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COVID-19 VACCINE HESITANCY AMONG YOUTH: A CASE STUDY OF GARKI HOSPITAL ABUJA
CHAPTER ONE
ABSTRACT
COVID-19 vaccine hesitancy among youth remains a critical public health challenge that threatens the attainment of herd immunity and the effective control of the SARS-CoV-2 pandemic. This study investigates the prevalence, determinants, and consequences of vaccine hesitancy among young people attending Garki Hospital, Abuja. Using a descriptive cross-sectional survey design, structured questionnaires were administered to 320 youths aged 18–35 years selected through systematic random sampling. Data were analyzed using SPSS version 26, and findings are presented using descriptive and inferential statistics. The work concludes with recommendations for community-based health communication strategies, targeted digital interventions, and policy reforms to enhance vaccine uptake among Nigerian youth. The study contributes to the growing body of evidence on vaccine hesitancy in sub-Saharan Africa and provides actionable recommendations for health practitioners, policy makers, and public health communicators.
1.0 INTRODUCTION
1.1 BACKGROUND OF THE STUDY
The appearance of the Coronavirus Disease 2019 (COVID-19) pandemic caused by the novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was one of the most devastating global public health crises of the twenty-first century. The virus rapidly spread across the globe thus the first detected cases in China (Wuhan, December 2019) represented the initial outbreak of the virus globally (World Health Organization [WHO], 2021). Nigeria, the most populous country in Africa, did not escape this disaster as thousands of confirmed cases and deaths were recorded in all thirty-six states of the country and the Federal Capital Territory (Nigeria Centre for Disease Control [NCDC], 2022).
As a response to the pandemic, the international scientific community has demonstrated an impressive achievement by creating several safe and effective COVID-19 vaccines in a record time. These vaccines, such as Pfizer-BioNTech, AstraZeneca, Moderna, and Johnson & Johnson, among others, were approved to be used in emergencies and were quickly deployed in countries (Voysey et al., 2021). In Nigeria, the national COVID-19 vaccination initiative started in March 2021, and the Abuja-based National Primary Health Care Development Agency (NPHCDA) coordinates the distribution and administration processes in the country (NPHCDA, 2022).
In spite of the fact that these life-saving vaccination is available, significant percentages of the Nigerian population especially youth remained adamant to vaccination. The phenomenon (which is widely known as vaccine hesitancy) refers to a delay in acceptance or refusal of vaccination despite the presence of vaccination services (MacDonald and the SAGE Working Group on Vaccine Hesitancy, 2015). The WHO has identified vaccine hesitancy as one of the ten greatest health threats to global health, and the COVID-19 pandemic has put this issue in the spotlight of discussions on global health (WHO, 2019).
Vaccine hesitancy among the youths in Nigeria is of great concern due to the fact that the youths form a part of the social groupings in communities and they are also agents of transmission through contacts among members of the social unit in the communities. There is a high rate of COVID-19 vaccine hesitancy among young adults which has been documented in studies across various African countries (Allagoa et al., 2022; Olomofe et al., 2021). Garki Hospital in Abuja has the advantage of presenting a strategic location to look at these dynamics due to its diverse mix of patients and urban rural demographics.
This research thus examines the occurrence and predictors of COVID-19 vaccine hesitancy among young people attending Garki Hospital, Abuja, in an effort to come up with evidence-based guidelines to enhance vaccine uptake among youth in the Nigerian setting.
Vaccination has historically been considered one of the most cost-effective interventions to public health in human history, and has led to the eradication of smallpox, near-eradication of poliomyelitis, and dramatic reductions in morbidity and mortality caused by a wide variety of infectious diseases (Andre et al., 2008). However, the COVID-19 pandemic has revealed major fault lines in the global acceptance of vaccines, especially that of younger cohorts of the population who, despite perceiving themselves as being low-risk of getting severely sick, occupy critical roles in the viral transmission chain (Sallam, 2021).
The youthful population in Nigeria is both an opportunity and a challenge to COVID-19 vaccination programmes due to the high percentage of young people in the country that is estimated to be just under 30 years of age (National Population Commission [NPC], 2021). On the one hand, it is highly likely that high vaccination coverage among young people would disrupt the network of transmissions significantly; on the other hand, the given demographic has already demonstrated a high level of resistance to the idea of vaccination in numerous studies that have been conducted throughout the country (Eniade et al., 2022; Olagoke et al., 2021).
