Population and vaccine hesitancy: a demographic and Socio-behavioural examination of a barrier to Covid-19 herd immunity in Nigeria

The theme of the 76th session of the United Nations (UN) General Assembly (2021) stresses on the need to tackle the global coronavirus pandemic and other challenging issues presently staring our world in the face. World leaders have tried to contribute their own quota towards changing the present narrative by vaccinating a large portion of their population. However, vaccine hesitancy has served as a barrier to achieving herd immunity in nations-Nigeria inclusive. The sociological theory of phenomenology and the concept of ‘‘sick role’’ were employed as the theoretical framework upon which the study was anchored. Descriptive cross-sectional survey and purposive sampling were used in the work. Data for the study was generated through primary (online survey of 150 respondents) and secondary sources. The content and thematic techniques were used to analyze the data so gathered. The causal factors of vaccine hesitancy in Nigeria were uncovered to include: ‘negative human awareness’, lack of or low public knowledge/agreement on public health need of the vaccine, disconnect (public mistrust of government) between the people and government and lack of awareness/proximity of vaccination points, among others. The paper recommends strategies for massive advocacy/social mobilization to counter negative social interaction and narratives making the rounds on the intake of the COVID-19 vaccine by the Nigerian populace to build general consensus on the need for the vaccine and adoption of the Nigeria Polio vaccination model of taking vaccine down to the people.


Introduction
As at 27th September 2021, the World Health organization (WHO, 2021) put global total number of COVID-19 cases and deaths at around a quarter of a billion and over four million respectively. For the Nigerian situation, the centre for Disease Control [ [23] , 2021] as at 28th September 2021, put total number of cases and deaths at 204,752 (two hundred and four thousand, seven hundred and fifty one) and 2690 (two thousand six hundred and ninety) respectively.
Beyond these numbers of infections and loss of human lives, the pandemic also unleashed and is still unleashing devastating socioeconomic hardships on societies of the world. In a socioeconomic impact study of COVID-19 by Eduardo and Federico (2021) of the Brookings Institute, reported how the pandemic took its toll on the progression of the world Gross Domestic Product (GDP); they averred that the COVID-19 worldwide downturn is the most profound since the end of World War II. The worldwide economy shrunk by 3.5 percent in 2020 as indicated by the April 2021 World Economic Outlook Report distributed by the International Monetary Fund (IMF), a 7 percent misfortune comparative with the 3.4 percent development figure back in October 2019. While practically every nation covered by the International Monetary Fund posted negative development in 2020 (IMF, 2020), the world poorest region saw the greater degree of the recession [24] .
Among these poorest parts of the world where the downturn was more pronounced is Nigeria. The economic effect of the COVID-19 pandemic in Nigeria, a low income country, has been huge, with plunging oil costs specifically influencing Nigeria's intensely oil dependent economy (Human Right [12] ). The IMF assessed that Nigeria's Gross Domestic Product shrunk by 3.2 percent in 2020, a glaring difference to the 2% financial development anticipated before COVID-19; at a time when the government urgently needed funds to treat the health effects of COVID-19, boost the economy, and safeguard livelihoods, government revenue also declined by nearly 3 percent of GDP, or $15 billion, according to the estimate (Human Right [12] ). The report further stated that the monetary effect of COVID-19-19 has deteriorated destitution levels in Nigeria, which even before the pandemic facilitated in excess of a modest amount of the world's super poor, characterized by the World Bank as individuals living on under $1.90 per day (Human Right [12] ). The World Bank expressed in January 2021 that this emergence will drive an extra 10.9 million Nigerians into neediness, with the quantity of individuals beneath the public neediness line-characterized as individuals living on under 137,430 Naira ($334) each year, or under $1 each day-expected to arrive at in excess of 100 million by 2022 (Human Right [12] ).
As such, to prevent further infections and deaths, defeat COVID-19 and recover from its social and economic ruins, Nigeria and countries of the world among other public health measures, aim to achieve herd immunity against the virus by vaccinating their populations. Nigeria's population is estimated to be 212,879,658 (Two Hundred and Twelve million, eight and seventy nine thousand, six hundred and fifty eight) as at October 2021 (Worldomer 2021). Out of the above population, only 1796,255 (one million, seven hundred and ninety six thousand, two hundred fifty five) of total eligible population targeted for COVID-19 vaccination are fully vaccinated as of September 21st 2021, (National Primary Healthcare Development Agency, NPHDA, [21] ).
The number above is a far cry as regards the level of uptake of vaccine among the population that will take Nigeria to herd immunity. Herd immunity, also known as community immunity, herd effect, mass immunity, or population immunity, is an unintentional form of insurance that only covers infectious diseases. It occurs when a sufficient portion of a population has developed immunity to an infection, whether via prior illnesses or vaccinations, reducing the likelihood that others without immunity would contract an infection (see Encyclopedia Britania, 2021, [8,10] , & [34] ). Vaccinating a large population of Nigerians would contribute to global herd immunity considering large share of Nigeria's population in the African continent and the world over. Among the causal factors of this low vaccination uptake, which is a key factor, is vaccine hesitance among the population. While world leaders and the United Nations (UN) have committed to making vaccine available globally by addressing implications of inequality in the global south (less developed and developing countries) and vaccine nationalism in the global north (developed countries) to vaccine availability.
The socio-behavioural lack of willingness among people in Nigeria to be vaccinated even when they are perceivably aware of COVID-19 and its sweeping negative impacts on the society, calls for sociological and scientific interrogation. Meanwhile, there are somewhat a handful of researches on vaccine hesitancy which understudied factors responsible for vaccine hesitancy, however, only a sparse of these works really focused on the Socio-Behavioural factors serving as drivers and barriers towards achieving herd immunity. Hence, the present precarious situation occasioned by the COVID-19 pandemic calls for the need for continuous engagement and re-engagement of the subject matter. More so, the current study has Nigeria as its focus which further reinforces the importance of the work. These therefore, are the theses and points of departure of the study.

