Vaccine Hesitancy: Resisting A Tool That Saves Millions

The recent introduction of the HPV vaccine into Nigeria’s routine immunization schedule has brought parental vaccine hesitancy to the forefront. A cross-sectional study by Korede et al, conducted in Kano State, a region with historically low immunization rates, is crucial in assessing the level of parental hesitancy and uncovering its determinants, potentially informing future public health policies. If the HPV vaccine were free or subsidized, about one-third [32.7 %] of parents would choose not to vaccinate their children against the virus. Only 4.2 % had ever heard of HPV, and a mere 5.1 % had heard of the cervical cancer vaccine or HPV vaccine. Compared to those who were aware of the virus, those who had never heard of HPV had higher adjusted odds of vaccine hesitancy. Some of the top reasons for parental hesitancy were their concerns about the safety of the vaccine and the lack of doctors’ recommendations.

COVID: A Perfect Storm
Almost immediately after the emergence of COVID-19, work on a vaccine began, building on decades of previous vaccine development research. In less than a year, four vaccines were developed and distributed around the world to combat a global pandemic that had claimed millions of lives. In communities with high vaccination rates case numbers have decreased . As of July 27, 2021 , 67% of the American population above 12 years of age has received at least one dose of a COVID vaccine and 58% are fully vaccinated (children under 12 years are currently not eligible for vaccination). However, COVID-19 vaccination rates in the US have also started to fall in recent weeks. Not surprisingly, areas of the country with surging COVID cases are those that have the lowest vaccination rates and could become breeding grounds for new variants that could break the protection vaccines are currently giving.
Nearly every reason to avoid vaccines discussed so far, and more, have played a role in the current COVID vaccine roll out. The fact that the vaccines have been effective in those that have received them, combined with a reduction in mask mandates and social distancing requirements, have created a perception among many Americans, including the unvaccinated, that COVID-mitigation practices are no longer needed. This perception has held despite rising infection rates in early summer and the emergence of more infectious variants. Vaccines remain scarce in some communities. Some populations, particularly Black and Latino communities have low rates, hypothesized to be due to the historic medical injustices done to these communities creating a sense of mistrust. False information and conspiracy theories continue to circulate online and are given support by many public officials seeking to rile up their bases. Others do not believe COVID is a serious threat and that the risk is “over”. Some believe the vaccine was rushed, despite the fact it was properly vetted by the regulatory authorities prior to distribution. Others refuse vaccination on the grounds that it violates their personal liberties.

Nigeria struggles with infectious diseases, and vaccination has become instrumental in curbing them. As a low-income country, Nigeria faces challenges in combating infectious diseases. Outbreaks of diseases like diphtheria, pertussis, poliomyelitis, tuberculosis, hepatitis, and measles have substantially burdened the population’s health and wellbeing. In response to these public health threats, concerted efforts have been undertaken to mitigate the spread of these diseases and protect the Nigerian people. Vaccination has emerged as an effective strategy against the global spread of infectious diseases, averting over 5 million deaths worldwide. The success and importance of vaccines in combating various contagious diseases, such as measles, polio, rubella, tetanus, diphtheria, and smallpox, have been recorded. Through widespread vaccination campaigns, with a primary focus on children, significant progress has been made in reducing the burden of these diseases in Nigeria. However, challenges in vaccination efforts persist. Vaccine Hesitancy (VH) was recently ranked eighth among the top threats to global health by the WHO and has enabled the perpetuation of vaccine-preventable diseases.

The COVID-19 pandemic has profoundly influenced how vaccines are perceived and utilized. With the widespread availability of vaccines and the pandemic’s prominent global presence, people have become more aware of vaccines and their advantages. Consequently, many countries have experienced a rise in vaccine acceptance. However, the pandemic has also shed light on the difficulties related to vaccine uptake, accessibility, and the level of trust in modern medicine, including in Nigeria.

LISTENNING TO RUMOURS
In 2003 five northern Nigerian states boycotted the oral polio vaccine due to fears that it was unsafe and the truth must be told that lessons still need to be learnt from the boycott: that the origins and continuation of the boycott were due to specific local factors. We can focus mainly on Kano state, which initiated the boycotts and continued to reject immunisations for the longest period, to provide a focused analysis of the internal dynamics and complex multifaceted causes of the boycott. We can also argue that the delay in resolving the year-long boycott was largely due to the spread of rumours at local levels, which were intensified by the outspoken involvement of high-profile individuals whose views were misunderstood or underestimated. Important lessons about responding to vaccine rumours were learnt the hard way in northern Nigeria in 2003, with a resulting delay in resolution of the crisis. The response to future crises must build upon the diplomatic success of the 2003 boycott, whilst recognising the importance of community values and the power of individuals. This analysis identifies the convergence of events, individuals and signals that led to the Nigerian boycott, an awareness of which may pre-empt and mitigate future crises.

