Political economy of vaccine distribution and acceptance in Nigeria: critical analysis of global health interventions and local realities

Vaccine uptake in Nigeria remains critically suboptimal despite global and national efforts to improve immunization coverage. Diseases like cervical cancer and malaria continue to burden public health, yet vaccine coverage remains lower than targeted. Therefore, this review critically explores how global health partnerships, funding structures, and local socio-political realities intersect to shape vaccine distribution and acceptance in Nigeria. A narrative review of the literature was conducted using academic articles retrieved from PubMed, Directory of Open Access Journals (DOAJ) and Google Scholar, and programmatic reports from the World Health Organization, Global Alliance for Vaccines and Immunization, United Nations Children Fund, and the National Primary Health Care Development Agency, published between 2015 and 2024. The review employed the political economy of health theory to assess power dynamics, policy shifts, and socio-cultural influences affecting vaccination programs. The review revealed that Nigeria’s immunization challenges are rooted in political economy dynamics, with only 5.46% of the 2024 budget allocated to health and out-of-pocket payments comprising 70.5% of total health spending. Despite donor aid, which recently came under drastic reduction, only 39% of eligible Nigerians completed COVID-19 vaccination as of December 2023, falling far below the 67% global coverage. HPV vaccine rollout indicated regional gaps: Taraba had 98% coverage, Lagos just 31%. Corruption, religious beliefs, poor infrastructure, including cold chain, and low health workforce density (1.95 health workers/1,000 people) hinder vaccine uptake. Gavi’s $1B aid since 2001 highlights dependency risks, as over 90% of vaccines in Nigeria have remained imported, reflecting systemic governance and funding imbalances. Strengthening local health systems, aligning donor policies with national health priorities, enhancing intersectoral collaboration, and fostering inclusive, transparent governance are essential steps toward building sustainable and resilient vaccine programs in Nigeria that are responsive to both global health directives and local socio-political realities.