# “Grandmothers as gatekeepers”: The role of older women in addressing vaccine hesitancy in urban slum communities in Ibadan, Nigeria

## TL;DR

This study explores how older women in Nigerian urban slums influence vaccine acceptance and can help reduce vaccine hesitancy.

## Contribution

The study identifies the unique role of older women in addressing vaccine hesitancy in urban slum communities in Nigeria.

## Key findings

- Older women use community mobilization and advocacy to address vaccine hesitancy.
- Vaccine hesitancy is driven by complacency, convenience issues, and lack of confidence in healthcare.
- Formalizing older women's roles could improve vaccination rates in slum communities.

## Abstract

Vaccine hesitancy is responsible for the resurgence of vaccine-preventable diseases in Nigeria due to suboptimal immunization as seen in urban slums. Older women are traditionally influential in infant health decision-making in African communities; however, their roles in addressing vaccine hesitancy remain underexplored. This study explored the perceived reasons for vaccine hesitancy and methods employed by older women to address vaccine hesitancy in selected urban slum communities in Ibadan, Nigeria. Narrative study design was adopted, and 22 focus group discussions were conducted with 175 older women from seven urban slum communities. Content analysis was used to analyze the data using the World Health Organization Strategic Advisory Group of Experts on Immunization (SAGE) ‘3 Cs’ model of vaccine hesitancy (complacency, convenience, confidence) and vaccine hesitancy determinant matrix. Perceived causes of vaccine hesitancy included poor knowledge about the importance of vaccines, parental nonchalance, low vaccination priority (Complacency), long clinic waiting times and vaccine stockouts (Convenience), mistrust of volunteers, poor healthcare workers’ attitude, immunization misconceptions, and previous negative experiences (Confidence). Older women addressed vaccine hesitancy through community mobilization, engagement with religious leaders, advocacy at the individual level, and by supporting trust in qualified health personnel. The older women demonstrated significant potential as key resources for addressing vaccine hesitancy. Leveraging their roles by formalizing their involvement in immunization programs could enhance the vaccination uptake in urban slum communities. Also, the existing approaches for handling vaccine hesitancy can be standardized to improve vaccination uptake.