Protected as Children, Exposed as Adults: Inside Nigeria’s Silent Immunisation Gap
Koko Maxwella 
ABUJA, Nigeria – In Nigeria, the word immunisation instantly evokes familiar scenes: crying infants wrapped in patterned Ankara blankets, worried mothers standing in sun-soaked queues, and nurses bending over cold boxes filled with childhood vaccines. Yet there is another image that rarely appears in the nation’s public health imagination — the adult Nigerian who also needs protection but finds none. Across the country, diseases such as hepatitis B, tetanus, shingles and influenza continue to quietly infect adults, many of whom have no idea that vaccines exist for them. Others who do know quickly discover that the system is simply not designed for them. As Nigeria reviews its National Immunisation Policy for the first time in years, experts warn that the country has maintained a childhood-only mindset that leaves adults dangerously exposed. Koko Maxwella, writes.
“It is a silent gap,” said a public health expert, Dr. Halima Yusuf. “Most of our national campaigns are centred around children. Adults are not even sensitised about the importance of boosters or preventive vaccines. Many facilities do not stock adult vaccines because there is no strong policy pushing it.”
Her frustration is shared across the health sector. For decades, Nigeria has celebrated improved childhood immunisation coverage — thanks largely to global programmes like Gavi — but has failed to integrate adult vaccination into mainstream health planning. The result is a system where adults must navigate a fragmented, expensive and often unavailable pathway to protection.
A System Designed for Children — and Children Alone
Unlike the fully funded childhood routine immunisation programme, adult vaccines have no subsidy, no dedicated cold-chain allocation and no existing budget line in most states. Even motivated adults struggle.
At a private clinic in Abuja, Dr. Kelvin Onuoha described the challenge as structural, not malicious. “People think hospitals are refusing to give adult vaccines, but the real issue is that the health system never built a structure for it,” he said. “If you walk into many public centres today and ask for an adult tetanus booster, they’ll tell you, ‘We don’t have it.’ And because the government doesn’t fund adult immunisation, people cannot even pay for what isn’t available.”
The absence of policy ripples through every layer of care. Primary health centres — the cornerstone of childhood immunisation — are not mandated or trained to deliver adult shots. Many nurses do not consider it part of their routine responsibilities.
According to Dr. Aisha Yusuf, the explain, “Childhood vaccines are free because they are part of Nigeria’s national immunisation programme,” she said. “Adult vaccines, however, are not included. There is no policy making them free. There is no policy supporting hospitals to store them. That is why even willing adults cannot access them.”
Hidden Costs, Hidden Risks
For many Nigerians, the first time they hear about adult vaccination is during a crisis.
That was the case for 35-year-old trader, Mrs Rose Ekanem, whose brother fell ill with hepatitis B earlier this year. “When he was diagnosed, the doctor told us the rest of us should take the vaccine,” she recalled. “We went to the general hospital, but they said they don’t have it. We kept going back. If these vaccines are important, why are they not in our hospitals?”
Her confusion mirrors that of millions. Without government funding, vaccines such as hepatitis B, influenza or HPV are available only in private facilities — and often at prohibitive prices. Those prices, experts say, determine who gets protected and who does not.
Some Nigerians, like 28-year-old teacher Miss Patience Daniel, are willing and able to pay, but still hit a wall. “I tried to get a flu vaccine during a recent outbreak but was told the hospital only administers it during certain periods,” she said. “I’m ready to pay, but they told me they don’t have it in stock and that only a few private hospitals might have it. How can something important be available in only two or three places?”
A Workforce Left Unprotected
Healthcare workers — ironically those at highest risk — are among the most unprotected adult groups. Many hospitals do not have staff vaccination programmes, leaving nurses, cleaners, laboratory technicians, and emergency responders exposed to infections that could be prevented with routine shots.
A nurse at a large public hospital, who asked not to be named because she is not authorised to speak publicly, described adult vaccination as “a personal responsibility, not an institutional one.”
“We tell mothers to vaccinate their children,” she said, “but nobody vaccinates us.”
Occupational health advocates argue that Nigeria’s private sector has also failed to implement workplace vaccination programmes, which are common in many countries. Industries such as food handling, hospitality, health, construction, and even law enforcement involve daily exposure to pathogens, yet have no immunisation requirements.
The Policy Vacuum — and the Moment for Change
Nigeria is currently reviewing its National Immunisation Policy; a move experts describe as a rare opportunity to redefine health protection for the entire population. But adult vaccination remains almost invisible in early drafts and public discussion.
A senior official at the National Primary Health Care Development Agency (NPHCDA), speaking independently, confirmed that adult vaccination “is being discussed but has not been fully integrated into the national vision.”
Public health analysts warn that the consequences of exclusion extend far beyond individual illness. Adult vaccine-preventable diseases drive up hospital admissions, reduce workforce productivity, and increase healthcare spending on avoidable treatment.
Nigeria’s commitments to the Sustainable Development Goals — especially SDG 3 on universal health coverage — hinge on expanding access to essential vaccines for all age groups, not only children. Without adult immunisation, universal coverage remains mathematically impossible.
A Growing Call for Lifelong Immunity
Doctors say the benefits of adult immunisation are straightforward and significant:
Tetanus boosters every 10 years prevent severe infections from everyday injuries.
Hepatitis B vaccines protect against a virus that affects millions globally.
Influenza shots reduce seasonal outbreaks and lower hospital admissions.
HPV vaccines reduce cervical and other cancers.
“What we need is simple,” Dr. Halima said. “Policy direction, funding support, and system integration. Vaccination should not end at childhood. Immunity is a lifelong need.”
The Human Cost of Delay
For adults like Rose, Emmanuel (her brother), and Patience, the impact of the gap is not theoretical — it is reality. Their stories reflect millions of unseen struggles across the country.
“If I can walk into a hospital to get malaria treatment,” Patience said, “Why can I not walk in to get a vaccine that prevents the sickness in the first place?”
As Nigeria pushes toward a stronger, more resilient healthcare system, experts say redefining immunisation as a cradle-to-old-age service is long overdue. Only when adult protection is normalised — affordable, accessible and routine — will the country truly achieve comprehensive public health security.
For now, the hope remains that one day, adults will be as protected as the children the system so proudly serves.
About the Author
Oluwafunbi Bello 
Oluwatobi Adu 
Hussaini Ibrahim