Programmatic evaluation of a school-based typhoid vaccination campaign: findings of qualitative research

Background: Globally, typhoid fever is a vaccine preventable infectious disease with significant morbidity and mortality. Apart from EPI center, other alternative and accessible venues were needed for this vaccine like schools. The purpose of this study was to identify the factors influencing acceptance and rejection of participation in school-based typhoid vaccination program in target communities in Karachi.Methods: A qualitative study was conducted, 46 in-depth interviews were conducted with parents, teachers and administrators in the schools where the typhoid vaccine was provided. NVivo was utilized for data coding and themes were derived along with WHO’s analytical framework, vaccine hesitancy, that is, confidence, convenience and complacency, in responses to the vaccination.Results: Participants described confidence as a key factor that largely rooted their perceptions and attitudes related to the vaccination program. Stakeholders showed their concerns about affordability, safety and effectiveness and convenience of the vaccine’s delivery to the students. Satisfied participants from the school-based program showed lack of trust in quality of vaccine and vaccination procedures.Conclusions: Our findings indicate the importance of providing adequate information on vaccination through multiple communication channels, sustained social mobilization programs including community engagement. Addressing concerns through dialogic interactions were crucial for motivation and acceptance of the vaccination program.