COVID-19
According to WHO [37] , a variety of illnesses belonging to the Coronaviridae family, which infect both humans and animals, are known as coronaviruses. Coronaviruses the infect human can cause minor illness, such as a common cold, or more serious illness (like MERS -Middle East Respiratory Syndrome and SARS -Severe Acute Respiratory Syndrome). In December 2019, a new coronavirus that had not been discovered before in humans appeared in Wuhan, China. The signs and symptoms include coughing, shortness of breath, fever, and respiratory issues. Pneumonia, severe acute respiratory syndrome, and possibly even mortality can result from infection in more severe situations.
After the epidemic outbreak in Wuhan, it spread to some parts of China and to other countries of the world, resulting to a pandemic declaration by WHO in 2020. Going by the way the public health threat is devastating, halting and altering structures of societies and economies of the world; one would look Karl Marx straight in the eyes and challenge his strong position in his material determinism submission, that economy is the "super structure" of the society. With health system as part of the sum of the whole of social system, the sweeping negative impact of epidemic and pandemic on every aspect of the global human society, has further empirically proven the functional inter and intra dependence of the systems of the social system, as held by the Functionalist school of sociological thoughts.

Vaccine skepticism/hesitancy
Generally, the term "vaccine hesitancy" describes the reluctance or delay in receiving a vaccine despite the availability of immunization services; it is intricate and context-dependent, changing with respect to time, place and vaccine type; variables such as confidence, complacency and convenience impact it [33] . Buttressing this position, Salmon et al. [32] aver that the mandatory nature of vaccines, coincidental temporal relationships to unfavorable health outcomes, lack of knowledge about diseases that can be prevented by vaccines, and lack of faith in businesses and public health organizations administering vaccines contribute to vaccine hesitancy. However, in this paper, attention is on hesitancy towards the COVID-19 vaccine in Nigeria and its implications to the attainment of the public health goal of herd immunity against the virus in the country.

Herd immunity
'Herd Immunity' which makes future disease spread unlikely, is the term used to describe a substantial section of a community that is immune to a disease, either through the development of antibodies following a viral infection or through vaccination [17] . The level of individuals who should be immune to accomplish herd immunity differs with every infection. For instance, achieving herd immunity in measles requires immunizing 95% of a community; the cut off point for polio is around 80% [17] , while due to the advent of new variants, it is difficult to determine the percentile for COVID-19 [18] . This is a novel area of exploration and will probably be hinged on the community in focus, the immunization, the populace targeted for inoculation, and other variables.
Accomplishing herd immunity with protected and powerful vaccines makes sicknesses more uncommon and saves lives, as stated by World Health organization [37] . It is this herd immunity against COVID-19 that Nigeria and countries of the world target to achieve by vaccinating a prioritised aspect of their population with a view to mitigating the upsurge of COVID 19 in their countries. In Nigeria, the prioritised population is adult 18 years and above. As such, there is a consequential link between herd immunity and vaccine hesitancy-as the former depends largely on how the latter as a barrier, is addressed.

