Table 3 Illustrative quotes for broader local, national, international, and global context-related (socio-political-economic, historic, health system) determinants of COVID-19 vaccination acceptance

Nature of COVID-19 information and communication environment

1

‘[Because of conspiracy theories, ] Some people are afraid that it [COVID-19 vaccination] is a means to kill the Africans because they say the African population is too large, especially the Nigerian population. For that reason, many people have sworn not to take the vaccination.’ (Male FGD 4)

2

‘I have heard about the [COVID-19] vaccination and I will not take the vaccination because I have seen on the [social] media where people in other countries were saying that they were killing them with the vaccination.’ (Male FGD 2)

3

‘I have also seen on the [social] media where they were giving the [COVID-19] vaccination and that place [the vaccination site on the body] became magnetic. Also, if you are to put an electric bulb on the place, it may light up the bulb. That is to show you how deadly the vaccine is.’ (Male FGD 2)

4

‘But ever since this COVID-19 vaccine came, rumours have been going round that the vaccine has been killing people. Even in schools, people rushed to pick their children up because they said it was killing the children after they received the vaccination. So, sometimes rumours are part of the things that put fear in some people [and make them not to get vaccinated].’ (Female FGD 4)

5

‘What spoiled my mind [discouraged me] was the story … that there was nothing like COVID-19, that any person they gave the [COVID-19] vaccination, that there is something [in the vaccine] white men [in other countries] are using to monitor the person’s body, with that thing they will be monitoring you.’ (Male FGD 3)

6

‘There are people who believe that they should wait for those who have received [COVID-19 vaccine] to know if they will die. Then if they waited for months or years and they didn’t die, then they will know the vaccine is good [really safe]. They will (then) agree to take it because they have stayed [waited] for years and seen that those who took it, nothing happened to them.’ (Female FGD 8)

7

‘I was thinking COVID-19 was no longer in the state, that it is now in the past, if not that you people came today. So, I did not know [that COVID-19 was still existing]. When COVID-19 came, once you put on your radio the only thing you will be hearing was COVID-19. Now it has become so cool [no more COVID-19 in the news] and we thought COVID-19 was no longer in Ebonyi state.’ (Female FGD 4)

Peculiar COVID-19 prevention and control policies and measures

8

‘COVID-19 is real because I have seen how serious the government was in trying to prevent it and how many movement restrictions were imposed.’ (Male FGD 4)

9

‘My dad did not believe that COVID-19 was real until they [government] asked everyone to stay at home. … He took the vaccination, but majority of the people are still in doubt.’ (Female FGD 6)

10

‘There was this vaccinated person I heard about in another country who got infected with COVID-19, after coming in contact with someone who had COVID-19, and was isolated. So, in that sense, I feel the COVID-19 vaccination is not as protective [as effective] as they said.’ (Female FGD 6)

COVID-19 vaccination policies and regulations

11

‘Concerning the [COVID-19] vaccination, the first dose I took, it was terrible. I would not have taken it but because of the place I work, we were made to take the vaccination. They asked all of us to go and take the vaccination.’ (Female FGD 6)

12

‘If not because they made it [COVID-19 vaccination] compulsory in some places, some people would not have taken it. Just like they made the wearing of face mask compulsory, … Because it was the same thing, because where I work, … if you do not take it [COVID-19 vaccination] you are gone [fired]. And if you want to travel out, if you do not take it, you cannot travel out, you cannot travel out of the country.’ (Female FGD 6)

13

‘For example, we that are going for service [National Youth Service], they actually told us to ensure that we are vaccinated [before going to orientation camp] … So, people take COVID-19 vaccination because of politics (mandatory policies) …’ (Male FGD 6)

14

‘On the part of the youth Corpers (for the National Youth Service), those going to the orientation camp, because me, I heard that it is now compulsory, that if you do not take the [COVID-19] vaccination, you will not be allowed into the camp. So, me, I did not even have the intention of taking it … I need to go to camp, I need to take this vaccination.’ (Female FGD 6)

15

‘… they [some of the unvaccinated] will say “let me still wait to see if the COVID-19 will rise again or calm down or the government will make it [COVID-19 vaccination] compulsory”, before they will go and receive it.’ (Female FGD 6)

