Racing the pandemic: collecting data on drivers and levels of vaccine confidence in Nigeria at a critical time

Chloe Lanzara
COVIDaction
Published in
4 min readApr 14, 2022

Written by Nilmini Herath, Alex De Figueiredo, Heidi Larson & the Vaccine Confidence Project

In March 2021 many people reflected on a year of living with the pandemic and wondered what the future would hold. One-year-on documentaries were aired, tributes were made to lives lost, articles were written, and essential workers were acknowledged. After a year of lockdowns, losses, isolation, home schooling, quiet birthdays, muted religious celebrations, and countless other strains on daily life, a myriad of emotions surrounding the pandemic had emerged. Some were disillusioned with their political leaders. Some were cautiously hopeful for a way out through vaccination. Some feared or lamented the continued measures for controlling COVID-19, while others welcomed them. Public sentiment everywhere was deeply mixed and quickly evolving, and Nigeria was no exception.

By this point, Nigeria’s death toll had proven to be relatively low, but the country had endured many of the same fears, restrictive measures and economic impacts faced in other parts of the world. The Nigerian experience of the COVID-19 pandemic had also interacted in complex and region-specific ways with its recent encounters with the Ebola epidemic, concerns about its healthcare system, ongoing regional conflict, economic hardships and differential levels of trust in authorities. Parts of the country additionally had to contend with a troubled history with vaccinations that in 2003 escalated into a three state Polio vaccination boycott and that has fuelled lasting concerns about all vaccinations. The country was in some ways and some areas more prepared and responsive, and in others more fearful, sceptical or distrusting. The Eta variant, thought to have originated in Nigeria, had recently been detected and the country was just exiting the peak of deaths in its second wave. Opinion at this point varied tremendously on whether COVID-19 should continue to be prioritised, whether policies or environmental factors were responsible for Nigeria’s relatively low death-toll, and on the benefits and risks of the COVID-19 vaccines.

Source: Shutterstock. Volunteers at the Lagos Food Bank Initiative outreach to Ikotun, Lagos, Nigeria, June 7, 2020.

In this context of division and uncertainty, the roll out of COVID-19 vaccination programmes dominated headlines in Nigeria, as they did around the world. At this time only 2% of the world was at least partially vaccinated, and they mostly lived in Europe, the USA, and a small handful of countries in Latin America and Asia. Nigeria had only just received its first 4 million doses, an important but small step towards vaccinating the 7th most populous country in the world with an estimated 212 million people. In this gap between COVID-19 vaccine roll-outs of different nations — a particularly long gap for Nigeria and many other Low and Middle Income Countries — the Nigerian people were watching the world. They watched as every version of every vaccine was analysed, as every side effect was scrutinised, and as every rumour was circulated. And of course, based on what they had seen abroad and at home, the Nigerian public, media and authorities shared information and opinions of their own, creating a complex vaccine information ecology. It was a crucial time for sentiment towards the COVID-19 vaccines to take shape and it was important to understand how and why different views around vaccines were forming.

Source: Shutterstock. Medical personnel administers a vaccine to a patient.

Thanks to the support of COVIDaction and the Foreign, Commonwealth and Development Office, a team of researchers were able to measure the evolution and drivers of Nigerians’ willingness to vaccinate against COVID-19 over the important period of Nigeria’s early stages of roll-out. From March to October 2021, PREMISE and the Vaccine Confidence Project conducted seven rounds of longitudinal data collection. Using the PREMISE mobile phone application as an innovative, safely deployed and cost-effective digital data collection tool, 38,000 interviews were conducted with over 15,000 participants situated throughout Nigeria’s 37 states and territories. This data collection effort sought to understand

· what proportions of Nigerians intended to vaccinate,

· how certain they were in this intention,

· how this differed over space and time, and

· what was driving these trends.

A wide range of potential drivers of vaccine sentiment were included, such as socio-demographic attributes, emotional and psychological factors, COVID-19 knowledge and perceived susceptibility, trusted sources, and other vaccine confidence barriers. The interviews also explored attitudes to (and determinants of) perceptions of childhood immunisations, in particular the DTaP, polio, and measles programmes. Including these measures would allow exploration into whether vaccine confidence in the set of COVID-19 vaccines is related to vaccine confidence in these other immunisation programmes.

While analysis of the data is still underway, it is clear that Nigeria faced persistently high levels of uncertainty throughout the survey period, in contrast to the general increases in vaccine confidence seen in many Western countries. And although a majority of Nigerians surveyed would likely accept a COVID-19 vaccine if offered to them, there are notable sub-national variations in both levels of likely COVID-19 vaccine acceptance as well as trends about these levels.

As of today, Nigeria continues to lag behind much of the world in its COVID-19 vaccination coverage with only 9.4% of its population at least partially vaccinated. While some of this is due to limitations in supply, this work suggests that ultimately the demand for vaccinations may become a limiting factor.

Overall, the findings from this work illustrate the importance of routine monitoring of sub-national attitudes to COVID-19 vaccines to detect emerging trends and to identify, explore, and address losses, or forgone gains, in vaccine confidence.

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Chloe Lanzara
COVIDaction

Senior Program Officer, Results for Development