Methodology
The cross-sectional survey was adopted as a research design for this study. The purposive sampling technique was used to target at least 450 respondents to form the sample size for the study. The sample size is considered best-fit as it represents a cross-section of the population. More so, a pre-tested and validated questionnaire on "Google form" (closed and open ended questions) was disseminated via social media platforms to reach out to the sample size. However, only 150 respondents aged 18 and above fully and appropriately responded to the questionnaire. Additionally, the content and thematic techniques were used to analyze and triangulate both the qualitative and quantitative responses, as well as data from the secondary sources.

Ethical consideration
Ethical clearance was obtained from the National Health Research Ethics Committee (NHREC), Department of Health Planning, Federal Ministry of Health.

Theoretical review
There are quite a number of sociological, Public health, social mobilization, behavioural change and risk communication theories (like Ethnomethodology, Health Belief model, B J. Fogg model of behavioural change and others) that can be used to interrogate the phenomenon of vaccine hesitancy. However, in this work, the sociological theory of phenomenology and concept of 'sick role' were used as theoretical frameworks.
Phenomenology: Social phenomenology is a methodology within the purview of Sociology that aims to uncover the role of human mindfulness in the creation of social activity, social circumstances and social universe. Fundamentally, phenomenology is of the conviction that society is a human development. The focal undertaking in social phenomenology is to make sense of the complementary associations that happen during human activity, reality construction, and situational structuring. In other words, phenomenologists try to sort out the connections between activity, circumstance, and reality that happen in the public arena. Phenomenology sees no perspective as causal, rather sees all aspects as fundamental to all others [5] . Arising from the foregoing, the element of ''human awareness'' and the role it performs in the production of social situations, social action, and social worlds are germane to the theoretical thrust and augments of this paper. As such, with the concept of phenomenology, this paper argues that, when the ''human cognition/awareness'' of the COVID-19 vaccine among a population in social interaction, are rather negatively filled with falsehood, rumours, myths and conspiracy theories instead of facts; this state of affairs produces hesitancy to the uptake of the vaccine as negative ''social action and situation''.
Therefore, government and stakeholders must strategically and massively infiltrate and dominate social interactions of the people on the need for vaccine uptake with facts and right information. Vaccine hesitancy is a reality socially constructed. As such, vaccine acceptance is also a reality that can be socially constructed.
The Concept of Sick Role: The concept of sick role is one of the contributions of a famous American sociologist, Talcott Parsons of the Functionalist theoretical perspective in sociology-which its thrust is that, the human society is a whole which has parts that function inter and intra (internal workings of each parts) connectedly and dependently to main the whole (and social order). According to Bissel and Traulsen [3] Parsons constructed his concept of roles as key components supporting the social order; in a nutshell, he was recommending that social order and social action depend on the objective of accomplishing value consensus. Therefore, consensus has to exist upon things for there to be some degree of order in the society; as such, Parsons conceptualized the "sick role" as an approach to understanding the freedoms as well as expectations patients ought to hope for in their associations with medical professionals and the manner the sick role functioned to ensure order; he thus opined that a patient is made to depend on the whims of others and so runs afoul of expected social obligations and roles (Bissel & Traulsen, [3] ).
The duo further argue that, Parson contended that in as much as individuals adhered to the restrictions accompanying the sick role, they were perceived to be legalizing such anti-social behavior. He suggested four elements of the sick role: (a) individuals are absolved from their ordinary social obligations like domestic roles or work. This exclusion requires some type of legitimization from medical specialists; (b) they are not considered answerable for their condition and cannot be anticipated to recuperate by a demonstration of will; (c) people must attempt to recover-if not, they can be blamed for malinger; (d) individuals are enjoined to look for and co-work with clinical experts to assist with making themselves well once more [3] .
From the theoretical review, the concept of sick role is therefore used in this work to argue that: for the barrier of COVID-19 vaccine hesitancy to be addressed, government and stakeholders must build ''value consensus'' with the population that the society is ill; and the ''sick role'' (as a social action) the population must play for the society to get well, is to get vaccinated.

