Vaccine Hesitancy and Immunization Inequity in Nigeria: Public Health Determinants, Misinformation Dynamics, and Health System Strategies for Improved Uptake

Abstract

Vaccine hesitancy and immunization inequity remain major public health challenges in Nigeria, where limited access, uneven service delivery, and weak confidence in vaccines continue to constrain progress toward universal immunization coverage. This narrative review examined the public health determinants of vaccine hesitancy, the role of misinformation in shaping vaccine decisions, and the health system strategies that may improve equitable uptake. The literature search period spanned 2008 to 2026, drawing on evidence from biomedical, public health, behavioral, and policy studies to capture both routine childhood immunization and vaccine acceptance in the COVID 19 era. The reviewed evidence shows that vaccine hesitancy in Nigeria is not driven by a single factor, but by a combination of structural and social influences. Low coverage is closely linked to poverty, rural residence, distance to health facilities, insecurity, weak primary care, poor antenatal contact, and geographical inequities that leave many children zero dose or under immunized. Hesitancy is also shaped by low trust in health authorities, fear of side effects, doubts about vaccine effectiveness, religious interpretation, gendered decision making, and limited health literacy. In parallel, misinformation has become a powerful driver of resistance, especially through social media and video platforms where conspiracy narratives, fear-based content, and doubts about government intentions amplify uncertainty and reduce confidence. The review also indicates that uptake improves when interventions go beyond information sharing and address the realities of access and trust. Community engagement, trusted local communication, mobile reminders, stronger primaryhealth care delivery, women centered empowerment strategies, and culturally responsive outreach were repeatedly associated with better uptake and stronger acceptance. Overall, the evidence suggests that reducing vaccine hesitancy in Nigeria requires an integrated response that combines reliable service delivery, misinformation control, community partnership, and equity focused policy action. Such an approach is essential for improving immunization coverage, reducing the burden of zero dose children, and advancing the country’s broader public health goals.