Abstract
COVID-19 vaccine hesitancy has emerged as a major challenge to global efforts to control the pandemic, particularly in Nigeria, where hesitancy to other effective vaccines such as polio and measles has been widely reported. Several individual, societal, and structural factors contribute to this behaviour and prevent the effectiveness of COVID-19 prevention efforts.
This study sought to identify the predictors of COVID-19 vaccine hesitancy in the seven states of North-Central, Nigeria.
A population-based cross-sectional online survey was conducted among residents using a semi-structured questionnaire adapted from the WHO SAGE vaccine hesitancy scale and distributed via social media networks over 8-weeks.
A total of 1,429 responses met the inclusion criteria and were analysed. Among the respondents, 60.7% were males, 47.5% were between the ages of 26 and 45, and 80.1% had postsecondary education. A total of 421 respondents (29.5%) were hesitant and unwilling to receive the vaccine. The reasons for hesitancy were concerns about side effects (37.1%), doubt about the existence of COVID-19 (11.0%), and the perception of time required to receive the vaccine (9.6%). Post-secondary education (AOR: 0.49, 0.36-0.66) and people of the Islamic faith (AOR: 0.68, 0.52-0.90) were found to be associated with lower levels of hesitancy.
The study found that vaccine hesitancy is a complex problem that is linked with multiple social determinants of health as lower educational attainment, lower income and Christian faith were found to be predictors of vaccine hesitancy. Confidence, Complacency and Convenience factors were expressed by respondents as concerns about side effects, doubt about the existence of COVID-19 and time required to receive the vaccines were the most prominent reasons for unwillingness to receive the vaccine. In order to protect the public health of communities, targeted interventions are required to increase vaccine acceptance by cultivating trust in vaccines, disseminating accurate information, and engaging with community stakeholders including religious groups.
Author Contributions
Copyright© 2024
Olutola Ayodotun, et al.
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Competing interests The authors have declared that no competing interests exist.
Funding Interests:
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Introduction
The COVID-19 pandemic resulted globally in more than 769 million cases and 6.9 million deaths. Within the first year of the COVID-19 pandemic, Janssen completed phase 3 trial of a potential COVID-19 vaccine The World Health Organization SAGE working group identified three barriers to vaccine uptake known as the 3C’s: Confidence/lack of confidence (in vaccines and lack of trust in the system that delivers them), complacency, (when perceived risks of vaccine-preventable diseases are low or when vaccination is considered secondary to other responsibilities at a given point in time) and convenience (which denotes the extent to which physical availability, affordability, and access to information and other immunization services exist). As of June 18, 2022, only 13% of Nigerians had completed all recommended COVID-19 vaccines despite the widespread availability of the vaccines This study is designed to identify the predictors of COVID-19 vaccine hesitancy in the seven states of North-Central, Nigeria.
Results
The study recorded a total of 1,999 survey entries, of which 13 did not consent to participate in the survey, yielding a response rate of 99.3%. We excluded 557 responses for not meeting the inclusion criteria. Thus, the final sample size for this study was 1,429. Out of the 1,429 responses included in the study analysis, 1,008 (70.5%) were willing to accept or had received at least one dose of the COVID-19 vaccine while 421 (29.5%) were unvaccinated and hesitant as shown in As shown in a. Traditional and Non-religious According to *p < 0.05 a. Traditional and Non-religious Concerns about side effects were the most common reasons for vaccine hesitancy (37.1%). Others expressed reasons such as doubt about the existence of COVID-19 (11.0%), the perception of time required to receive the vaccine (9.6%), dislike or fear of