Introduction: Dengue 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 Findings: Our 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. Results: Overall, 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. Conclusions: The 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.
Ortega et al. (Thu,) studied this question.