Willingness to receive Ebola vaccines among pregnant and lactating women in Kampala, Uganda: insights from a post-outbreak cross-sectional study.

BACKGROUND

Pregnant and lactating women face heightened risk of mortality due to Ebola disease during outbreaks, yet have historically been excluded from vaccine trials and emergency vaccination campaigns. This study assessed willingness to receive an Ebola vaccine and identified associated factors among pregnant and lactating women in Kampala-Uganda, in the aftermath of the 2022 Sudan ebolavirus outbreak and amid the COVID-19 pandemic.

METHODS

A cross-sectional survey was conducted in 2023 among pregnant/lactating women receiving antenatal/postnatal services at Kawempe National Referral Hospital. Data were collected using a structured questionnaire adapted from the WHO SAGE Working Group on Vaccine Hesitancy and included additional items on Ebola vaccine attitudes, socio-demographics, prior vaccination experiences, vaccine preferences (oral vs injectable) and health status, including chronic illness. The primary outcome was willingness to receive an Ebola vaccine. Modified Poisson regression was done using STATA version 15 and a p-value <0.05 was considered statistically significant.

RESULTS

Among 424 participants (212 pregnant, 212 lactating), 252(59.4%) expressed willingness to receive an Ebola vaccine. In multivariable analysis, willingness was significantly associated with previous COVID-19 vaccination (adjusted Prevalence Ratio [aPR] = 1.32; 95%CI:1.02-1.70) and a preference for injectable vaccines only, compared to those open to oral or injectable modes (aPR = 1.54; 95%CI:1.18-2.00). Among those who were unwilling or unsure (n = 172), the most cited reasons for hesitancy were fear of side effects (22.1%) and lack of awareness about Ebola vaccines (20.3%).

CONCLUSION

While just over half of the pregnant and lactating women in this study were willing to receive an Ebola vaccine, concerns about safety and limited awareness remain important barriers. Prior COVID-19 vaccination and preference for injectable vaccines were positively associated with willingness, suggesting that trust and familiarity with vaccination influence acceptance. Tailored risk communication and community engagement, and inclusion in vaccine planning are essential to ensuring equitable protection during EVD outbreaks.