Presentation (CTI)

OBJECTIVES: As countries realign energy policies in response to climate change and fiscal pressures, the removal of fossil fuel subsidies has become common. In low-income settings, higher fuel prices may raise the cost of accessing essential services and disrupt preventive healthcare. This study examines how Nigeria’s May 2023 petrol subsidy removal affected routine childhood immunization coverage, timeliness, and vaccination behavior.
METHODS: We combine the 2023 Nigeria Demographic and Health Survey with petrol price data from the National Bureau of Statistics. Using Nigeria’s national immunization schedule, we reconstruct child-level vaccine histories and define dose-specific age windows. For each child-vaccine pair, we map the relevant window to contemporaneous state-level fuel prices and construct post-reform exposure measures. Identification exploits quasi-experimental timing from the nationwide subsidy removal using within-child comparisons across vaccines due at different ages (child fixed effects) and within-vaccine comparisons across cohorts and states (vaccine-by-state fixed effects). Outcomes include completion of required vaccines, on-time vaccination, days under-vaccinated, and cross-vaccine bunching and spacing across visits.
RESULTS: A 1% increase in petrol prices following the subsidy removal reduced the probability of completing all required childhood vaccinations by 4.3% (p<0.01), with effects more pronounced in rural communities with lower health facility density. Among children with vaccination cards, timely receipt of required vaccines declined by 9.6% (p=0.01). Behavioral responses consistent with increased access frictions were observed: cross-vaccine bunching increased after the reform. For example, 10-week combination vaccines were administered with 12 fewer days of spacing (p=0.04), and the odds of receiving multiple vaccines in a single visit increased (OR=1.5, p=0.03).
CONCLUSIONS: Energy subsidy removal can generate unintended effects on healthcare access in low-income settings by increasing access barriers. As countries pursue climate-aligned energy reforms, compensating policies, such as expanded outreach and service delivery adaptations, may be needed to preserve access to essential health services during periods of rising energy costs.