From research to action: strengthening surveillance to eliminate vaccine-preventable cancers in Nigeria

¹Department of Community Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria, ²Nigerian Cancer Society, Abuja, Nigeria, ³Washington University in St. Louis School of Medicine, St. Louis, Missouri, United State of America, ⁴University of North Carolina School of Medicine, Chapel Hill, North Carolina, United State of America, ⁵Nigerian Institute for Medical Research, Yaba, Lagos, Nigeria, ⁶Department of Biostatistics and Epidemiology, Nanjing Medical University, Jiangning District, Nanjing, Jiangsu, China

^&Corresponding author
Chinelo Cynthia Nduka, Department of Community Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria

Essay    

Introduction: cervical and liver cancers are among Nigeria’s most common preventable cancer killers. Cervical cancer remains a leading cause of cancer death in women of reproductive age. At the same time, hepatocellular carcinoma (HCC), largely due to chronic hepatitis B virus (HBV), continues to exact a heavy toll [1,2]. Proven tools exist, such as timely HBV birth-dose vaccination (HepB-BD) within 24 hours of birth, routine HPV vaccination for adolescents, and basic screening pathways [3,4]. Nigeria has adopted these policies (nationwide HPV rollout began in 2023; HepB-BD is in the national immunization schedule) [5, 6]. But there are lags in coverage, timeliness, and continuity to completion, especially when many births occur outside health facilities and vaccine hesitancy is common [7, 8]. At the same time, cancer registries and immunization/screening data are poorly linked, limiting visibility on where coverage stalls and limiting real-time responses [9]. This disconnection between immunization systems and cancer registries, coupled with fragmented data flows, hampers targeted decision-making, while communities face awareness gaps and misinformation that depress uptake. Experience from Rwanda shows that digitally linking HPV vaccination data with broader cervical cancer services is feasible and improves program delivery [10]. This commentary draws on that experience to propose how Nigeria can close that execution gap by aligning vaccination scale-up with a lean, linked surveillance architecture that turns local data into routine program decisions.

Argument: Nigeria already has the evidence, vaccines, and policy frameworks to end vaccine-preventable cancers [5,6]; the binding constraints are implementation and accountability. Despite a National Cancer Control Programme (NCCP), the HBV birth dose is not consistently integrated into routine delivery points (especially those outside health facilities), and HPV vaccination has not yet been scaled to the levels required [11]. Disconnections between immunization systems and cancer registries, along with fragmented data flows, hamper targeted decision-making. Meanwhile, communities, especially women and girls, face awareness gaps and misinformation, further depressing uptake [12]. These misalignments create a self-reinforcing cycle: weak surveillance obscures the local burden and service gaps; thin evidence weakens advocacy; weak advocacy depresses financing and political priority; underfunded programs then fail to expand access. Breaking this cycle requires political leadership, linked surveillance, and deliberate translation of research into time-boxed, policy-ready actions tied to routine decision calendars (micro-planning, procurement, budgets).

Evidence: global and regional experience shows that rapid progress against vaccine-preventable cancers depends less on new science and more on delivery design and linked surveillance [13]. Programs that anchor HPV vaccination in schools and mobilize trusted local messengers routinely achieve swift gains in HPV vaccination uptake and coverage [14]. Where countries institutionalize HepB vaccination with a strict birth-dose standard (within 24 hours), and create options for day-0 delivery outside facilities, childhood HBV prevalence falls, and adolescent/young-adult liver cancer declines follow [15]. Long-running African cohort studies confirm that infant HepB vaccination markedly reduces chronic infection and later liver cancer risk, underscoring relevance to West African settings [16]. In parallel, jurisdictions that link cancer registries to immunization and screening data through routine feeds and simple planning dashboards improve hotspot targeting, resource allocation, and accountability, enabling quicker course corrections when coverage stalls [17]. Country precedents illustrate these transferable mechanisms. Rwanda paired school-based HPV delivery with community mobilization to accelerate uptake [14]. China embedded universal infant HepB with a day-0 birth dose, documenting dramatic reductions in childhood HBV and subsequent HCC [15]. The Gambia Hepatitis Intervention Study provides long-term African evidence that infant hepB vaccination lowers chronic infection and liver cancer risk [16]. Zambia and South Africa strengthened registries and connected them to prevention programs, using routine dashboards to direct outreach and reallocate resources [17]. The common thread, and Nigeria’s opportunity, is to deliver vaccines where people actually are (schools for HPV; facility and non-facility birth points for HepB-BD) and to wire surveillance to routine decision calendars so data trigger timely, concrete actions.

