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Effect of Vaccine Hesitancy on Childhood Immunization Uptake in Nigeria

Abstract

Vaccine hesitancy is an important public health challenge that can reduce the uptake of recommended childhood vaccinations and increase the risk of vaccine-preventable diseases. It refers to delay in acceptance or refusal of vaccines despite the availability of vaccination services and is influenced by factors such as concerns about vaccine safety, misinformation, distrust of health authorities, religious and cultural beliefs, perceived low risk of vaccine-preventable diseases, previous experiences with healthcare services, and uncertainty regarding vaccine effectiveness. Childhood immunization is one of the most effective public health interventions for preventing infectious diseases, reducing childhood morbidity and mortality, and promoting population health. In Nigeria, childhood immunization uptake remains a major public health concern, particularly in communities affected by poverty, insecurity, limited healthcare infrastructure, geographical barriers, inadequate health information, and low confidence in vaccination programmes. Although Nigeria has expanded routine immunization services and implemented several strategies to improve vaccination coverage, disparities in immunization uptake persist across regions and population groups. Vaccine hesitancy may further contribute to missed and delayed vaccinations, thereby reducing the effectiveness of immunization programmes and increasing the risk of outbreaks of vaccine-preventable diseases. Against this background, this study investigates the effect of vaccine hesitancy on childhood immunization uptake in Nigeria. The study is anchored on the Health Belief Model (HBM), Theory of Planned Behavior (TPB), and the 3Cs/5Cs framework of vaccine hesitancy. The Health Belief Model explains vaccination behavior through individuals' perceptions of disease susceptibility, disease severity, vaccine benefits, and barriers to vaccination, as well as cues that encourage preventive action. The Theory of Planned Behavior proposes that attitudes toward vaccination, perceived social expectations, and perceived behavioral control influence parents' intentions and decisions regarding childhood immunization. The vaccine hesitancy framework emphasizes factors such as confidence in vaccines and health authorities, complacency regarding vaccine-preventable diseases, and convenience or practical barriers to accessing vaccination services. Collectively, these theoretical perspectives provide a comprehensive framework for explaining how vaccine hesitancy may influence childhood immunization uptake in Nigeria. The study adopts a quantitative cross-sectional research design. Primary data will be collected from parents and caregivers of eligible children in selected communities in Nigeria using a structured interviewer-administered questionnaire. A multistage sampling technique will be employed to select states, local government areas, communities, households, and eligible parents or caregivers. Vaccine hesitancy will be measured using concerns about vaccine safety and effectiveness, confidence in healthcare providers and immunization programmes, perceived risk of vaccine-preventable diseases, acceptance or delay in vaccination, exposure to vaccine-related misinformation, trust in health authorities, and willingness to vaccinate children according to the recommended schedule. Childhood immunization uptake will be measured using vaccination status, completeness of age-appropriate vaccinations, timeliness of vaccination, missed vaccination doses, delayed vaccination, and utilization of routine immunization services. Descriptive statistics will be used to summarize respondents' sociodemographic characteristics, levels of vaccine hesitancy, and childhood immunization uptake. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic or multiple regression analysis, will be employed to determine the effect of vaccine hesitancy on childhood immunization uptake. Appropriate diagnostic tests will also be conducted to assess multicollinearity, model specification, goodness of fit, and the robustness of the estimated relationships. The study anticipates that vaccine hesitancy will have a significant negative effect on childhood immunization uptake in Nigeria. Parents and caregivers with higher levels of vaccine hesitancy are expected to be more likely to delay, refuse, or incompletely administer recommended childhood vaccines. Concerns about adverse effects, distrust of vaccine information, misinformation, perceived lack of necessity, and doubts about vaccine effectiveness may reduce parents' willingness to utilize routine immunization services. Conversely, higher confidence in vaccines and healthcare providers is expected to encourage timely and complete childhood vaccination. However, vaccine hesitancy may interact with broader barriers to immunization, including distance to healthcare facilities, transportation costs, vaccine availability, waiting time, insecurity, poverty, and limited access to reliable health information. Therefore, improving childhood immunization uptake may require not only addressing vaccine confidence but also strengthening the accessibility, convenience, reliability, and quality of routine immunization services. This study is expected to make significant contributions to the literature on immunization, health behavior, maternal and child health, and public health in Nigeria by providing empirical evidence on the relationship between vaccine hesitancy and childhood immunization uptake. The findings will provide useful information for the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency (NPHCDA), Nigeria Centre for Disease Control and Prevention (NCDC), National Emergency Management Agency, state ministries of health, local government health authorities, immunization programme managers, healthcare providers, community health workers, development partners, and policymakers regarding the factors influencing parental vaccination decisions. The study will also provide evidence-based recommendations for strengthening vaccine confidence, improving risk communication, addressing misinformation, engaging community and religious leaders, improving healthcare-provider communication, strengthening routine immunization services, and promoting timely and complete childhood vaccination across Nigerian communities.

Keywords: Vaccine hesitancy, childhood immunization, vaccine uptake, vaccination coverage, vaccine confidence, parents, caregivers, routine immunization, child health, public health, Nigeria.