An Explorative Assessment of Factors Associated with Vaccine Hesitancy in Rural and Urban Communities in Akwa Ibom State, Nigeria
Abstract:
Vaccine hesitancy remains a critical bottleneck to optimising immunisation coverage and herd immunity globally. In sub-Saharan Africa, particularly within Nigeria's socio-cultural landscape, vaccine deployment faces varied structural, cognitive, and contextual impediments. This study explored the multiple factors influencing vaccine hesitancy across rural and urban communities in Akwa Ibom State, Nigeria. Utilising an exploratory, cross-sectional qualitative design, 12 In-Depth Interviews (IDI) were conducted across three Urban (Uyo, Abak, Oron) and three Rural (Itu, Oruk Anam, Nsit Ibom) Local Government Areas. Participants were selected through stratified purposive sampling to reduce bias. Narratives from IDIs were transcribed, coded and interpreted using thematic analysis, incorporating both inductive and deductive approaches. Rural participants exhibited high foundational demand and positive vaccine optimism, driven primarily by perceived disease severity, and this was aided by peer-to-peer diffusion of positive vaccination experiences. However, their vulnerability stemmed from information deficits. Conversely, urban cohorts exhibited fragmented risk perceptions, deep-seated institutional mistrust, and acute sensitivity to systemic and physiological risks. Urban settings were uniquely vulnerable to digital misinformation accelerated by dense, unmediated information within their environments. Local authority structures varied fundamentally: rural areas relied heavily on centralised, culturally legitimised figures (village heads, town criers), whereas urban networks required decentralised communication modes (churches, broadcast media, digital networks). Vaccine hesitancy is highly context-specific and ecologically distinct in Akwa Ibom State. Public health interventions must discard homogeneous, top-down communication paradigms in favour of tailored, double-loop community participation strategies that embed peer-champion mechanisms and localised risk communication within existing rural and urban communities.References:
[1]. World Health Organization.
Immunization coverage. Geneva: WHO; 2024 [cited 2026 Jul 8]. Available from: https://www.who.int/news-room/fact-sheets/detail/immunization-coverage
[2]. Andre FE, Booy R, Bock
HL, Clemens J, Datta SK, John TJ, et al. Vaccination greatly reduces disease, disability, death
and inequity worldwide. Bull World Health Organ. 2008;86(2):140-6.
doi:10.2471/BLT.07.
[3]. Thomson A, Robinson K,
Vallée-Tourangeau G. The 5As: A practical taxonomy for the determinants of
vaccine uptake. Vaccine. 2016;34(8):1018-24. doi:10.1016/j.vaccine.2015.11.065.
[4]. World Health Organization. Ten
threats to global health in 2019. Geneva: WHO; 2019 [cited 2026 Jul 8].
Available from: https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019
[5]. Wagner AL, Masters NB, Domek
GJ, Mathew JL, Sun X, Asturias EJ, et al. Comparisons of vaccine hesitancy
across five low- and middle-income countries. Vaccines. 2019;7(4):155.
doi:10.3390/vaccines7040155.
[6]. Larson HJ, Jarrett C,
Eckersberger E, Smith DMD, Paterson P. Understanding vaccine hesitancy around
vaccines and vaccination from a global perspective: A systematic review of
published literature, 2007-2012. Vaccine. 2014;32(19):2150-9. doi:10.1016/j.vaccine.2014.01.081.
[7]. Babalola S. Maternal reasons
for non-immunisation and partial immunisation in northern Nigeria. J Paediatr
Child Health. 2011;47(5):276-81. doi:10.1111/j.1440-1754.2010.01909.x.
[8]. Dubé E, Laberge C, Guay
M, Bramadat P, Roy R, Bettinger JA. Vaccine hesitancy: An overview. Hum Vaccin Immunother.
2013;9(8):1763-73. doi:10.4161/hv.24657.
[9]. Hansen PR, Schmidtblaicher M,
Bloom N. The value of vaccination. In: Bloom DE, editor. The value of
vaccination. New York: Springer; 2011. p. 1-8. doi:10.1007/978-1-4419-7185-2_1.
[10]. Bish A, Yardley L, Nicoll A,
Michie S. Factors associated with uptake of vaccination against pandemic
influenza: A systematic review. Vaccine. 2011;29(38):6472-84.
doi:10.1016/j.vaccine.2011.06.107.
[11]. Bertoncello C, Ferro A, Fonzo
M, Zanovello S, Napoletano G, Russo F, et al. Socioeconomic determinants in
vaccine hesitancy and vaccine refusal in Italy. Vaccines. 2020;8(2):276.
doi:10.3390/vaccines8020276.
[12]. Zhang J, Xiao Y, Yao X, Zu J.