Implications: if Nigeria continues with fragmented data and uneven delivery, cervical and liver cancers will keep claiming preventable lives, with late presentation driving high costs and poor outcomes. Implementing a lean surveillance-to-action loop, capturing a minimum dataset (HPV vaccination uptake; HepB-BD within 24 hours and late-dose catch-up), linking it to local government area (LGA)/state dashboards, and issuing less than 2-page decision notes on a monthly cadence offers immediate, measurable benefits.

Health impact: increase the proportion of newborns receiving HepB-BD within 24 hours (including those outside facilities via traditional birth attendants (TBAs), and private outlets with simple late-dose catch-up pathways) and boost HPV dose-1 initiation and series completion through school micro-planning, reminder–recall, and myth-busting by trusted messengers.

System impact: routine data review, ensure a brief turnaround in less than 30 days, implement hotspot flagging, and enable rapid course correction (rescheduling sessions, mobilizing extra teams, resolving stockouts).

Policy impact: institutionalize an evidence-to-decision rhythm (quarterly reviews; public “You said → We did” notes), strengthen budget justifications tied to observed gaps, and clarify accountability between immunization programs and cancer control.

Equity impact: use disaggregated data to prioritize rural/low-income wards, girls, and non-facility births, narrowing persistent access and trust gaps. In short, feasibility is proven, and the gains are multi-level; the binding constraint is execution. Nigeria’s path forward is practical: design delivery to match local realities, link surveillance to routine decisions, and hold programs accountable for timely action.

Recommendations: the arise roadmap: Nigeria’s path forward is not to discover new science but to execute with discipline. We propose arise-align, review, integrate, strengthen, evaluate, a lean roadmap that links vaccination delivery to a continuous surveillance-to-action loop. Align within a fixed timeline, the Federal Ministry of Health, working with the National Primary Health Care Development Agency (NPHCDA), Nigeria Centre for Disease Control (NCDC), National Cancer Control Programme (NCCP), and state health authorities, should constitute a joint steering group that agrees on a small set of priority indicators, HPV vaccination coverage (single dose); HepB birth dose within 24 hours (including non-facility births); basic screening tallies and publishes a decision calendar tied to micro-planning and budget cycles. Evidence from World Health Organization (WHO) immunization monitoring guidance supports focusing on a limited set of actionable indicators to improve data use and accountability [18], and experience from national HPV programs in sub-Saharan Africa shows that early, multi-sectoral coordination of planning and data systems can enhance coverage outcomes [14]. Civil society, cancer survivors, educators, and community representatives should be included from the outset to ensure the indicators reflect real barriers and to secure political and social buy-in, consistent with evidence that broad stakeholder engagement strengthens relevance, feasibility, and sustained use of health data for action [19].

Review research institutions and policy analysts should conduct a rapid gap assessment of current data flows and service delivery: where single-dose HPV coverage among girls aged 9–14 is lowest (by school/ward), where day-0/≤24-hour HepB-BD fails due to births occurring outside facilities, and where stockouts or staffing gaps recur. The output is not a lengthy report but a short, time-bounded analysis that identifies actionable hotspots by LGA and ward, with 2–3 priority fixes per hotspot. Integrate NPHCDA and NCDC, with state data teams, should establish a minimal data link that brings HPV single-dose coverage (9-14 years), HepB-BD timeliness (≤24h, with late-dose catch-up), and basic screening tallies into routine LGA/state dashboards, with simple concordance checks against registry signals. Each month, these dashboards should trigger two-page decision notes specifying what must change (e.g., add a school session; mobilize community health influencers, promoters, and services (CHIPS) agents/TBAs/private outlets for rapid birth notification so a vaccinator can deliver HepB-BD within 24 hours; run reminder–recall; resolve stockouts) and who is accountable. Evidence from Nigeria shows that CHIPS agents and other community health workers improve timely vaccination, birth notification, and service uptake, particularly for hard-to-reach populations [20].

