When COVID-19 emerged, it revealed vulnerabilities in health systems across the globe. There was widespread concern among public health experts that the pandemic would cripple essential services, including routine immunization. At the same time, it accelerated innovation and adaptability in service delivery. In Northern Nigeria, where routine immunization (RI) systems had already navigated complex operational contexts, the pandemic posed a significant test. Yet rather than collapse, the system adapted. It absorbed the shock, identified areas for improvement, and brought several latent strengths to the surface. A 2023 study published by SCIDaR in Sustainability examined RI systems across six states, Bauchi, Borno, Kaduna, Kano, Sokoto, and Yobe, and confirmed this balanced reality (MDPI 2023).
Drawing on research and our experiences, we would explore the impact of the shock on the health systems, how RI systems were able to address the challenges, and the key enablers that helped the system remain efficient and function during the period. We hope that this case study helps health actors understand the drivers of resilience and find ways to strengthen their systems, ensuring readiness for potential shocks in the future.
Initial Impact of the pandemic
As expected, the frequency of outreach sessions reduced across the board. In Bauchi, Sokoto, and Yobe, the number of coordination meetings also declined in 2020 compared to 2019. Completion of action points fell in Sokoto and Yobe. Frontline workers had to manage increased workloads, often without full access to protective equipment. This was partly due to movement restrictions and workforce shortages. Additionally, community engagement efforts were scaled back, allowing misinformation to gain ground and vaccine confidence to dip.
Despite these disruptions, the study highlighted encouraging progress, especially in vaccine supply and supportive supervision. Despite early constraints, vaccine stock outs reduced in 2020 compared to 2019. Similarly, monitoring visits to health facilities increased, underscoring improvements in oversight and system responsiveness.
Understanding the Indicators for Resilience
Even with the unprecedented strain that the COVID-19 pandemic placed on health systems globally, certain elements within Northern Nigeria’s routine immunization (RI) architecture enabled the system to remain functional and, in some areas, even improve. The study identified specific drivers that underpinned these resilience mechanisms and practices that allowed service delivery to continue despite widespread disruptions. Recognizing these factors is critical not only for sustaining progress but for designing future-ready immunization systems. The four key factors that contributed to system resilience were:
- Strong community engagement
- Consistent supervision
- Vaccine supply chain performance
- Digital monitoring tools
The data from the study made it clear that strong community engagement was one of the strongest pillars of resilience in the routine immunization system during the pandemic. By prioritizing people-centered and community-led approaches, health actors were able to build trust, strengthen social cohesion, and limit the adverse effects of COVID-19 on immunization uptake. Coordinated and proactive engagement strategies helped sustain demand for vaccines and counter misinformation at the community level. Rather than relying on top-down directives, the shift toward two-way communication and participatory approaches grounded in local realities was instrumental in maintaining service continuity and supporting outbreak control.
Supportive supervision was a functional component of the immunization system that allowed for the identification of existing gaps, provided an opportunity for on-site training, and documented real-time findings for program improvement. Supportive supervision also remained consistent and, in some instances, improved.
Importantly, several system components demonstrated resilience. Vaccine supply chains, in particular, performed strongly. All six states recorded improvements in the timely delivery of vaccines to apex facilities in 2020, compared to the previous year. Stockout rates in Borno, Sokoto, and Yobe were notably higher in 2019 than in 2020. These results were linked to the introduction of direct-to-facility delivery models and the strategic use of COVID-19 response infrastructure to support routine immunization. This approach eased pressure on facility teams and helped maintain uninterrupted services.
Digital monitoring tools originally developed for COVID-19 tracking were successfully repurposed for RI. The number of LGA-led routine immunization support supervision (RISS) visits to health facilities rose significantly in Bauchi, Kano, and Yobe in 2020 compared to 2019. These tools enabled timely, effective oversight despite movement limitations. As highlighted in the study, this flexibility helped close supervision gaps and ensured program continuity. In settings where these components remained stable, immunization services continued with fewer disruptions.
Taken together, the findings point to a critical insight: systems led at the state level, especially those related to logistics and supervision, were more adaptable than those heavily reliant on direct community interaction. Going forward, investments must prioritize strengthening the aspects of RI delivery that were most impacted: health facility operations and community engagement.
“Lockdowns halted nearly all outreach, and caregivers became fearful,” a Kaduna LGA immunization officer shared.“When movement stopped, we switched to mobile reporting. It kept our eyes on the ground, vaccines didn’t pause,” added another immunization coordinator in Kaduna.
To further enhance future readiness, Health systems will benefit from targeted investments in three key areas: revitalizing community-level outreach, scaling digital supervision tools, and integrating contingency planning into frontline service delivery. The pandemic challenged the system, but it also validated what works and where to build from.
This taught everyone that resilience is not just about managing disruption, it is about transforming how systems function under pressure, and that now is the time to invest strategically in people, platforms, and processes that ensure consistent, equitable immunization coverage.
