Nigeria has endured a prolonged diphtheria outbreak for years. The disease continues to claim lives needlessly. The latest figures from the Nigeria Centre for Disease Control show more than 10,000 confirmed cases in 2026 alone, with eight northern states accounting for 98 per cent of them.
Kano remains the epicentre, while Borno, Bauchi, Plateau, Katsina and others report fresh clusters and deaths. About 68 per cent of confirmed cases have been found to involve people who were never vaccinated. This is not a mystery pathogen. It is a failure of basic public health.
Lagos State offers a contrasting picture. It has recorded only a handful of confirmed cases this year, managed them promptly, traced contacts and maintained designated treatment centres. The state has also pushed vaccination drives and public messaging. Its performance is better, though coverage still sits at around 64 per cent and zero-dose children persist in some dense communities. Even Lagos cannot claim victory while the national immunity gap remains wide.
It must be admitted that the national response has improved in one important respect. Case fatality rates have fallen as access to diphtheria antitoxin and organised treatment centres has expanded. Partnerships with groups such as Médecins Sans Frontières have helped vaccinate hundreds of thousands of children in Kano and support clinical care. These efforts deserve recognition. But they do not address the root cause.
Diphtheria thrives where routine immunisation is weak. National coverage for the third dose of diphtheria-containing vaccine remains suboptimal. Insecurity, hard-to-reach communities, population movement and vaccine hesitancy compound the problem in the North. Reactive campaigns after outbreaks appear are necessary but insufficient. They treat the symptom while the underlying immunity deficit continues to generate new waves of infection.
Authorities at federal and state levels need to shift from crisis management to sustained prevention. First, the National Primary Health Care Development Agency and state primary health care boards should treat routine immunisation as a non-negotiable priority. This means identifying every zero-dose and under-immunised child, particularly in the highest-burden local government areas, and delivering the full schedule of pentavalent vaccine plus recommended boosters. Outreach must be continuous, not episodic.
Second, security and logistics barriers require practical solutions. Mobile vaccination teams, partnerships with community and traditional leaders, and temporary safe corridors in insecure zones can extend reach where fixed facilities fail. Stockouts of vaccine and antitoxin must end. Reliable supply chains and buffer stocks are very essential.
Third, laboratory capacity and surveillance need urgent strengthening. Too many cases are still classified as clinically compatible rather than laboratory-confirmed. Faster diagnosis improves both individual treatment and the accuracy of the national picture.
Fourth, public communication ought to confront hesitancy directly. Clear, consistent messaging in local languages, delivered through trusted community channels, is more effective than occasional press briefings. Parents need to understand that the vaccine is free, safe and protective.
Lagos should not rest on its oars. It must close remaining coverage gaps in informal settlements and ensure school-age children receive any missed doses or boosters before term begins. Other southern and urban states should study Lagos’s surveillance and rapid response systems while recognising that national failure will eventually export cases southward.
Diphtheria is entirely preventable. Every death and every hospital admission represents a gap that competent public health systems elsewhere have closed. Nigeria has the tools, the partners and the knowledge. What it has lacked is the consistent political will to vaccinate every eligible child before the next outbreak forces another round of emergency meetings. The time for that will is now.
Dear Vows
