Perceptions of oral cholera vaccine and reasons for full, partial and non-acceptance during a humanitarian crisis in South Sudan

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Vaccine. 2016 Jul 19;34(33):3823-7. doi: 10.1016/j.vaccine.2016.05.038. Epub 2016 Jun 10.

Perceptions of oral cholera vaccine and reasons for full, partial and non-acceptance during a humanitarian crisis in South Sudan

Peprah D¹, Palmer JJ², Rubin GJ³, Abubakar A⁴, Costa A⁴, Martin S⁴, Perea W⁴, Larson HJ⁵.

Author information

• ¹London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom. Electronic address: dorothy.peprah@lshtm.ac.uk.
• ²London 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.
• ³King´s College London, Department of Psychological Medicine, Weston Education Centre, Cutcombe Road, London SE5 9RJ, United Kingdom.
• ⁴World Health Organization, Geneva, Switzerland.
• ⁵London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom; Department of Global Health, University of Washington, Seattle, WA, USA.

Abstract

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 choleraas 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 reasonsincluded 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.

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