible children are being reached and vaccinated. We noticed drastic improvement in immunisation of children because of that; this is what you need to reduce the number of zero-dose children” – Vaccine Uptake Stakeholders Dialogue
39% of deaths in children under five occur in those who never received a childhood vaccine
Nigeria ranks second globally in absolute numbers of zero-dose children, with an estimated 2.2 million zero-dose children in 2021. Zero-dose children are those who have not received a single dose of routine childhood vaccines. These vaccines protect against diseases that kill children, such as tuberculosis, polio, diphtheria, tetanus, whooping cough (pertussis), hepatitis B, rotavirus diarrhoea, measles, yellow fever, and meningitis. Without these vaccines, they are far more vulnerable to serious illness, lifelong disability, and death. Unfortunately, an estimated 39% of deaths in children under-five years occur among those who have not received any vaccine.
Reaching zero-dose children with life-saving vaccines has become a national priority, as demonstrated by Nigeria’s 2018-2028 Strategy for Immunisation and PHC Systems Strengthening. The strategy plans to reduce zero-dose prevalence by 50% by 2028. Setting the goal and developing strategies to achieve it is a crucial first step. However, success depends on effectively implementing strategies that overcome barriers, leverage strengths, and promote sustainable, country-led processes without over-reliance on donors.
With support from the WHO Alliance for Health Policy and Systems Research, the Health Policy Research Group through its vaccine uptake research project, has identified evidence-based strategies for reaching zero-dose and under-immunised children. In this blog, we explore how to effectively ground immunisation activities at the local level.
The ‘grassrootedness’ issue of zero-dose children in Nigeria
Zero-dose children are not just distant statistics; they are actual children living in communities across Nigeria, from local compounds and informal settlements to remote villages three hours away from the nearest health post. People often discuss them as a single group. However, our recent work identified distinct archetypes of these children facing different combinations of barriers to vaccination.
Some zero-dose children live in remote communities where distance, poor roads, and limited access to health facilities make routine immunisation difficult. Others live in urban poor settlements where financial hardship, competing livelihood priorities, and limited access to reliable health information reduce vaccine uptake. And there are those who face insecurity, displacement, migration, or sociocultural beliefs that shape decisions about childhood vaccination. Although these barriers differ, they are all experienced locally and shape how families interact with health services, the information they receive, the leaders they trust, and the institutions they rely on.
These local realities also point to the importance of local governments. For many caregivers, the local government is the closest level of government, statutorily responsible for coordinating primary healthcare services and engaging communities through traditional and other local structures. While federal and state governments set policies, provide technical direction, and shape the broader immunisation system, local governments are closer to the communities where these barriers are experienced.
Strategies designed at the federal or state level may not always reflect the circumstances of communities where zero-dose children live; hence, local governments are better placed to identify underserved communities, work with local leaders and organisations, coordinate frontline responses, and address the specific circumstances that keep children from vaccination.
Vaccination decisions and implementation are local
What practical steps can be taken to involve local governments in solving the zero-dose problem? This question was central to the two structured stakeholder dialogues convened by the Health Policy Research Group, University of Nigeria, in Abuja in 2025 and 2026. Representatives from federal, state, and local governments, as well as development partners and other actors in Nigeria’s immunisation system, agreed that vaccination decisions and implementation must be grounded locally. Key highlights include:
The gap is not policy; it’s implementation. Stakeholders agreed that Nigeria’s vaccination policy and guidelines already affirm the localisation of immunisation, but they need to be translated into coordinated action at the local level.
Stronger local conditions are needed to reach underserved children. Participants repeatedly pointed to the need for stronger local leadership and ownership, clearer accountability and stewardship, better cross-sector coordination locally, and sustained and incentivised political commitment within local government areas.
Local government chairpersons need state-level drive to prioritise vaccination. In Nasarawa State, the Deputy Governor chaired the quarterly Primary Health Care Task Force, which all 13 Local Government Chairmen attended. Beyond reviewing immunisation performance, the platform created clear lines of responsibility and ensured that local government leaders were actively involved in solving vaccination implementation challenges within their respective LGAs.