Dynamic analysis of an SIR epidemic model with pulse vaccination and saturation
incidence. Int J Biomathematics. 2011;4(1):11-26.
[13]. Oladokun RE, Adedokun BO,
Lawoyin TO. Children who are not fully immunised and factors responsible for
this in Ibadan, South-Western Nigeria. J Trop Pediatr. 2009;56(5):322-8.
doi:10.1093/tropej/fmq004.
[14]. Antai D. Inequitable childhood
immunization uptake in Nigeria: A multilevel analysis of individual and
contextual determinants. BMC Infect Dis. 2009;9:181.
doi:10.1186/1471-2334-9-181.
[15]. Wei F, Mullooly JP, Goodman M,
McCarty MC, Hanson AM, Crane B, et al. Identification and characteristics of
vaccine refusers. BMC Pediatr. 2009;9:18. doi:10.1186/1471-2431-9-18.
[16]. Wu AC, Wisler-Scher DJ,
Griswold K, Colson E, Shapiro ED, Holmboe ES, et al. Postpartum mothers'
attitudes, knowledge, and trust regarding vaccination. Matern Child Health J.
2008;12(6):766-73. doi:10.1007/s10995-007-0302-4.
[17]. Patra S, Patra B, Bhatt GS. A
mathematical model for the control of an infectious disease using vaccination.
Int J Math Anal. 2012;6(25):1215-24.
[18]. Chen RT, Rastogi SC,
Mullen JR, Hayes SW, Cochi SL, Donlon JA, et al. The Vaccine Adverse Event Reporting System
(VAERS) and media reporting of adverse events following immunization. JAMA.
[Details missing from original text].
[19]. Wise J. Covid-19: New data on
Oxford AstraZeneca vaccine backs continued use in over 30s, say regulators.
BMJ. 2021;373:n1095. doi:10.1136/bmj.n1095.
[20]. National Resource Center for
Refugees, Immigrants, and Migrants (NRC RIM). Conducting rapid qualitative
community assessments: Discussion guide for vaccine confidence and hesitancy in
RIM communities. University of Minnesota; Centers for Disease Control and
Prevention; 2021 [cited 2026 Jul 8]. Available from: https://nrcrim.org
[21]. MacDonald NE. Vaccine
hesitancy: Definition, scope and determinants. Vaccine. 2015;33(34):4161-4.
doi:10.1016/j.vaccine.2015.04.036.
[22]. Iwuagwu AO, Rayner D, Ngwu CN,
Kalu ME. 'Why I have not taken the COVID-19 vaccine': A descriptive qualitative
study of older adults' perceived views of COVID-19 vaccine uptake in Nigeria. J
Popul Ageing. 2024;17(2):239-59. doi:10.1007/s12062-023-09410-z.
[23]. Zimmerman T, Shiroma K,
Fleischmann KR, Jeng W, Forelle M, Lee Y. Misinformation and COVID-19 vaccine
hesitancy. Vaccine. 2023;41(1):136-44. doi:10.1016/j.vaccine.2022.11.014.
[24]. Unfried K, Priebe J. Vaccine
hesitancy and trust in sub-Saharan Africa. Sci Rep. 2024;14:10860.
doi:10.1038/s41598-024-61205-0.
[25]. Falade B. The colonial effect:
Language, trust and attitudes to science as predictors of vaccine hesitancy
across Africa. Glob Health Sci Pract. 2024;20(1).
doi:10.1177/20966083241257338.
[26]. Gao L, Zhang Y, Li W, Chen S.
How urban versus rural population relates to COVID-19 booster vaccine
hesitancy: A propensity score matching design study. Hum Vaccin Immunother.
2024;20(1):2297490. doi:10.1080/21645515.2023.2297490.
[27]. Frontiers in Tropical
Diseases. Addressing malaria vaccine hesitancy in Nigeria: Lessons from the
Pfizer-Kano incident and COVID-19 vaccination. Frontiers; 2025.
doi:10.3389/fitd.2025.1691239.
[28]. Adeyemi RA, Ayandele O,
Popoola O. Exploring COVID-19 pandemic perceptions and vaccine uptake among
community members and primary healthcare workers in Nigeria: A mixed methods
study. medRxiv [Preprint]. 2024. doi:10.1101/2024.09.02.24312966.
[29]. Rangi J, Mfinanga E, Sungura R, Tarimo E, Mahande MJ, Kidenya BR, et al. Contribution of community champions to accelerate the uptake of COVID-19 vaccination in Rukwa region, Tanzania. Pan Afr Med J. 2023;45(Suppl 1):5. doi:10.11604/pamj.supp.2023.45.1.39705.
