Predictors of vaccine hesitancy spectrum among healthcare workers in selected Nigerian States and their implications for public health policy

Vaccine-hesitant healthcare workers (HCWs) pose challenges to immunization programs, especially in low- and middle-income countries. In Nigeria, HCWs influence public vaccine acceptance as responders and information sources. Hesitancy varies by personal, workplace, and regional factors. This study therefore aims to assess the prevalence and determinants of vaccine hesitancy among HCWs in Oyo and Kwara States, Nigeria, in order to identify context-specific strategies to improve vaccine acceptance and coverage. A descriptive cross-sectional online survey was conducted between March and April 2023 to collect data from HCWs in Oyo and Kwara States. Participants were consenting HCWs with at least one year of service. A total of 723 entries were completed and retrieved, and a two-stage sampling technique was used. IBM Statistical Product and Service Solutions (SPSS) version 26 data analysis. Ordinal logistic regression (proportional odds model) was used to assess vaccine acceptance and hesitancy, including moderate, high delay and refusal, with regional differences evaluated at a 5% significance level. Survey results showed 63.0% of participants fully accepted vaccination, while 18.0% delayed moderately, 7.0% delayed significantly, and 14.0% refused. Key drivers of hesitancy included pregnancy, safety concerns, distrust in production, and limited availability. Significant factors influencing hesitancy were grade level (p < 0.001, aOR = 0.011, 95% CI: 0.056–0.104), facility settings (p = 0.018, aOR = 0.189, 95% CI: 0.048–0.748), years of service (p < 0.001, aOR = 0.890, 95% CI: 0.835–0.947), test result outcome (p = 0.008, aOR = 0.195, 95% CI: 0.058–0.658), religious beliefs (p < 0.001, aOR = 0.089, 95% CI: 0.075–0.201), and political boundaries (p = 0.034, aOR = 2.859, 95% CI: 1.083–7.552). Healthcare workers in Nigeria show different levels of vaccine hesitancy, which range from delayed acceptance to complete refusal, based on their location, individual circumstances and institutional influences. The solution to these challenges requires building trust, delivering specific educational programs, and enhancing vaccine availability to boost healthcare worker involvement in immunization programs.