Exploring perceptions and attitudes towards vaccines in a remote western DRC health zone

The Democratic Republic of the Congo (DRC) struggles with low full childhood vaccination coverage (around 50 %) and a high children-under-five mortality rate (79 deaths per 1000 live births). This situation is potentially exacerbated by vaccine hesitancy, which was identified by the World Health Organization (WHO) as one of the top 10 global health threats in 2019. To gain deeper insights into levels of vaccine confidence possibly influencing vaccination coverage, we explored perceptions and attitudes towards childhood and adult vaccines in Boende (Tshuapa province, western DRC), which experienced an Ebola outbreak in 2014 and hosted the EBL2007 Ebola vaccine trial (2019-2022). Using purposeful sampling, we conducted 29 individual interviews and 14 focus group discussions with diverse community members between July 2022 and March 2023. Our findings suggest the prevalence of a relatively low level of trust in COVID-19 vaccines compared to other vaccines. Additionally, the fear of Ebola disease seemed to lead to general acceptance of the EBL2007 trial vaccine, although some concerns were voiced about pre-testing and the decision to conduct the trial in the DRC. While trust in childhood vaccines and reported uptake appeared to be high, concerns existed regarding potential adverse effects and the possibility that vaccines targeted African children specifically. Our analysis further identified four recommendations to possibly enhance vaccine confidence in the region. This study highlights the multifaceted nature of vaccine confidence, influenced by the perceived risk of the targeted diseases, past experiences with medical interventions and staff, and sociopolitical contexts. However, we emphasise that increasing vaccine uptake requires a comprehensive approach, addressing not only vaccine confidence, but also crucial aspects like access to vaccines and robust disease surveillance activities. This would ultimately reduce the burden of vaccine-preventable diseases and lead to better public health outcomes in the region.