needles (7.2%) and possible complications caused by underlying medical conditions (5.5%). A few believed that the vaccines were not effective (6.5%) ( According to *p < 0.05 a. Traditional and Non-religious As shown in The majority of respondents reported support for vaccination from community and religious leaders (85.5%). However, 68.8% of them expressed unwillingness to follow the advice of leaders. The majority lacked trust in the government’s ability to procure the highest quality vaccine (71.5%), 66.3% perceived the COVID-19 vaccine as unsafe while 62% perceived it as non-essential for preventing the COVID-19 virus. More than 40% expressed a lack of trust in health workers to safely deliver the vaccine (47.5%) and unfavourable clinic waiting time for vaccination as factors that discourage them from taking the COVID-19 vaccine. (43.2%), (
FCT
524
36.7
Benue
79
5.5
Kogi
147
10.3
Kwara
46
3.2
Nasarawa
223
15.6
Niger
238
16.7
Plateau
172
12.0
Female
562
39.3
Male
867
60.7
18–25
618
43.3
26–45
678
47.5
>45
133
9.3
Single
916
64.1
Married
404
28.3
Previously married
109
7.6
Christianity
817
57.2
Islam
577
40.4
Othersa
35
2.5
No
285
19.9
Yes
1,144
80.1
Unemployed
628
43.9
Employed
801
56.1
Less than #30, 000
523
36.6
#30,000 - #150,000
660
46.2
Above #150, 000
246
17.2
0.12
FCT
28 (35.4%)
51 (64.6%)
79
Benue
149 (28.4%)
375 (71.6%)
524
Kogi
53 (36.1%)
94 (63.9%)
147
Kwara
11 (23.9%)
35 (76.1%)
46
Nasarawa
52 (23.3%)
171 (76.7%)
223
Niger
75 (31.5%)
163 (68.5%)
238
Plateau
53 (30.8%)
119 (69.2%)
172
0.52
Female
171 (30.4%)
391 (69.6%)
562
Male
250 (28.8%)
617 (71.2%)
867
0.31
18 – 25
195 (31.6%)
423 (68.4%)
618
26 – 45
190 (28.0%)
488 (72.0%)
678
Above 45
36 (27.1%)
97 (72.9%)
133
0.25
Single
274 (29.9%)
642 (70.1%)
916
Married
109 (27.0%)
295 (73.0%)
404
Previously married
38 (34.9%)
71 (65.1%)
109
0.00*
Christianity
258 (31.6%)
559 (68.4%)
817
Islam
147 (25.5%)
430 (74.5%)
577
Othersa
16 (45.7%)
19 (54.3%)
35
0.00*
No
124 (43.5%)
161 (54.5%)
285
Yes
297 (26.0%)
847 (74.0%)
1, 144
0.91
Unemployed
184 (29.3%)
444 (70.7%)
628
Employed
237 (29.6%)
564 (70.4%)
801
0.00*
Less than #30, 000
185 (35.4%)
338 (64.6%)
523
#30,000 - #150,000
177 (26.8%)
483 (73.2%)
660
Above #150, 000
59 (24.0%)
187 (76.0%)
246
FCT
149 (28.4)
375 (71.6)
524
Ref
Ref
Benue
28 (35.4)
51 (64.6)
79
1.38 (0.84-2.27)
0.20
1.19 (0.71-2.00)
0.52
Kogi
53 (36.1)
94 (63.9)
147
1.42 (0.96-2.09)
0.08
1.21 (0.81-1.81)
0.35
Kwara
11 (23.9)
35 (76.1)
46
0.79 (0.39-1.60)
0.51
0.77 (0.38-1.59)
0.48
Nasarawa
52 (23.3)
171 (76.7)
223
0.77 (0.53-1.10)
0.15
0.68 (0.46-1.00)
0.05
Niger
75 (31.5)
163 (68.5)
238
1.16 (0.83-1.62)
0.39
1.09 (0.76-1.55)
0.64
Plateau
53 (30.8)
119 (69.2)
172
1.12 (0.77-1.63)
0.55
1.07 (0.73-1.57)
0.74
Female
171 (30.4)
391 (69.6)
562
Ref
Ref
Male
250 (28.8)
617 (71.2)
867
0.93 (0.73-1.17)
0.52
1.00 (0.78-1.28)
0.98
18-25
195 (31.6)
423 (68.5)
618
Ref
Ref
26-45
190 (28.0)
488 (72.0)
678
0.84 (0.67-1.07)
0.17
0.92 (0.69-1.22)
0.58
>45
36 (27.1)
97 (72.9)
133
0.81(0.53-1.22)
0.31
0.84 (0.49-1.47)
0.55
Single
274 (29.9)
642 (70.1)
916
Ref
Ref
Married
109 (27.0)
295 (73.0)
404
0.87 (0.67-1.12)
0.28
0.99 (0.72-1.36)
0.94
Previously married
38 (34.9)
71 (65.1)
109
1.25 (0.83-1.91)
0.29
1.42 (0.84-2.40)
0.20
Christianity
258 (31.6)
559 (68.4)
817
Ref
Ref
Islam
147 (25.5)
430 (74.5)
577
0.74 (0.58-0.94)
0.01
0.68 (0.52-0.90)
0.01*
Others
16 (45.7)
19 (54.3)
35
1.82 (0.92-3.61)
0.08
1.65 (0.81-3.33)
0.17
No
124 (43.5)
161 (56.5)
285
Ref
Ref
Yes
297 (26.0)
847 (74.0)
1,144
0.46 (0.35-0.60)
0.00
0.49 (0.36-0.66)
0.00*
Unemployed
184 (29.3%)
444 (70.7%)
628
Ref
Ref
Employed
237 (29.6%)
564 (70.4%)
801
1.01 (0.81-1.28)
0.91
1.00 (0.79-1.26)
0.99
Less than #30, 000
185 (35.4)
338 (64.6)
523
Ref
Ref
#30,000 - #150,000
177 (26.8)
483 (73.2)
660
0.67 (0.52-0.86)
0.00
0.77 (0.59-1.01)
0.06
Above #150, 000
59 (24.0)
187 (76.0)
246
0.58 (0.41-0.81)
0.00
0.66 (0.44-0.99)
0.05
Leaders, gatekeepers, and pro-vaccination
Do religious leaders in your community support taking the COVID-19 vaccine?
61 (14.5%)
360 (85.5%)
Do politicians, teachers, and health workers in your community support vaccination?
29 (6.9%)
392 (93.1%)
Do you follow the advice of your religious/cultural leaders about the COVID-19 vaccination?