Efforts by the nigerian government and key stakeholders towards vaccinating the population and addressing vaccine hesitancy
As stated by the National Primary Health Care Development Agency [20] , the Federal Government of Nigeria plans to completely inoculate 40% of its populace against COVID-19 preceding the end of 2021, and 70% by the end of 2022. As such, NPHCDA as the lead agency/stakeholder is believed to be leading the vaccination campaign across Nigeria through local government areas, social mobilisers, radio/TV jingles, including the use of role models like Ooni of Ife in the messages. In October 2021, the federal government through the presidential taskforce on COVID-19 announced mandatory vaccination for federal government workers. The workers were mandated to present evidence of vaccination or negative COVID-19 Polymerase Chain Reaction (PCR) test result for them to gain access to their offices. This nature of directive further highlights the challenge of vaccine hesitancy even among a demography which ought to be knowledgeable on the individual, public health and socioeconomic strategic importance of the vaccination.

Socio-Behavioural related factors driving COVID-19 vaccine hesitancy in Nigeria
It is instructive to mention that there are certain socio-behavioural related factors that contribute to vaccine hesitancy in Nigeria. Concurring to this fact, Oladapo et.al (2021) assert that need for vaccination, not withstanding, scepticism and apathy abound in the acceptance and utilization of the prescribed vaccines by the Nigerian population. Several factors contribute to vaccine hesitancy by the Nigerian population. These factors include: concerns about vaccine safety, suspicion regarding need for vaccines, anxiety concerning the dire effects, myths on the efficacy and safety of vaccines, among others [33] .
Corroborating the above, Rutten et.al. [30] opine that the fast rate at which the COVID-19 vaccine was developed may have undermined vaccination confidence and increase apathy about the vaccine. Another socio-behavioural factor that may have aggravated COVID-19 vaccine hesitancy in African countries, Nigeria not being an exception is the plethora of hypotheses on mainstream and social media alleging Africans' "immunity" to the virus owing to the environmental and climatic conditions present in the region [7] . In the Nigerian context, it is on record that Northern Nigeria has experienced a big challenge of vaccine scepticism arising from myriads of factors like religious beliefs, un-actualised needs, past negative experience from Oral Polio Vaccine (OPV) safety [9,36] .
Nigeria's polarised nature in terms of her numerous peoples with different cultures and ideologies is another factor to vaccine hesitancy. According to the National Demographic Health Survey [19] , Nigeria's multi-ethnic and multi-religious na-ture can make way for vaccine hesitancy to thrive. It is illuminating to mention that the socio-behavioural factors driving vaccine hesitancy is not limited to the ordinary citizens that make up the Nigerian population. It is quite worrisome that health care workers (excluding doctors) are not left out on the issue of vaccine hesitancy in Nigeria. Oriji et al., [27] embarked on a research in the South-South region of Nigeria with emphasis on Tertiary Hospital Workers (excluding medical doctors) to ascertain the level of hesitancy towards COVID-19 Vaccination. It was uncovered that there was an exceptionally unfortunate turnout of health workers for COVID-19 inoculation. 70.5% of the respondents refused the vaccine on the grounds of wanting to know its effects on those who received prior; while 62.1% argued that the vaccine has not been subjected to thorough clinical trials. From the foregoing, it is evident that certain socio-behavioural factors ranging from personal beliefs, issue of mistrust, theories claiming African peoples' immunity to COVID-19, and a host of others serve as drivers of COVID-19 vaccine scepticism/hesitancy within the Nigerian populace.

COVID-19 vaccine hesitancy as barrier to herd immunity in Nigeria
The WHO [38] advocates using vaccination to create "herd immunity" in order to reduce the number of unwanted cases and fatalities. For Betsch et al. [2] , vaccine uptake must be high enough before it can afford the needed protection (Herd Immunity) to the population. Also, high levels of vaccination are essential towards achieving herd immunity and reduce COVID-19 infections among the population and vulnerable persons susceptible to transmissions [6,14,16] .
According to the Africanews [1] , expert opinion has it that vaccine hesitancy will not only impede COVID-19 response effort s but prevent Nigeria from achieving herd immunity. For Cascini et.al [4] , vaccine hesitancy is a principal barrier in actualising herd immunity across diverse populations. Furthermore, the Private Sector Health Alliance (PSHAN) has cited vaccine hesitancy as a major reason why Nigeria has not achieved herd immunity despite only 19 percent of the country's population having received the COVID-19 vaccine [35] . In a similar vein, [26] argue that the majority of people in Nigeria are pessimists and vaccine skeptics, and there are numerous conspiracy theories circulating that have discouraged people from accepting the vaccine, despite the fact that vaccines may currently be the only means of eradicating this deadly virus (COVID-19) from the face of the planet.
More so, in a cross-sectional survey in Nigeria's six geo-political zones on COVID-19 vaccine hesitancy conducted by Ogunbosi et al. [25] , they averred that adults in Nigeria have a high rate of vaccination hesitancy, which is more prevalent among members of the Igbo ethnic group, Christians, people who live in the Northeast and Northwest geopolitical zones, as well as people who dislike vaccines created abroad. For the intended COVID-19 vaccination uptake rate and herd immunity, targeted interventions are needed [25] . The foregoing reveals the importance of high level of vaccine uptake, and how its hesitancy among the population challenges the attainment of herd immunity target in Nigeria.

