Vaccine Hesitancy and Refusal: Behavioral Evidence from Rural Northern Nigeria

It is widely believed that vaccine hesitancy is prevalent in African countries, although this belief is without rigorous evidence. Our field experiment in rural northern Nigeria behaviorally measured the prevalence of vaccine hesitancy-the non-uptake of vaccines despite their availability due to non-monetary factors directly associated with vaccination. We randomly assigned two tasks to women: answering a short survey at their house vs. additionally receiving a free tetanus vaccine by submitting a voucher. The differences in their completion rates captured vaccine hesitancy, showing the rate to be about 13%. Our study reveals that absolute refusers with negative willingness to pay (WTP) for vaccines, who are likely to have strong misperceptions or a distrust of vaccines, account for about half of vaccine hesitaters, while floating refusers with zero or weakly positive WTP, who are likely to be indifferent about vaccines, account for the other half. A simple intervention, such as a door-to-door vaccination campaign, is likely to be effective for floating refusers, while interventions for absolute refusers need to effectively change their misperceptions or distrust of vaccines.