Dengue vaccine acceptability in Peru: A mixed-methods study in two dengue-endemic Peruvian cities

IntroductionDengue poses a major public health challenge in Peru, with Piura and Loreto experiencing recurrent outbreaks and limited control options. A dengue vaccine could complement current vector control strategies and reduce transmission, yet community perceptions and potential barriers to uptake remain unclear. Methodology/Principal FindingsOur mixed-methods study design was conducted in the dengue-endemic districts of Piura and Iquitos, and was guided by the 5C model (confidence, complacency, convenience, communication, and context). We conducted sixteen focus group discussions (147 participants) to explore perceptions, motivations, and concerns regarding a hypothetical future dengue vaccine. Next, a survey (n=883) assessed willingness to receive the vaccine, and the factors associated with vaccine refusal, using logistic regression. ResultsOverall, 81.2% of survey participants indicated willingness to receive a dengue vaccine. Qualitative findings underscored the need for clear information on efficacy, eligibility, and side effects, provided by trusted health professionals. Survey participants wanted to know about vaccine side effects (83.1%), effectiveness (69.8%), and number of doses (33.8%) to feel confident about the vaccine. In multivariate analysis, lack of knowledge about dengue transmission (OR 3.34), a negative opinion on the COVID-19 vaccine (OR 2.52), higher education levels (OR 6.48), and preference for natural immunity from an infection (OR 2.46) were associated with an increased risk of hesitancy towards the dengue vaccine. Willingness to pay for the vaccine (OR 0.37) and preference for house-by-house vaccination campaigns (OR 0.54) were associated with reduced levels of hesitancy. ConclusionsThe most important factors surrounding vaccine hesitancy were contained within confidence and context. While most participants were receptive to a future dengue vaccine, misinformation, negative COVID-19 vaccine views, and distrust of public institutions pose barriers. Tailored communication, engaging trusted local leaders, and ensuring easy access will be critical for successful dengue vaccination campaigns in these endemic regions. Author SummaryDengue, a mosquito-borne disease, is a growing global problem evidenced by increased outbreaks in recent years. Peru is a dengue-endemic country, with areas such as Iquitos and Piura consistently reporting high numbers of dengue cases every year. The main strategy for dengue control consists of reducing mosquito populations, including fumigation to kill adults and larvicide to prevent larva from developing into adults. Several dengue vaccines candidates provide promising support for reducing the burden of dengue, but community attitudes towards a future vaccine need to be examined so that future implementation can be successful. Through focus group discussions and surveys, our results found that themes of confidence and context influenced perceptions of a vaccine the most. Future vaccine campaigns should ensure messaging is clear and consistent, with information about vaccine side effects, eligibility, and doses. Outreach strategies should be implemented with accessibility in mind, as this will prevent barriers of community access.