Data presentation and analysis
For qualitative data-for the purpose of triangulation-the questions below were asked.

Generally, what do you think about Covid-19 and the vaccine?
A total of 131 responses were gotten. Analysed thematically, the data shows more negative than positive awareness and narratives among the population in their social interactions. Dominantly on the negative side, are responses like '' from the first view, I did not accept that there is COVID- 19   the citizens trust and believe in them first to make the country a better place before the citizens can believe in a vaccine.'' And another respondent: '' The government should try and be trust worthy. I believe if the government is, they can easily convince the masses to be vaccinated . Accordingly, the findings above support and validate the theoretical assumptions posited with the phenomenology and concept of sick role as the study's theoretical framework. Phenomenologically for instance, the respondents comments above-which also corroborated the quantitative data-show that COVID-19 vaccine hesitancy as a phenomenon is largely driven by the phenomenon of ''negative awareness'' by the populace in the meanings, perceptions and notions around COVID-19 and the vaccine they form in the course of social interaction. Just like a respondent said: '' the vaccine should be avoided by all means! Why should people take vaccines for a virus that's not affecting them? Recently, there has been series of protests against some substances used in making the vaccine; some reputable doctors in some Western countries are even skeptic about the vaccine. I don't trust the West when it comes to things like this. I don't trust the vaccine especially when it's coming from the people who have been heavily campaigning for population control in the world.'' Similarly as the study posited with the concept of sick role , comments like the above, show among the populace the lack of social acceptance of the fact that taking the vaccine is the "sick role" the people should play for the society to defeat the virus through herd immunity, as expected.

Discussion of key findings
The data above, both the primary quantitative/qualitative and data from literature reviewed-show not just lack of awareness; but dominant presence in the social interaction among the population of 'negative human awareness' about COVID-19 vaccine-which is saturated with misinformation and myths. For instance Dube et al., [7] cited the widespread misconception that Africans are resistant to the virus. The public's anxiety and suspicion over the production process and safety of vaccines are also part of the negative human awareness. These factors are even more complex as health workers are also expressing such fear and mistrust. Interestingly, in a study by Oriji et al., [27] uncovered that there was an exceptionally unfortunate turnout of health workers (excluding doctors) for COVID-19 inoculation. 70.5% of the respondents refused the vaccine on the grounds of wanting to know its effects on those who received prior; while 62.1% argued that the vaccine has not been subjected to thorough clinical trials ( Tables 1 and 2 ).
In the same vain, primary data from the study's respondents shows 40.9% and 10.7% (51.6% put together respondents) respectively disagreed and strongly disagreed that the vaccine in Nigeria is safe (see Table 2.2); while Table 2.3 shows that 47% and 12.1% (59.1% put together of 149 respondents) respectively disagreed and strongly disagreed that the vaccine is effective to protect them from the virus. More so, Table 2.5 reveals that 9.3% and 36.4% (45.7% put together of 140 respondents) respectively said the reason they have not taken the vaccine is that it is not safe and fear of its side effects. Khan, et al. [13] reinforced this position by arguing that fear of the vaccination's potential negative effects is one of the factors with the biggest influence on people's tendency to take the COVID-19 vaccine. This 'negative human awareness' drives and exacerbates the challenge of lack of /low knowledge/agreement on the public health 'sick role' as an indispensible role the population should play by taking the vaccine (which is a public good social action) is another key finding of the study. For instance, 38.3% and 14.5% (52.8% put together) respectively disagreed and strongly disagreed that the population should take the vaccine for the virus to be defeated (see Table 2.4). Herd immunity can only be achieved when a greater percentage of the populace are immune to a disease either through inoculation or by building immunity from previous diseases (see [17] ). That being said, the finding of Table 2.4 where 52.8% respondents disagreed and strongly disagreed with this notion is not only precarious but also subtly advocates for vaccine hesitancy. Meanwhile, it was argued that vaccine hesitancy is a principal barrier in actualising herd immunity across diverse populations Cascini et.al [4] , this further goes to complicate achieving herd immunity against COVID-19 in Nigeria. However, the revelation of Table 2.4 above is not new across the world. Hence, the hesitancy over the COVID-19 vaccination is evidently visible globally [11,15,31] .  A troubling reality in this finding as causal factor is that hesitancy is also high among demographics expected to be more knowledgeable and easily receptive of the 'sick role' of taking the vaccine. For instance, survey for this study targeted people that have not taken the vaccine; and of the 140 respondents who reported the reasons (as presented in Table 2.5 above), 97.3% attained higher education, 33.8% are tertiary institution students while 27.8% are civil servants. This makes the war of COVID-19 vaccine hesitancy in Nigeria even more raging. In another dimension from Table 2.5, it shows 36.4% of the total population of the 140 respondents picked "fear of side effect" as the reason why they have not been vaccinated. This in turn corroborates assertion by researchers that vaccine side effects and perceived safety contribute to vaccine hesitancy among the population ( [29] ; Sar et al., 2021; [22] ).
Similarly, another interesting finding (primary data) as a causal factor is disconnect between government and the population. Beyond the 52.8% who did not accept the public health 'sick role' of taking the vaccine, 15% said the reason they have not taken the vaccine was that they do not trust the government; while 7.9% said government should focus on other things. Corroborating this disconnect between government and the population, are respondents' statements like ''I do not believe COVID-19 is in Nigeria and therefore the government should not waste resources on the vaccine. But in countries where there is COVID-19, I believe the drug (vaccine) should be seriously enforced. I likewise have confidence in the efficacy of the COVID-19 immunization'' and ''I think our government is playing politics with it. With this, it makes the people think something fishy is going on, they sing the praise of it more than any other thing in the nation extorting funds from the World Health organization (WHO) and other prominent personalities and non-profit organizations.'' Similarly, the Nigerian government and other researchers working on COVID-19 were challenged by Prof. Cyril Otoikhian to provide evidence of the virus' presence in the nation [28] . As a structural causal factor, this already existing deep rooted problematic socio-political reality shows the peculiarity and complexity of Nigeria's case of COVID-19 vaccine hesitancy. Lastly, is lack of awareness of availability (or proximity) of vaccination points at respondents' locations as indicated by 9.3% of 140 respondents (see Table  2.5). As a finding, it is also a causal factor worthy of attention in the area of community vaccination strategies.