16

‘… they [government/community leaders] should make COVID-19 vaccination compulsory and prohibit people from going to farm [on specific COVID-19 vaccination days], that anybody that go to farm will pay 2000 or 3000 naira [otherwise, people will always go to farm and not have chance to go for the vaccination].’ (Female FGD 9)

Provision of incentives for COVID-19 vaccination

17

‘When you give some people money, you give them 2000 or 3000 naira, that is when they will stop going to the farm [and go and receive the COVID-19 vaccination].’ (Female FGD 9)

18

‘… they [people] need incentives [to go and receive COVID-19 vaccine]. … if you come [to receive the vaccine] and they give you one thousand or 500 naira, you will see the long queue that it will lead to.’ (Male FGD 1)

The history of the Ebola viral disease outbreak

19

‘When we heard it on the radio, but we saw people attending functions [going about their normal daily activities without restrictions], it was hard for us to believe COVID-19 was real. Just like what they did during the time of Ebola, we were told to bath and drink salt water, which many or all of us did but nothing like Ebola came [to Ebonyi state] and some people died because of it [bathing with and drinking of salt water to prevent Ebola]. This kind of experience contribute to some people not going to take the COVID-19 vaccination.’ (Female FGD 4)

(Un)Trustworthiness of the government and bad/good governance

20

‘I think another distrust, another distrust started from the period of COVID-19 lockdown when the COVID-19 palliatives were not distributed but hoarded instead. You [the state government] hoarded the food that was supposed to be given to the masses and you are now telling them, “you must go and receive COVID-19 vaccination”. So, it is not really coming through [people are not heeding the call]. If they [the government] had distributed the palliatives to the people and are now telling them, “there is a vaccination that you have to receive”, we will believe the government is with us.’ (Male FGD 6)

21

‘There was a time [during the lockdown] they [the government] said they would share COVID-19 palliatives to the masses, but since then they have not done that. Because of that, people are not buying the idea of going to take the [COVID-19] vaccination since they have not fulfilled their promise.’ (Male FGD 4)

22

‘Look at the election campaign promises, no one has been fulfilled. So, how can you believe such government when they bring something [like COVID-19 vaccination] for you to receive? That is what is happening. Like my brother said, this COVID-19 palliative they [the government] hoarded for themselves instead of distributing to the masses, … Even the money they released, the federal government released for them [the federal and state governments] to distribute to people, up till now I have not gotten my own, so many people have not gotten their own. How can you believe that what they [the governments] are saying [about COVID-19 and COVID-19 vaccination] is the truth?’ (Male FGD 6)

23

‘Why they are saying that [saying that nothing will make them receive the COVID-19 vaccination] is that, some people say they have not gained anything from the Nigerian government and will never receive the [COVID-19] vaccination. I have not received any incentives from the government who have been using dubious means [including this COVID-19 vaccination campaign] to misappropriate public funds.’ (Male FGD 4)

24

‘The people that have not received the [COVID-19] vaccination, I told you earlier that they lost confidence, they do not believe in the government, they have lost confidence in the government. That is why they have not taken it [the COVID-19 vaccination]. Those who have taken it, they believe in the government and whatever the government say is the truth.’ (Male FGD 6)

(Un)Trustworthiness of the health system and international/global health partners

25

‘Coming back to Africa here, I think the main reason why people are doubting the [COVID-19] vaccine is that the vaccine is being faked [is substandard]. You know they [people] believe everything about Africa [is fake], we fake everything, the way paracetamol and all other drugs [are being faked]. So, for a vaccine like this, they believe it has been faked, … so people are running away from taking it …’ (Male FGD 6)

26

‘They [those not intending to get vaccinated] are afraid and will say, maybe, there is another disease they [the foreign providers, government] want to inject [people with] or they want to put something in their body.’ (Female FGD 10)

27

‘Let me add my own [opinion]. What I understand in [about] this thing [the reasons for non-acceptance of COVID-19 vaccination] is fear. Also, they will say it is an expired vaccine.’ (Female FGD 7)

28

‘I can say even as at now, some people still don’t believe that the [COVID-19] vaccine is real, some people don’t take it seriously. I remember when I went to take my own vaccination, someone was saying that the available vaccines had expired and were no longer effective. So, I think that could be a reason [for non-acceptance of the vaccination].’ (Female FGD 6)