Although routine immunisation coverage has improved in recent years, many children in northern Nigeria still receive no vaccines at all or fail to complete the schedule.
Under the harsh April sun, the heat was oppressive in Fagge Local Government Area of Kano State. But 56-year-old Uma Usman kept walking from one compound to another, calling out familiar names, knocking gently on half-open doors and asking after children she had come to know over the years.
Her job is to find children who missed their routine immunisation appointments.
“I know the community very well, so I follow them house by house,” Mrs Usman told PREMIUM TIMES. “If the parents don’t come, we check the register and trace the households.”
For Mrs Usman, behind every missed appointment, there is a story.
Sometimes a child is ill. Sometimes a mother cannot raise money for transport. Sometimes parents are occupied with work or family responsibilities.
“When you reach a house, you find it is not that they don’t want to come,” she said. “Something just stood in the way.”
Mrs Usman’s daily routine illustrates a broader reality observed in a PREMIUM TIMES investigation in Kano and Gombe states.
Contrary to the widespread assumption that vaccine shortages are the biggest obstacle to routine immunisation, frontline workers in the two states described a different problem. Vaccines are usually available. The challenge is ensuring children complete the immunisation schedule.
However, for many families who spoke with PREMIUM TIMES, the barrier is not acceptance but access. Long distances to health facilities, transport costs, delayed outreach activities and the daily struggle to earn a living often interrupt follow-up visits. As a result, many children receive their first vaccine but never complete the doses needed for full protection.
The consequences extend far beyond individual families.
This investigation examined routine immunisation efforts and challenges in Kano and Gombe between 2023 and 2026, drawing on field visits, interviews, official records and data from health authorities and development partners.
The period captures the continuing struggle to reach children who have never received a vaccine, as well as those who start their vaccination schedule but fail to complete it.
According to UNICEF, Nigeria has one of the world’s largest populations of zero-dose children, those who never received a routine vaccine. Its latest data shows that only about 67 per cent of surviving infants receive the third dose of the diphtheria, tetanus and pertussis (DTP3) vaccine, while coverage for the second dose of the measles vaccine is about 35 per cent.
Although routine immunisation coverage has improved in recent years, many children still receive no vaccines at all or fail to complete the schedule.
Behind those national figures are thousands of individual stories like the ones Mrs Usman encounters every week.
But the investigation found another, less visible reality.
Across communities in Kano and Gombe, routine immunisation continues largely because health workers, volunteers and community mobilisers bridge gaps created by delayed funding, difficult terrain and overstretched primary healthcare systems.
Many spend their own money to reach remote settlements. Volunteers without formal employment trace children from house to house. Outreach activities continue even when operational funds arrive months late.
The pattern seen in Fagge extends far beyond one community.
In Takai LGA of Kano State, reaching children who miss vaccination appointments often means travelling long distances across scattered settlements. Health workers say routine clinic sessions alone are not enough; repeated outreach visits are essential to find children who fail to return.
“There is never a time when people come and we do not have vaccines,” said Muhammad Ali, the officer-in-charge at Gamawa Health Post in neighbouring Gombe State.
Field records reviewed by PREMIUM TIMES and interviews with frontline workers showed that children scheduled for follow-up are not always reached as planned.
Health workers explained that outreach teams frequently face transport constraints, limited time, and difficult terrain, making it impossible to visit every household listed for follow-up during a single outreach exercise.
“We don’t refuse to go,” one health worker said. “But sometimes the list is longer than what we can physically cover in one outreach.”
Many children miss vaccine doses because follow-up visits could not be completed.
In Billiri LGA of Gombe State, the pattern is the same.
Health workers and volunteer mobilisers spend almost as much time searching for children who missed appointments as they do on administering vaccines.
Across these locations, one pattern persists: children often begin immunisation but fail to complete the schedule because of family challenges.
For Ignatius Essien, general manager of eHealth Systems Africa, the difficulty families face getting to health facilities helps explain the introduction of the Zero Dose Support Programme.
