Yellow Fever Vaccination in North East Nigeria: Coverage, Uptake, and Barriers to Achieving Optimal Immunization Rates

Abstract

Background: Yellow fever remains a significant public health threat in Nigeria’s North East, with recurrent outbreaks driven largely by suboptimal vaccination coverage. The World Health Organization (WHO) recommends at least 80% population coverage to prevent yellow fever transmission; however, coverage in conflict-affected regions remains inadequate. Understanding vaccination uptake and context-specific barriers is essential for designing effective immunization strategies. Objective: The present study assesses yellow fever vaccination coverage and uptake in North East Nigeria and identifies barriers hindering achievement of the WHO-recommended coverage threshold. Methods: A community-based cross-sectional study was conducted using a multistage cluster sampling technique across six states (Adamawa, Bauchi, Borno, Gombe, Taraba, and Yobe). Of the 650 adults initially selected, 563 respondents completed the survey and were included in the final analysis. Data were collected using structured questionnaires capturing vaccination status, awareness of vaccination services, and perceived barriers to uptake. Descriptive statistics summarized coverage levels, while inferential analyses examined associations between socio-demographic variables and vaccination status. Statistical significance was set at p < 0.05. Results: Overall, 57% of respondents reported being vaccinated, substantially below the WHO-recommended 80% coverage threshold, leaving 43% unvaccinated. Vaccination uptake was significantly higher among respondents with tertiary education and regular access to healthcare services (p < 0.05). Major barriers to vaccination included lack of awareness of vaccination sites (38%), long distances to health facilities (34%), fear of vaccine side effects (22%), and conflict-related insecurity and population displacement (16%). Lower income and limited educational attainment were significantly associated with reduced vaccination uptake. Conclusion: Yellow fever vaccination coverage in North East Nigeria remains critically below the WHO-recommended level required for effective disease control. Limited awareness, access barriers, vaccine hesitancy, socioeconomic constraints, and conflict-related displacement continue to impede optimal uptake. Strengthening routine immunization, improving risk communication, and implementing targeted strategies for conflict-affected and hard-to-reach populations are essential to achieving herd immunity and preventing future outbreaks.