Vaccine Hesitancy among University Students in North-Central Nigeria: Determinants and Implications for Immunisation Uptake

Abstract

Vaccine hesitancy presents a multidimensional public health challenge, particularly among undergraduate students in North-Central Nigerian universities a population at heightened risk for campus-transmissible diseases and navigating autonomous vaccine decisions for the first time. This narrative review, guided by the SANRA framework, synthesizes evidence on factors influencing vaccine hesitancy among sub-Saharan African university students, with specific application to Federal University of Lafia and Nasarawa State University Keffi, while evaluating the relationship between hesitancy and immunization uptake. A comprehensive search of PubMed, Scopus, Web of Science, AJOL, and Google Scholar (2014–2024) prioritized sub-Saharan African studies involving populations aged 18–35 years, alongside grey literature from WHO and Nigeria's NPHCDA. Socio-demographic determinants included male sex, first-year enrollment, non-health-sciences affiliation, rural origin, low parental education, and Islamic affiliation. Cultural barriers encompassed faith-based skepticism rooted in Northern Nigeria's polio boycott legacy, ethno-medical beliefs, adverse peer norms, and patriarchal decision-making. Psychological predictors featured low perceived susceptibility, diminished vaccine confidence, external health locus of control, conspiracy beliefs, and side-effect anxiety. Social media misinformation predominantly via WhatsApp was the dominant information-environment driver. Vaccine hesitancy demonstrated a consistent inverse relationship with optional vaccine uptake, most pronounced for COVID-19 (40–55% hesitancy), HPV (20–30%), and meningococcal vaccines (15–25%). Integrated multilevel strategies targeting modifiable psychological and informational determinants, while engaging cultural and religious gatekeepers, are urgently required to address this critical public health issue in Nigerian university settings.