Stakeholder recommendations to optimize vaccination implementation and uptake for disease outbreaks: Qualitative insights from less-established adult and childhood vaccination programs in Nigeria.

Achieving sufficient vaccination coverage to mitigate disease outbreaks remains a persistent challenge in Nigeria, particularly for less-established vaccination programs. We aimed to obtain stakeholder recommendations for optimizing the implementation and uptake of less-established adult and childhood vaccination programs in Nigeria. We conducted eight Focus Group Discussions (FGDs) and 53 interviews with 132 participants purposively selected from three Nigerian states, Oyo, Nasarawa, and the Federal Capital Territory. Data were analyzed using inductive thematic analysis. Participants made several cross-cutting recommendations for optimizing less-established adult and childhood vaccination programs across five themes: 1. Institutional readiness as a foundational determinant of program performance; 2. Multilevel trust mechanisms operating through community engagement, co-creation, peer advocacy, and adverse event governance; 3. The emergency mobilization and routine institutionalization tension; 4. Policy enablers, including incentive schemes and vaccination mandates; and 5. Operational enablers, including risk communication and multisectoral coordination. Program-specific recommendations addressed reminder systems, schedule alignment, and integrated service delivery for measles second dose and malaria vaccination for children. This study generated recommendations for policymakers and program managers in Nigeria and similar contexts to improve vaccination implementation and uptake in both routine and outbreak settings.