From Pilot Plan to Public Trust: Community Perceptions of a Dengue Vaccine Campaign in Iquitos, Peru

Background A dengue vaccine has the potential to significantly reduce dengue transmission, severe disease, and mortality. In November 2024, Peru started to roll out the Qdenga (TAK-003) dengue vaccine for children ages 10–16 in four priority regions with historically high levels of dengue transmission. This qualitative study examines facilitators and barriers to the roll out of the Qdenga vaccine from parent and health provider and authority perspectives in Iquitos, Peru. Methods Six focus group discussions (FGDs) (n = 55) with parents of eligible children and four key informant interviews (KIIs) with Loreto Regional Health Department (GERESA) nursing coordinators were conducted in Iquitos. Recorded sessions were transcribed and analyzed using thematic analysis and organized using the Consolidated Framework for Implementation Research (CFIR). A complementary dataset from Piura was used to further contextualize the findings. Results Policy word choice created unintended implementation barriers, specifically the use of the term “pilot plan” in the technical guidance created distrust among many community members, who felt that their children were “guinea pigs” in a plan to test the safety and efficacy of a new vaccine. The centralized plan of a clinic-based strategy resulted in low uptake, so local health districts adapted their strategies to involve schools and door-to-door vaccination outreach, which ultimately led to the achievement of the first dose vaccination goal. Trust and convenience complemented each other, as participants reported high levels of trust in public health officials and appreciated the school and door-to-door based strategies. Conclusions In settings where transportation to health facilities is challenging and the community expresses hesitancy regarding vaccination programs, this study suggests that a robust, on-the-ground public health campaign that meets participants and their children where they are is an effective strategy for ensuring vaccine uptake. It also suggests the importance of local health facilities effectively adapting national vaccination campaign strategies to local settings.