Perceptions of oral cholera vaccine and reasons for full, partial and non-acceptance during a humanitarian crisis in South Sudan.
Oral cholera vaccination (OCV) campaigns were conducted from February to April 2014 among internally displaced persons (IDPs) in the midst of a humanitarian crisis in Juba, South Sudan. IDPs were predominantly members of the Nuer ethnic group who had taken refuge in United Nations bases following the eruption of violence in December 2013. The OCV campaigns, which were conducted by United Nations and non-governmental organizations (NGOs) at the request of the Ministry of Health, reached an estimated 85-96% of the target population. As no previous studies on OCV acceptance have been conducted in the context of an on-going humanitarian crisis, semi-structured interviews were completed with 49 IDPs in the months after the campaigns to better understand perceptions of cholera and reasons for full, partial or non-acceptance of the OCV. Heightened fears of disease and political danger contributed to camp residents' perception of cholera as a serious illness and increased trust in United Nations and NGOs providing the vaccine to IDPs. Reasons for partial and non-acceptance of the vaccination included lack of time and fear of side effects, similar to reasons found in OCV campaigns in non-crisis settings. In addition, distrust in national institutions in a context of fears of ethnic persecution was an important reason for hesitancy and refusal. Other reasons included fear of taking the vaccine alongside other medication or with alcohol. The findings highlight the importance of considering the target populations' perceptions of institutions in the delivery of OCV interventions in humanitarian contexts. They also suggest a need for better communication about the vaccine, its side effects and interactions with other substances.
London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom. Electronic address: dorothy.peprah@lshtm.ac.uk.
Dorothy
D
Peprah
London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom; Centre of African Studies, School of Social & Political Sciences, University of Edinburgh, 15a George Square, Edinburgh EH8 9LD, United Kingdom.
Jennifer J
JJ
Palmer
King's College London, Department of Psychological Medicine, Weston Education Centre, Cutcombe Road, London SE5 9RJ, United Kingdom.
G James
GJ
Rubin
World Health Organization, Geneva, Switzerland.
Abdinasir
A
Abubakar
World Health Organization, Geneva, Switzerland.
Alejandro
A
Costa
World Health Organization, Geneva, Switzerland.
Stephen
S
Martin
World Health Organization, Geneva, Switzerland.
William
W
Perea
London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom; Department of Global Health, University of Washington, Seattle, WA, USA.
Heidi J
HJ
Larson
D000328:Adult; D000533:Altruism; D022121:Cholera Vaccines / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007117:Immunization, Secondary; D008297:Male; D032541:Mass Vaccination; D008875:Middle Aged; D009938:Organizations; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D036301:Qualitative Research; D000068037:South Sudan; D014480:United Nations; D000068336:Warfare and Armed Conflicts; D055815:Young Adult
D022121:Cholera Vaccines
Cholera; Humanitarian crisis; Oral cholera vaccination; Vaccine acceptance; Vaccine hesitancy; Vaccine perceptions