Vaccine hesitancy is regarded to be on a continuum between full vaccine acceptance and full vaccine refusal, with contextual factors depending on each specific setting (Larson et al., 2014). In the context of Nigeria, there is a plethora of studies that have identified particular drivers of COVID-19 vaccine hesitancy, such as concerns about vaccine safety and efficacy, the widespread accessibility of misinformation through social media platforms, religious and cultural objections, and deeply rooted distrust in government health institutions due to past experiences of failed policies (Eze et al., 2022; Jegede, 2007).
Garki Hospital, a hospital formed as a district hospital within the Federal Capital Territory of Abuja, has a diverse population that includes civil servants, students, traders, and residents of both formal and informal settlements. Since it is one of the chosen COVID-19 vaccination centres in Abuja, the hospital can be considered an appropriate location to conduct the research on the dynamics of vaccine hesitancy. Significant gaps in health knowledge and practice were recorded in previous health behaviour studies carried in similar facilities in the FCT of Nigeria, highlighting the importance of specific health behaviour research at facility level (Yahaya et al., 2021).
The theoretical basis of the research is based on the Health Belief Model (HBM), which argues that the perceptions of individuals about their susceptibility to diseases, severity of the disease, benefits of the preventive action, and barriers to taking such action determine the health-related behaviours of the individuals (Rosenstock, 1974). Also, the Theory of Planned Behaviour (TPB) is invoked to explain the influence of social norms, attitudes and perceived behaviour control in influencing vaccine decision-making (Ajzen, 1991). These frameworks enable effective conceptual scaffold to interpret the psychosocial processes driving COVID-19 vaccine hesitancy among Abuja young people.
1.2 STATEMENT OF THE PROBLEM
Although, since March 2021, COVID-19 vaccination campaigns have been rolled out in Nigeria, the vaccination coverage rates have continued to remain significantly below the national and global targets. By December 2022, only about 4.2% of the total population of Nigeria was fully vaccinated, one of the lowest vaccination rates in Africa (Our World in Data, 2023). This dire performance is fuelled not least by high rates of vaccine doxology especially among young adults who form the numerical majority of the Nigerian population.
In Garki Hospital Abuja, anecdotal reports of the healthcare workers indicate that a good percentage of the youth who present at the facility either choose not to get vaccinated, or express reservations against getting vaccinated against COVID-19. But the particular magnitude of this hesitancy, its definite determinants, the socio-demographic tendencies of refusal are relatively poorly documented by systematic empirical research. This knowledge gap does not allow designing and implementing specific interventions to enhance vaccine uptake in this environment.
Furthermore, the proliferation of health misinformation through social media platforms such as Facebook, Twitter (now X), and WhatsApp has created an infodemic that compounds vaccine hesitancy among Nigerian youth (Cinelli et al., 2020). The failure of health communication strategies to effectively counter this misinformation and build vaccine confidence represents a critical policy and programmatic gap. Without understanding the specific contours of vaccine hesitancy at the facility and community level, public health responses will remain insufficiently targeted and, consequently, ineffective.
This study addresses the identified gaps by systematically investigating the prevalence, determinants, and consequences of COVID-19 vaccine hesitancy among youth at Garki Hospital, Abuja, thereby providing an empirical foundation for evidence-based interventions.
1.3 OBJECTIVES OF THE STUDY
The broad objective of this study is to examine COVID-19 vaccine hesitancy among youth at Garki Hospital, Abuja. The specific objectives are to:
- Determine the prevalence of COVID-19 vaccine hesitancy among youth attending Garki Hospital, Abuja.
- Identify the socio-demographic factors associated with COVID-19 vaccine hesitancy among the study population.
- Ascertain the primary reasons for COVID-19 vaccine hesitancy among youth at Garki Hospital, Abuja.
- Examine the role of social media and health information sources in shaping COVID-19 vaccine attitudes among youth.
