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Addressing Vaccine Hesitancy through Community Engagement

April 30, 2024

Vaccination wasn't a new concept for Samawilu Muhammad Alkasim, a 29-year-old resident of Tsangaya village in Kano State. While rumors of vaccine side effects swirled, Samawilu saw the bigger picture: vaccinations saved lives, including his own. The faint BCG scar on his arm stood as a silent testament. It didn't harm me, he thought with resolve.

Samawilu, a resident of Tsangaya village | Photo Credit: NI-ABAE

But one month after the launch of New Incentives’ program in Albasu, when his second daughter, Bilkisu, was due for her next round of vaccinations, a flicker of worry crossed Samawilu's mind. Following a New Incentives’ sensitization activity with leaders, the village head, Murtala Sulaiman, had announced that ₦1,000 incentives would be given to caregivers for vaccinating their children. That caused a stir among some men in the community. "Is it really free money?" some had questioned. Samawilu himself was skeptical.

Deciding to get to the bottom of it, Samawilu visited the local clinic. Seeing his concern, the routine immunization service provider, Aminu Abdullahi Maiunguwa, kindly explained, "The ₦1,000 isn't like a bribe for vaccination, but a helping hand. It helps with transportation costs, making it easier for families to bring their children in. Some children might also experience a slight fever after the shots, and the money can be used for paracetamol." 

Aminu, a routine immunization provider, explains the purpose of New Incentives’ cash transfers to Samawilu. | Photo credit: NI-ABAE

According to Aminu, vaccination has always been a priority in the village of Tsangaya. "However, the introduction of the cash incentives has further increased participation. Interestingly, after being informed about the reason for the incentives, people now have peace of mind, knowing they will be rewarded for their commitment to vaccinating their children," he said.

Routine childhood immunization is one of the most cost-effective public health interventions in the world, estimated to avert 3.5 to 5 million deaths per year.  But in Nigeria, vaccine hesitancy remains a challenge in many communities, shaped by cultural norms and misinformation. There are 2.3 million children in Nigeria who are categorized as zero-dose, meaning they have not received a single dose of any diphtheria-, tetanus-, or pertussis-containing vaccine in the country’s routine immunization schedule. Immunization coverage varies greatly across Nigeria, with the lowest coverage in the northern part of the country.

There are 2.3 million children in Nigeria who are categorized as zero-dose.

By the end of 2026, we aim to enroll approximately 8 million infants in New Incentives’ evidence-based program, known in Nigeria as the All Babies program. To achieve this, we work with our partners in the states where we operate to identify underlying factors leading to vaccine hesitancy and ways to address them. 

The Importance of Educating Fathers and Whole Communities about Vaccines

Although mothers are typically the ones to take their children to the clinic for vaccinations, educating fathers about the safety and life-saving benefits of vaccines is critical for encouraging routine childhood vaccinations. In recent surveys we have conducted, 8% of caregivers reported that their reason for a missed vaccination was due to their husband or another family member not permitting it, one of the most common reasons caregivers cited. In this cultural context, women in some communities require their husbands’ permission to travel outside the house, and many mothers have told staff they are prevented or discouraged from getting their children vaccinated due to their husbands’ distrust of vaccines.

Maryam, a field officer, and  Auwalu, a routine immunization provider, engage fathers at an awareness session. | Photo credit: NI-ABAE

For these reasons, New Incentives and clinic staff encourage men to attend awareness meetings to provide them with accurate information about vaccines and share more about the program. They discuss the diseases that the vaccines prevent and how the vaccines function, including how to handle mild side effects. They also go over the details of our program, including how and when the incentives are provided and the requirements for program enrollment. Importantly, they always allow ample time for discussion so that attendees can ask questions and air any concerns they have. This open dialogue is a critical part of the sessions.