These findings align with research on accountability in Nigeria’s routine immunisation system, which has found that immunisation programmes perform better when political leadership is visible, responsibilities are clearly assigned, strategies are context-specific, and accountability is both institutional and personal. When leaders at different levels know they are responsible for outcomes and are supported or incentivised to coordinate action across health, finance, traditional institutions, and communities, ownership is strengthened, and implementation improves.
Overall, the evidence indicates that local government engagement should extend beyond mere participation in immunisation efforts. Local leaders require the authority, responsibility, and coordination systems to transform national and state priorities into practical actions that address their community’s specific needs.
Turning evidence into local action
Since local governments play a key role in addressing the zero-dose issue, the next step is to understand what can realistically be achieved within the current system. Our stakeholder discussions and broader research identify several practical ways to achieve this. They include:
Strengthen local political leadership and accountability: Mainstream immunisation performance as a local governance priority, not only a health sector responsibility. As demonstrated in Nasarawa State, visible political leadership, through mechanisms such as regular Primary Health Care Task Force meetings involving Local Government Chairmen, helps create clear lines of responsibility, mobilise counterpart funding, and sustain attention on immunisation performance.
Institutionalise multisectoral coordination at the local level: Zero-dose children are often missed because the barriers they face extend beyond the health sector. Local governments are uniquely positioned to convene education authorities, traditional and religious leaders, community-based organisations, transport providers, security agencies, and other local actors around a shared immunisation agenda. Rather than relying on informal relationships or one-off collaborations, LGAs can establish regular coordination platforms that enable these sectors to jointly identify underserved communities, solve implementation bottlenecks, and monitor progress.
Use local data to drive local solutions: Communities differ in the reasons children remain unvaccinated. Some face geographic isolation, others insecurity, poverty, migration, or low confidence in vaccines. Local governments should use available immunisation and primary healthcare data to identify where zero-dose children are concentrated and tailor responses to each community’s realities, rather than relying solely on uniform, nationwide approaches.
Build and sustain community trust through local institutions: Trust is built locally through familiar leaders, repeated engagement, and community structures that people already know. Local governments can strengthen this trust by working closely with Ward Development Committees (WDCs), traditional rulers, religious leaders, women’s groups, youth organisations, and community volunteers to promote immunisation, counter misinformation, and ensure caregivers receive consistent, credible information through trusted channels.
Leverage ongoing local government reforms as an opportunity: Recent national discussions on strengthening local government autonomy offer an opportunity to reinforce these efforts by giving local governments greater authority and flexibility to coordinate primary healthcare and immunisation programmes. Greater financial and administrative authority could enable local governments to better coordinate immunisation activities, mobilise local resources, strengthen multisectoral collaboration, and respond more quickly to the unique challenges facing zero-dose children in their communities.
Conclusion
As Nigeria continues to strengthen its immunisation programme, local governments should be recognised not merely as policy implementers, but as strategic partners in achieving equitable vaccine coverage. Harnessing their leadership, accountability, and convening power within the existing governance system offers a practical, evidence-informed pathway to ensuring that no child is left behind.
Authors’ Bios
Dr. Uzoma Diarah is a Medical Officer at the Enugu State Government House Medical Centre and Health Marketing & Communications Manager at Studypages PBC, San Francisco. She is a researcher at the Health Policy Research Group, University of Nigeria, with research interests in vaccine uptake, sexual and reproductive health, and health policy and systems research.
Prof. Chinyere Mbachu is the Principal Investigator of the vaccine uptake research project and a Professor of Community Health in the Department of Community Medicine, College of Medicine, University of Nigeria, Enugu Campus. A Fellow of the West African College of Physicians (FWACP) in Community Health, she has spent much of her career building the field of health policy and systems research in Nigeria, including training policymakers, practitioners, and postgraduate medical doctors in the use of evidence for policy and practice. Her research interests include health systems governance and accountability, political economy analysis of health reforms, and getting research evidence into policy and practice.