Strengthen: states and primary health care boards should use those decision notes to adjust delivery in real time: school-based micro-planning for HPV single-dose campaigns; defaulter tracing and trusted-messenger outreach where confidence barriers persist; and practical pathways for HepB-BD at non-facility births (pre-packed vaccine/consumable kits at nearby facilities, TBA/CHIPS agents birth-notification slips, and simple late-dose catch-up plans). Training and supervision should prioritize the few behaviors that move coverage rather than generic capacity building. For special-risk groups that still require more than one HPV dose (e.g., immunocompromised populations), include schedule-completion support in the plan.

Evaluate: quarterly reviews should close the loop, publishing a public dashboard and a brief “You said → We did” summary that shows how community inputs changed action. A light monitoring set is sufficient to sustain accountability without overburdening teams: turnaround from question to brief (≤30 days); completeness/timeliness of monthly extracts; trends in HepB-BD within 24 hours (and late-dose catch-up) and HPV single-dose coverage among girls 9-14; schedule completion for clearly defined special-risk groups; and equity gains in rural/low-income wards. Over 12-18 months, this cadence institutionalizes an evidence-to-decision rhythm and makes course correction routine. Taken together, Arise is not five new projects; it is one disciplined process in which alignment sets the agenda, review identifies bottlenecks, integration makes data usable, strengthening delivers the fix, and evaluation keeps the system honest. It directly answers the implementation and accountability gaps identified in this commentary and translates established evidence into monthly, owned actions.

Conclusion     

Nigeria can sharply cut cervical and liver cancer by doing two things consistently well: delivering vaccines where people actually are, in schools for single-dose HPV vaccination of girls 9-14 years and at both facility and non-facility birth points for day-0/≤24-hour HepB BD, and linking surveillance to routine decisions so coverage stalls trigger timely course correction. The precedents are clear, the tools are available, and the public health return is large; what is required now is disciplined execution with accountability. Arise provides a practical way to embed that discipline. By aligning actors around a minimal indicator set, quickly reviewing bottlenecks, integrating immunization and registry signals into simple LGA/state dashboards, strengthening delivery through concrete monthly actions, and evaluating on a predictable cadence, Nigeria can turn research into results. Over the next year, success should be judged not by new strategies written but by higher HepB-BD within 24 hours (including non-facility births), higher single-dose HPV coverage among girls 9-14, on-schedule completion for clearly defined special-risk groups, shorter evidence-to-action turnaround (≤30 days), and visible equity gains in the communities least well served. This is the kind of lean, surveillance-driven implementation this commentary calls for, and that Nigeria can deliver.

Competing interests     

The authors declare no competing interests.

Authors' contributions     

Chinelo Cynthia Nduka and Abidemi Omonisi conceptualized the manuscript. Chinelo Cynthia Nduka, Temitope Ojo, Folahanmi Akinsolu, Juliet Iwelunmor, Joseph Tucker, Oliver Ezechi and Abidemi Omonisi were involved in the design. Chinelo Cynthia Nduka and Abidemi Omonisi produced the first draft of the manuscript. Chinelo Cynthia Nduka, Temitope Ojo, Folahanmi Akinsolu, Olufunto Olusanya, Abidemi Omonisi and Joseph Tucker reviewed and refined the manuscript. All the authors have read and agreed the final manuscript.

Acknowledgments     

We acknowledge the US-Nigerian Cancer Control Center for Research on Implementation Science Excellence (C3-RISE) Network.

References