Vaccination is a critical tool in the global response to the COVID-19 pandemic. Yet, COVID-19 vaccine hesitancy has not been well explored in parts of Nigeria. We assessed the predictors of acceptability of the COVID-19 vaccine and identified reasons for vaccine hesitancy among adults in urban Kano, northern Nigeria. Using a mixed-methods design, we administered structured questionnaires to a cross-section of adults (n = 446), complemented with 20 in-depth interviews. Binary logistic regression and the framework approach were used to analyze the data. About one-half (51.1%, n = 228) of the respondents were willing to take the COVID-19 vaccine. Vaccine acceptance was higher among older respondents (≥30 years) (adjusted Odds Ratio (aOR) = 1.76, 95% Confidence Interval (CI): 1.14–2.99 (≥30 vs. <30), higher-income earners (≥30,000 Naira) (aOR = 2.06, 95%CI:1.12–3.80, ≥30,000 vs. <30,000), and those with a history of a chronic medical disorder (aOR = 1.90, 95%CI:1.06–3.72). Vaccine acceptance was also higher in persons with high risk perception (aOR = 1.61, 95%CI:1.13–2.81, high vs. low), those who were unconcerned about vaccine safety (aOR = 1.71, 95%CI:1.13–3.55), and those who were not worried about efficacy (aOR = 2.02, 95%CI:1.14–4.11) and infertility-related rumors (aOR = 1.98, 95%CI:1.24–3.18). Themes revealed doubts about the existence of COVID-19, mistrust for authorities, and popular credence to rumors and conspiracy theories. In conclusion, COVID-19 vaccine acceptance was sub-optimal and influenced by respondent’s age, income, co-morbidities, risk perception, and concerns about vaccine safety, efficacy, and rumors. Context-specific, evidence-based risk communication strategies and trust-building measures could boost vaccine confidence in similar settings.
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