Conclusion/ policy intervention measures
With the employment of both qualitative and quantitative analyses/approaches, the paper has made a good attempt at bringing to the fore the factors driving COVID-19 vaccine hesitancy in Nigeria. And has established the fact that addressing the identified causal factors (lack of or low public knowledge/agreement on public health need of the vaccine; negative human awareness; disconnect (public mistrust of government) between the people and government and lack of awareness/proximity of vaccination points, lack of faith in corporations and public health organizations administering vaccines among others) towards massive vaccination and herd immunity target, is a war that must be fought accordingly. We therefore hope that government, stakeholders, public health/development practitioners, academic community and the general public; will find the knowledge and recommendations the paper has produced useful. Among other angles, further studies on the subject matter, should target more diversified demographics of respondents. Policy intervention measures outlined below are sought: Negative Human Awareness' must be countered and dislodged: This study has established the heavy presence of 'negative human awareness' about COVID-19 among the people in their social interaction in Nigeria. Programmatically, the narratives must be changed through massive and strategic advocacy and social mobilization-social/behavior change communication and risk communication-through broader and deep community engagement and dialog using community structures and key influencers/role models. The required concerted efforts must go beyond radio and television jingles! Social interaction about the vaccine among the population must be saturated with right information.
Public health 'Sick Role' consensus and Trust Bridge between the population and government must be built: As a way of implementing science and monitoring & evaluation theory of change, the first strategy above is not just for awareness creation, but to build public consensus, trust, acceptance and buy-in on the need for the uptake of the vaccine as a social action toward herd immunity against the virus, to avoid more infections, loss of lives and socio-psychological and economic ruins occasioned by the pandemic.
Beyond vaccination points, taking vaccine to the people: Going by B J. Fogg model of behavior change, which (simply) postulates that for a population to change behavior (from the behavior of vaccine hesitancy to vaccine acceptance/uptake) they must be motivated, have the ability to do so and must be triggered/prompted to do so. Logically, the first and second strategies could address the elements of motivating the population. While house-to-house strategy like the Polio vaccination model in Nigeria, should be adopted in the campaign for massive COVID-19 vaccination of the populace aimed at achieving herd immunity target in Nigeria.

Declaration of Competing Interest
There is no conflicting interest regarding this article.