COVID-19 vaccine acceptability and determinants of hesitancy among adults in Lagos, Nigeria

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has had a profound global impact. Vaccination remains a key strategy for controlling transmission and reducing morbidity and mortality. However, vaccine hesitancy poses a significant public health challenge, particularly in low- and middle-income settings. This study assessed COVID-19 vaccine acceptability and the determinants of vaccine hesitancy among adults in Lagos State, Nigeria. A cross-sectional, community-based study was conducted among 854 adults selected through multistage sampling across three Local Government Areas in Lagos State. Data were collected using a pretested, semi-structured, interviewer-administered questionnaire. Descriptive statistics were used to summarize variables, while chi-square tests and multivariable logistic regression analyses were performed to identify factors associated with vaccine hesitancy. Statistical significance was set at p ≤ 0.05. The mean age of respondents was 42.5 ± 13.6 years, and 51.2% were female. Overall, 44.1% of participants accepted the COVID-19 vaccine, while 55.9% were hesitant. Vaccine hesitancy was significantly associated with age, gender, marital status, ethnicity, religion, and educational level ( p ≤ 0.05). Multivariable analysis showed that respondents aged ≤ 20 years (OR = 5.5) and 21–40 years (OR = 2.0), as well as those with secondary education (OR = 2.0), were more likely to be hesitant. Independent predictors of vaccine hesitancy included secondary education (AOR = 2.3; p < 0.001), low perceived risk of COVID-19 (AOR = 1.7; p = 0.011), and poor preventive practices (AOR = 1.8; p = 0.002). COVID-19 vaccine hesitancy remains high among adults in Lagos State despite generally good knowledge levels. Targeted, context-specific health promotion interventions addressing risk perception, misinformation, and safety concerns are essential to improve vaccine uptake and strengthen pandemic response efforts.