Maryam and  Auwalu speak to the village head and other fathers at an awareness session. | Photo credit: NI-ABAE

In March, Maryam Isa Muhammad, a New Incentives field officer who works in the Wudil local government area of Kano State, conducted an awareness meeting with husbands in Yan Lahadi, a remote village, alongside the routine immunization officer of the village’s health clinic, Auwalu Abubakar. This is one of more than 6,200 awareness meetings by New Incentives in the first quarter of 2024 alone. About 20 husbands attended the meeting, including Dalhatu Galadima, the village head. According to Maryam, Yan Lahadi, a village that is predominantly Muslim and of the Hausa ethnicity, was selected for the awareness meeting due to observations that some caregivers were not returning for vaccinations and had become defaulters.

New Incentives participated in more than 6,200 awareness meetings during the first quarter of 2024.

During the session, the team engaged with those present to understand and address their concerns. Aminu Samaila, a father of two, postponed his market trip to attend the awareness session that day. He wanted to understand why his second child, immunized two days before the session, cried excessively at night, had a fever, and developed swollen thighs post-vaccination. Auwalu shared that such reactions are normal in some infants and not a cause for concern. He advised applying gentle pressure and rubbing the skin around the injection site. If the swelling persisted, he recommended returning to the facility for an ice pack application.

Aminu, a resident of Yan Lahadi village | Photo credit: NI-ABAE

Another participant, Iliyasu Muhammad, a farmer and father of seven, said that he once doubted vaccines but changed his mind after consulting with the village head a few months before his third child was born.

"Since then, I understand the importance of vaccinating my children, and I make sure that my wife never misses a vaccination day," he said. 

Illiyasu, a resident of Yan Lahadi village | Photo credit: NI-ABAE

Fathers are not the only family members who can be influential. In a nearby village, a 63-year-old resident of Dawakin Tofa in Kano, who preferred not to be named, recounted that after her three-month-old grandson cried through the night following his February vaccination, she vowed to shield him from what she called “further distress” and adamantly refused additional immunizations for him. The child’s mother, torn between tradition and the importance of vaccines, said she could not go against her mother-in-law's instructions and didn’t go to the next vaccination. It wasn't until a dedicated UNICEF volunteer community mobilizer and our field officer spoke to them during an awareness activity that the tide turned. They convinced the child’s grandmother to reconsider, and she agreed.

The Critical Role of Community Leaders 

In addition to family members, traditional and religious leaders are very influential, playing a critical role in helping to spread information and establish trust. Assistant field manager Sani Mukhtar talks about the important role they play. "In planning awareness sessions, which we conduct at least once a quarter, we involve community leaders, and they are primarily responsible for setting the activity's date and timing. Their endorsement is essential for the activity to even happen." 

Dalhatu Galadima, village head of Yan Lahadi, and his son, Umar | Photo credit: NI-ABAE

Dalhatu Galadima, the Village Head of Yan Lahadi,  stands out as a steadfast supporter of vaccination. He witnessed the devastating impact of preventable diseases in his community as a child, motivating him to ensure all his children receive full vaccinations. "My commitment stems from my belief in the benefits of vaccination because of my personal experiences," he recounted. Determined to prevent history from repeating itself, Dalhatu said that since becoming a village head 30 years ago, he has been working against vaccination hesitancy in Yan Lahadi.

"During prayer times, especially dawn prayer, we inform husbands who were absent during the meeting and urge them to inform their wives [about the program and benefits of vaccines]," he recounted. As we continue to collaborate with states and conduct awareness activities to combat vaccine hesitancy, it's encouraging to witness the support from community leaders like Dalhatu and their positive influence. 

"In planning awareness sessions... we involve community leaders. Their endorsement is essential for the activity to even happen." 

Back in the village of Tsangaya, Samawilu is just one example of a father who consulted with leaders, then stepped up from doubt to trust, engaging other fathers, sharing his experiences and insights, and collaborating with his village head and clinic health workers to educate and safeguard children from preventable diseases.

One thing that’s clear is that changing hearts and minds is painstaking work. New Incentives plays a small role in these efforts to raise awareness about the safety and benefits of vaccines and correct misinformation. We deeply respect all the mothers, fathers, village heads, and clinic staff who are fighting against vaccine hesitancy in the areas where they work and live. The battle against preventable diseases can only be won by working together to correct misinformation and save lives.

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