MSF Rations Diphtheria Antitoxin in Northern Nigeria as Stocks Run Dangerously Low

Doctors Without Borders (MSF) said in a statement from Abuja on Friday, Nov. 13, that its stocks of diphtheria antitoxin in Nigeria are "dangerously low." The group says its teams have repeatedly had to ration the drug or treat patients without enough of it.

"The global shortage of diphtheria antitoxin is becoming a matter of life and death," said Dr. David Kizito, MSF's medical coordinator in Nigeria. "We risk being unable to treat children and save lives as the outbreak continues."

The drug and the clock

Antitoxin is the only specific treatment that neutralizes the toxin produced by diphtheria. It sits on the WHO Model List of Essential Medicines. MSF says it works best within 48 hours of symptom onset.

Without appropriate treatment, MSF says, 30 to 40 percent of people with diphtheria may die. The toxin can damage the heart, nerves and kidneys.

The supply problem is global. The antitoxin is made from the blood plasma of immunized horses, and a December 2025 report found that many producers have stopped making it because demand is hard to predict. MSF says neither Nigeria nor most other countries keep emergency reserves.

The numbers

Nigeria has fought diphtheria since late 2022. MSF puts the cumulative toll at more than 41,000 suspected cases, more than 24,000 confirmed infections and over 1,260 deaths.

For 2026 alone, MSF cites 12,977 suspected cases, 10,476 confirmed infections and 406 deaths as of Aug. 9. That is a three-month-old snapshot.

A Red Cross situation report dated Nov. 11, citing Nigeria Centre for Disease Control and Prevention data as of Nov. 7, lists 28,151 confirmed cases and 1,126 deaths in Nigeria this year. That covers 26 states, the Federal Capital Territory and 361 local government areas.

The two sets of figures do not line up. The Red Cross count of 2026 confirmed cases is higher than MSF's cumulative confirmed total since 2022. The data cutoffs are nearly three months apart, and neither organization has explained the gap. Anyone trying to size this outbreak is working from numbers that do not reconcile.

What MSF is seeing on the ground

The worst-hit northern states include Bauchi, Borno, Kaduna, Katsina, Kano, Plateau, Sokoto and Zamfara. MSF has treated more than 9,000 diphtheria patients this year.

In Katsina State, MSF teams managed 86 cases between Oct. 26 and Nov. 12. Of those, 70 were severe and 16 non-severe. Teams reached 1,315 contacts, vaccinated 1,301 of them and gave antibiotic prophylaxis to 1,311.

In Zamfara State, where an outbreak was declared in September, MSF-supported facilities in Gusau recorded more than 671 admissions in the month from Oct. 6. Most were children. Four of every five admitted patients had not been vaccinated.

Only 25,000 of the 90,000 vaccine doses needed for a reactive campaign in Zamfara have been supplied, according to MSF. That leaves 65,000 doses short.

In Kano State, MSF and the state Ministry of Health ran a two-round campaign in April and June that gave more than 835,000 vaccine doses to children.

A school outbreak in Kano

Kano's own officials are asking for more vaccine. Prof. Muhammad Adamu Abbas, director-general of the Kano State Centre for Disease Control, confirmed an outbreak at First Lady's College in Mariri, Kumbotso Local Government Area. The boarding school has more than 2,000 students.

Abbas said his agency received the report on Wednesday and sent a team. Of 313 suspected cases tested, 12 were clinically confirmed. One severely ill student was admitted to the Infectious Diseases Hospital in Kano. Others are being treated at the school, and medication went to all suspected contacts.

"There is a need for massive vaccination in the school, which we presently do not have," Abbas said.

Diphtheria has also reportedly killed about 50 people in Rano Local Government Area of Kano in October, according to local reports. The state agency confirmed it is investigating that incident, and the figure has not been independently verified.

What MSF wants

Diphtheria is vaccine-preventable. Kizito said children keep arriving at clinics with life-threatening complications because they are not fully vaccinated or cannot reach care in time.

MSF is asking federal and state authorities, donors and international partners to secure existing antitoxin, vaccines and other essential medicines. It also wants those supplies cleared quickly at ports of entry and moved fast to affected communities. Delay at the port is a bureaucratic problem that Nigerian officials control.

No reserve stockpile exists, producers have been leaving the market, and the drug has a 48-hour window. The open question is whether the 65,000-dose gap in Zamfara and the vaccine request from Kano's school outbreak get filled before the next wave of admissions.