A Critical Examination of Equity Dimensions in Nigeria’s COVID-19 Vaccination Rollout

Nigeria's COVID-19 vaccination programme faced significant equity challenges in vaccine access, distribution, and uptake that reflected pre-existing health system inequalities, and a rigorous critical examination of these equity dimensions provides lessons applicable to future epidemic response and vaccine programme design. This study conducted a critical examination of equity dimensions in Nigeria's COVID-19 vaccination rollout from 2021 to 2023. A mixed-methods policy analysis and epidemiological study was employed. The epidemiological component analysed subnational COVID-19 vaccination coverage data from NPHCDA and DHIS2 for all 36 states and FCT across the 24-month rollout period, examining equity across geographic, income, gender, and age dimensions using concentration indices and geographic information system mapping. The policy analysis examined rollout planning documents, procurement records, distribution guidelines, and priority group definitions against equity frameworks from WHO SAGE and COVAX. Structured interviews were conducted with 28 vaccination programme managers, equity advocates, and community health practitioners. Results showed extreme geographic inequity in rollout pace, with south-western states achieving priority group coverage 14 months ahead of north-eastern states. Income-related concentration was severe in early rollout phases, with higher-income urban populations disproportionately vaccinated. Gender equity gaps favoured males in northern states and females in southern states. Disability and occupational categories received inconsistent priority recognition. Policy analysis identified four structural equity failure mechanisms: urban facility-centric distribution logistics, digital registration barriers, prioritisation framework ignoring informal sector workers, and political influence on geographical rollout sequencing.