From Block Rejections to Stock-Outs: Leveraging Social and Behavior Change for HPV Vaccine Uptake in Lagos State

Lagos State – Nigeria's most urbanized and populous setting – was expected to achieve rapid acceptance during the October 2023 HPV vaccine introduction due to its high literacy levels, strong media presence, and significant cervical cancer burden. Instead, Lagos became the epicenter of widespread misinformation, block rejections, and community resistance, resulting in a low 38% launch coverage despite a prolonged campaign. While other states recorded over 80% in one campaign, the progress in Lagos was slow. Entrenched rumors around infertility, depopulation agendas, and covert birth control spread rapidly through social media, influential voices, religious networks, and school systems, revealing a deeper trust deficit and challenging assumptions that urban populations are more resilient to misinformation.

In response, the Social and Behavior Change (SBC) team re-engineered its strategy from early 2024, prioritizing trust-building, multi-sectoral partnership, community-led advocacy, and systematic school engagement. High-level religious and traditional gatekeepers were repositioned as amplifiers of factual information; teachers and school bodies bridged communication gaps with parents; and male influencers helped reshape gendered decision-making. Youth ambassadors normalized uptake among peers, while mass and digital media efforts shifted narratives at scale.

These coordinated efforts generated measurable improvements, accelerating coverage to 74.6% by November 2024 and triggering statewide vaccine stock-outs. The Lagos experience demonstrates how tailored SBC strategies – rooted in trust, representation, and community voice – can convert deep-seated vaccine hesitancy into sustained demand, offering a valuable model for complex urban contexts confronting disinformation.