Political Economy of Vaccine Hesitancy and Immunisation Programme Failure in Post-Conflict Communities of North East Nigeria

Vaccine hesitancy in North East Nigeria is deeply embedded in political, historical, and institutional dynamics that are inadequately captured by behavioural models focusing on individual-level determinants. This study investigates the political economy of vaccine hesitancy and immunisation programme failure in post-conflict communities of Borno and Adamawa States through a critical political economy lens. The research employs an interpretivist, multi-sited ethnographic design conducted over 24 months across eight communities at different stages of post-conflict recovery. Methods include prolonged participant observation, 100 semi-structured interviews with community members, traditional and religious leaders, health workers, military civil-military coordination officers, and NGO programme staff, alongside analysis of immunisation programme documents, media coverage, and government communications. Foucauldian Discourse Analysis is applied to examine how power relations, distrust narratives, and state legitimacy crises shape community constructions of vaccination risk. Actor-Network Theory additionally frames the analysis of how non-human actants including vaccines, cold chain equipment, and rumours shape programme outcomes. The study's original theoretical contribution is a Political Economy of Vaccine Hesitancy framework that integrates macro-structural factors including governance, conflict, and historical distrust into hesitancy analysis. Findings challenge reductionist individual-behaviour models and provide a basis for politically sensitive immunisation programme design in post-conflict Nigeria. Keywords: vaccine hesitancy, political economy, post-conflict, immunisation, North East Nigeria.