- Proffer recommendations for reducing vaccine hesitancy and improving COVID-19 vaccination uptake among youth in the Federal Capital Territory.
1.4 RESEARCH QUESTIONS
This study is guided by the following research questions:
- What is the prevalence of COVID-19 vaccine hesitancy among youth attending Garki Hospital, Abuja?
- What socio-demographic factors are significantly associated with COVID-19 vaccine hesitancy among the study population?
- What are the primary reasons for COVID-19 vaccine hesitancy among youth at Garki Hospital, Abuja?
- How do social media and health information sources influence COVID-19 vaccine attitudes among youth?
- What interventions can effectively reduce vaccine hesitancy and improve COVID-19 vaccination uptake among Nigerian youth?
1.5 RESEARCH HYPOTHESES
The following hypotheses are formulated to guide this investigation:
H01: There is no significant relationship between socio-demographic factors (age, gender, education level, and occupation) and COVID-19 vaccine hesitancy among youth at Garki Hospital, Abuja.
H02: There is no significant association between exposure to social media health misinformation and COVID-19 vaccine hesitancy among the study population.
H03: There is no significant relationship between institutional trust in government health agencies and COVID-19 vaccine acceptance among youth at Garki Hospital, Abuja.
1.6 SIGNIFICANCE OF THE STUDY
This study is significant for several reasons. From a public health standpoint, it generates facility-specific evidence on the prevalence and determinants of COVID-19 vaccine hesitancy, which is essential for designing targeted and context-sensitive interventions to improve vaccination coverage in Abuja and, by extension, across Nigeria. The findings will be particularly useful to health programme managers at the NPHCDA, FCT Health Secretariat, and facility-level health teams responsible for COVID-19 vaccination campaigns.
From a theoretical perspective, the study contributes to the application and validation of the Health Belief Model and Theory of Planned Behaviour within the Nigerian public health context, thereby enriching the literature on health behaviour theories in low- and middle-income countries (LMICs). Given the paucity of facility-based vaccine hesitancy research in the FCT, the study fills an important empirical gap in the Nigerian health research landscape.
For policymakers, the study’s recommendations provide actionable guidance for the development of youth-sensitive health communication strategies, regulatory frameworks for controlling health misinformation on social media, and community engagement models that leverage trusted voices including religious leaders, community elders, and social media influencers to promote vaccine confidence.
For academic researchers, the study provides a methodological template for facility-based vaccine hesitancy research and identifies areas requiring further investigation, including longitudinal studies on vaccine attitude change and the effectiveness of specific communication interventions.
1.7 SCOPE OF THE STUDY
This study is delimited to youth aged 18–35 years who attended Garki Hospital, Abuja, between January and June 2023. The study focuses exclusively on COVID-19 vaccine hesitancy and does not examine hesitancy toward other routine vaccines. Geographically, the study is confined to Garki Hospital within the Federal Capital Territory, and findings may not be directly generalisable to rural or other urban settings in Nigeria without further contextualisation. The study employs a quantitative cross-sectional design, and as such, is limited in its ability to capture the longitudinal dynamics of vaccine attitude formation and change.
1.8 DEFINITIONS OF TERMS
COVID-19: Coronavirus Disease 2019, an infectious respiratory disease caused by the SARS-CoV-2 virus, characterised by symptoms ranging from mild respiratory illness to severe pneumonia and death.
Vaccine Hesitancy: The delay in acceptance or refusal of vaccination despite the availability of vaccination services, existing on a spectrum between full acceptance and outright refusal (MacDonald & the SAGE Working Group on Vaccine Hesitancy, 2015).
Youth: For the purposes of this study, youth refers to individuals aged 18 to 35 years, consistent with the African Union’s definition of youth applicable to the Nigerian context.
Herd Immunity: The indirect protection from infectious disease that occurs when a sufficient proportion of a population has become immune, either through vaccination or prior infection, thereby reducing the likelihood of further disease spread.
Misinformation: False or inaccurate information, regardless of intent to deceive, that circulates through various media channels and influences health behaviour.
Health Belief Model (HBM): A psychological framework used to explain and predict health-related behaviours, based on individuals’ perceptions of the threat posed by a disease and the benefits of taking action to avert it.
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