1.1.3. Nigeria

In 2021, Nigeria had one of the highest numbers of zero-dose children (2.2 million) in the world [2], a challenge that was exacerbated by COVID-19. Equity analyses of 2013 and 2018 DHS data demonstrate stark inequalities based on wealth (over 70 percentage points), maternal education (50 percentage points), and place of residence (nearly 40 percentage points). Nigeria is one of the few countries where, nationally, more boys are vaccinated than girls [6]. Geographic inequality is significant between Nigeria's states, and within them, the majority of zero-dose and under-immunized children are living in the northern states. Qualitative research of barriers to vaccination has highlighted mistrust of the government and vaccines, lack of awareness, fear of adverse events following immunization, shortage of health workers, long waiting times, and long travel times [20]. COVID-19 has also exacerbated some of these barriers and recent research on the reasons behind the slow uptake of COVID-19 vaccinations point to many of the same determinants [21].
