Nigeria needs to show “commitment” and “improvement” in routine immunisation figures in hopes of retaining support from the Global Alliance for Vaccines and Immunisation (GAVI) beyond 2021.

That’s the year GAVI support is meant to stop after a rebasing of Nigeria’s economy meant it was no longer considered a low-income country in need of immunisation support.

GAVI chief executive officer Seth Berkley visited Nigeria to meet with lawmakers, traditional leaders and governors in hopes of advocating to close gaps in immunisation financing and reach millions of unimmunised children.

“The decision that will be made on whether GAVI can continue to provide support after 2021 will be based upon the commitment that’s being shown by the government and the improvement that it’s done,” Berkley said.

“Many stakeholders have invested huge amounts of money—so far $732 million, and I think people want to see that results are occurring from that. That will decide on whether further support is provided.”

GAVI support has helped pay for vaccines in the last 17 years, but a transition out of its support has raised concern about sustaining financing for immunisation.

Since his arrival in the country on Monday, he’s met with Vice President Yemi Osinbajo and federal lawmakers, and on Thursday visited Maje Primary Health Centre in Niger—one of the first batch of 109 renovated under the PHC Revitilisation Programme.

He also held a townhall meeting with the Emir of Suleja HRH Awwal Ibrahim and Niger deputy governor Ahmed Ketso.

Despite increasing supply of vaccines, only two in 10 children in Niger get full routine immunisation. A national survey last year found an average three in 10 across the country was fully covered by immunisation.

“Nigeria now has the largest number of unimmunised children in the world, more than India, which has four times the population,” said Berkley.

“Coverage rates in surrounding countries are much higher, that’s why you are seeing the outbreaks [of vaccine preventable diseases]. These problems are solvable. The challenge is getting the political will, the community will to make that happen.”

The Maje centre has vaccine supply, but mobilising families to take children for immunisation is a problem. Only five of its workers are paid, all others are volunteers, staff complained before Niger deputy governor and health commissioner Mustapha Jibril.

The centre also lacks operational funds for outreaches and staff there complain of using their own airtime to call families to the centre.

Niger authorities have linked the number of unimmunised children to “unrealistic population estimates”, indicating actual populations exceed vaccine doses expended on target population.

Faisal Shuaib, executive director of the National Primary Health Care Development Agency, which regulates primary health care nationwide, said accepting last year’s survey which showed only 30% national immunisation coverage was a start for Nigeria.

“For decades, there have been false reports around the number of kids vaccinated in Nigeria, but surveys show we are not doing enough, reaching our kids,” Shuaib said.

“For the first time last year, we accepted the result. Knowing this is the baseline, we are now working with partners and traditional institutions.”

“If we do a great job of mobilising the communities then you can begin to see an increase in the number of kids that are being reached.

“It is not about unrealistic population estimate. That is a challenge but it is so small compared to the fact that we need to [admit] we are not doing enough and the government is now beginning to provide resources.

“In the 2018 budget, there is a 100% increase in the allocation for the procurement of vaccines and operations around delivery of vaccines. There has been declaration of public health emergency around the number of unimmunised children in Nigeria.”