289 (68.6%)
132 (31.4%)
Does your religion/culture recommend against the COVID-19 vaccination?
355 (84.3%)
66 (15.7%)
Political influences
Do you trust that your government is deciding in your best interest concerning the COVID-19 vaccine
265 (62.9%)
156 (37.1%)
Are you convinced that your government purchases the highest quality of the COVID-19 vaccine
301 (71.5%)
120 (28.5%)
Do you trust that the government is making the best efforts to store the vaccines in the right conditions?
288 (68.4%)
133 (31.6%)
Geographical barriers
Does distance limit you from getting the vaccine?
264 (62.7%)
157 (37.3%)
Does clinic time or waiting at the clinic prevent you from getting the COVID-19 vaccine?
239 (56.8%)
182 (43.2%)
Pharmaceutical industry
Do you think governments are pushed by the pharmaceutical industries to recommend vaccines?
106 (25.2%)
315 (74.8%)
Do you trust the pharmaceutical companies that produce the COVID-19 vaccine?
303 (72.0%)
118 (28.0%)
The Vaccines/Vaccination issues
Do you think the vaccine is safe
279 (66.3%)
142 (33.7%)
The COVID-19 vaccine is essential for us
261 (62.0%)
160 (38.0%)
Do you trust the healthcare workers to safely administer the vaccine to you?
221 (52.5%)
200 (47.5%)
Is the vaccination process convenient, i.e., is it easier for you to get vaccinated
262 (62.2%)
159 (37.8%)
Do you think that if everyone in society maintains preventive measures (face masks, social distancing, etc.), COVID-19 can be eradicated without vaccination?
136 (32.3%)
285 (67.7%)
Discussion
The COVID-19 pandemic resulted in significant disruption in the health and livelihoods globally. Despite the evidence that vaccines offer viable protection against the disease, achieving universal acceptance remains an uphill task. Nigeria has reported challenges with the uptake of several vaccines in different parts of the country including vaccines that were aimed at the prevention of infant mortality On a global level, vaccine hesitancy rates above 50% have been reported in China, Malaysia, Australia, Pakistan and Italy. Respondents of the Islamic faith had a 32% lower risk of hesitancy compared to the Christians. The impact of faith on health and social behaviours is very profound in Nigeria. Many adopt mannerisms or practices that conform to the teachings of religious leaders or community leaders. The notable anti-vaccine messaging that emanated from some prominent Christian leaders at the beginning of the pandemic may have contributed to vaccine hesitancy among some members of the faith. Our study identified a combination of confidence, convenience, and complacency factors as influencers of vaccine hesitancy. Nearly half of the vaccine-hesitant respondents cited a lack of confidence in the safety and side effect profile of the vaccines as the reasons for their unwillingness to be vaccinated. Other studies have documented similar findings. Complacency factors were demonstrated by those who expressed that the COVID infection was not real, the vaccine was not required and those who felt the use of universal precautions and personal protective equipment were adequate to address the epidemic. This may be potentiated by the high risk of misinformation among hesitant respondents as more than 50% of them relied on sources that are prone to biases such as social media, friends, and others for information about the vaccine. Examples of pervasive misinformation about the COVID-19 vaccine include rumours of the vaccine as a means of inoculating tracking chips into humans, the COVID-19 epidemic is a punishment from God, the illness is an effect of 5G technology deployment, while some believed it was just the regular flu. Convenience factors were expressed by more than a third of the respondents who indicated that distance from homes to vaccination centres, the perceived waiting time required to complete the vaccination, and the process of vaccination were unfavourable for them. These factors are likely associated with the cost of transportation or the opportunity costs of vaccination over other activities of priority such as work. This study provides a perspective on the COVID-19 vaccine hesitancy in a large region of Nigeria. Though similar studies have been conducted in other states or regions of the country, this adds to the body of knowledge about the magnitude of vaccine hesitancy and the factors that drive them in a large region of Northern Nigeria. We acknowledge some limitations of the study which may have affected the generalizability of its findings. This includes online survey methodology with possible selection and response biases. Participants were those with access to internet, computers or smartphones. In addition, the inferences from this study relate to the COVID-19 vaccine and may not apply to vaccines for other diseases.
Conclusion
This study's findings reaffirm vaccine hesitancy as a threat to COVID-19 prevention efforts in the North Central region of Nigeria. It enhances our understanding of the predictors of vaccine hesitancy and the reasons why people refuse to be vaccinated with the COVID-19 vaccine. The study found that vaccine hesitancy is a complex problem that is linked with multiple social determinants of health as lower educational attainment and Christian faith were found to be predictors of vaccine hesitancy. Confidence, Complacency and Convenience factors were expressed by respondents as concerns about side effects, doubt about the existence of COVID-19 and the time required to receive the vaccines were the most prominent reasons for unwillingness to receive the vaccine. The study highlights the importance of leveraging trusted sources of information, such as healthcare workers and social media, to disseminate accurate and timely information about COVID-19 and the vaccine. To protect the public health of communities, targeted interventions are required to increase vaccine acceptance by cultivating trust in vaccines, disseminating accurate information, and engaging with community stakeholders including religious groups.