Cervical cancer vaccine hesitancy in Nigeria stems from low awareness of HPV and the vaccine, widespread misinformation amplified by social media, fears of vaccine side effects and its link to infertility, mistrust rooted in past vaccination experiences, and socio-cultural factors like religious beliefs. Barriers also include the cost of the vaccine and lack of doctor recommendations. To overcome this, strategies include community-level education, involving trusted sources like doctors, engaging social media influencers to combat myths, and ensuring vaccine affordability and accessibility.

WHAT LESSONS CAN HISTORY TEACH US?
The issues impacting vaccination rates today are largely the same as those first raised in response to the smallpox vaccine: the perceived short- and long-term side effects of vaccinations, concerns about government intrusion into personal health decisions, the loss of knowledge of the devastation these diseases can have, and a general mistrust of evidence-based science in favor of non-scientists in the public media.

At a high level, we need to be upfront about vaccine side effects and diligent about reporting adverse reactions. Downplaying or hiding this information would do a disservice to patients and would only strengthen anti-vaccination claims. This has been done well so far in the COVID vaccine roll out. One vaccine was associated with very rare cases of severe allergic reactions shortly after injection, which were easily treatable by the vaccine provider with epinephrine. As a result, a 15-minute waiting period following vaccination was instituted. Another vaccine was associated with around half a dozen cases of blood clots, primarily in women. The use of the vaccine was appropriately and temporarily put on hold, the cases were examined, and it was concluded that for most populations the vaccine did not pose a risk. A warning was added to alert those in the risk group to consider an alternative vaccine.

History has shown that the most strident critics are unlikely to be swayed by any evidence and arguments. Those with large audiences must recognize the impact that they can have and encourage their followers to be vaccinated. Together we must tell the stories of vaccine successes to preserve and strengthen the foundational support for vaccination.

We were able to overcome centuries of hesitation to eradicate smallpox via vaccination. By having rational discussions and sharing vaccine success stories, we can put concerns into perspective and help to sway those hesitant about vaccines into full-fledged supporters.

VACCINES PROTECT US FROM SERIOUS DISEASES.
They help our children stay healthy to learn, play and grow. Think of vaccines like software updates for your body: they give your immune system the tools it needs to block harmful germs before they can cause illness and they work really well! As an example, in the years before we had a measles vaccine, almost every child got measles by age 15. This led to millions of infections, thousands of hospitalizations and hundreds of deaths each year. Today, two doses of a measles vaccine keep 97 in 100 people from getting measles. Even if someone does catch it, their case is much milder and safer.

MORE ABOUT VACCINES AND PUBLIC HEALTH
We know that health decisions can feel deeply personal—you want to do what’s right for your family. Choosing to vaccinate is one of the most powerful ways to protect your loved ones and support a strong healthy community. It’s a choice that helps kids stay in school, families avoid preventable illness and all of us move through life with peace of mind.

Vaccines support our health at every stage of life—from childhood through adulthood—helping us stay healthy so we can work, learn, care for others and enjoy the moments that matter.

If most people in a community get vaccinated, germs have fewer chances to spread. This community immunity helps protect those who cannot get vaccinated, like newborns or people with certain health conditions. It’s a team effort—your choice to vaccinate helps protect your family, your neighbors and your whole community. We saw this during COVID-19 and we see it every time we stop an outbreak.

It’s normal to have questions. Health choices are important and people want to be sure they’re doing the right thing. That’s why vaccines go through strong testing before they’re approved and are carefully watched after they’re in use. Scientists, doctors and public health experts work together to make sure vaccines are safe and effective.
Immunization is a global health success story, saving millions of lives every year. Vaccines reduce risks of getting a disease by working with your body’s natural defenses to build protection. When you get a vaccine, your immune system responds.

We now have vaccines to prevent more than 30 life-threatening diseases and infections, helping people of all ages live longer, healthier lives. Immunization currently prevents 3.5 million to 5 million deaths every year from diseases like diphtheria, tetanus, pertussis (whooping cough), influenza and measles.

Immunization is key to primary health care, an indisputable human right, and one of the best health investments money can buy. Vaccines are also critical to the prevention and control of infectious disease outbreaks. They underpin global health security and are a vital tool in the battle against antimicrobial resistance.

The COVID-19 pandemic strained health systems, resulting in dramatic setbacks. The most recent data for diphtheria-pertussis-tetanus (DTP) immunization coverage underscores the need for ongoing catch-up, recovery and system-strengthening.

Measles, because of its high transmissibility, quickly exposes immunity. In 2024, the routine first dose of measles vaccine was missed by 20.6 million children – far from the 2019 level of 19.3 million children.