The beginning of 2021 saw a marked rise in COVID-19 cases in South Sudan, followed by a partial lockdown. At the end of March 2021, South Sudan received 132,000 AstraZeneca vaccines through the COVAX Facility, which was expected to fully vaccinate 66,000 people. About a month into the roll-out of the vaccine in Juba, only 3,500 people had reportedly been vaccinated, prompting concerns of vaccine hesitancy amongst the South Sudanese population. Moreover, by May 2021, South Sudan’s National Task Force on COVID-19 had opted to return 72,000 doses to avoid the risk of them expiring before use.
In response, REACH undertook this assessment to understand the current community perceptions of COVID-19 and gauge awareness of the vaccine across South Sudan, as well as the perceptions and willingness to be vaccinated amongst the South Sudanese population. The assessment aims to fill information gaps relating to communitylevel beliefs and perceptions around COVID-19 and its vaccine to enable the development of effective communication and awarenessraising campaigns in South Sudan.
A total of 32 focus group discussions (FGDs) with purposefully sampled participants from camp and non-camp settings were conducted across 9 of the 10 states in South Sudan between May and June 2021. The FGDs were held in Kapoeta and Torit counties (Western Equatoria State); Juba town, and Juba internally displaced persons’ (IDP) site [former Protection of Civilians (PoC) site] in Juba county (Central Equatoria State); Maridi county (Eastern Equatoria State); Wau IDP site (Masna) and Wau IDP site (former PoC site) in Wau county (Western Bahr el Ghazal State); Aweil town in Aweil Centre county (Northern Bahr el Ghazal State); Mingkaman in Awerial county and Rumbek town in Rumbek Centre county (Lakes State); Bentiu IDP site (former PoC site) in Rubkona county and Nyal in Payinijar county (Unity State); Pariang county (Ruweng Administrative Area); Bor town and Bor IDP site (former PoC site) in Bor county, and Akobo county (Jonglei State); and Malakal PoC site in Malakal county (Upper Nile State).
Half of the FGDs were conducted with female participants only, and half with only male participants. Participants were aged 18 years or above and each discussion was composed of participants who shared at least one language to enable open and candid discussions. In addition, to provide more insight, two key informant interviews (KIIs) were conducted in the IDP site in Juba, one with a religious leader and another with a community leader. Unless stated otherwise, the analysis in this brief discusses findings from the FGDs. All findings presented are indicative of broad community perceptions. For more information, refer to the Research Methodology Note.
High levels of awareness and concern relating to COVID-19 were reported in FGDs held across South Sudan. However, a lack of belief and concern regarding COVID-19 was raised in a number of FGDs held in non-camp settings, indicating some prevalence of misinformation regarding the subject amongst these communities.
While communities in IDP camps were more commonly reported to be concerned about COVID-19 in comparison to their noncamp counterparts, participants in camps mentioned limitations in their ability to practice social distancing due to overcrowding where they lived. Concerns were also raised regarding a lack of resources or facilities for testing for COVID-19 in some areas.
A number of challenges are reported to be faced by communities, including unemployment, lack of access to education facilities, shortages in medicine and other essential commodities, as well as a deterioration in social relationships, as a result of COVID-19 and subsequent preventive measures put in place.
Awareness of the COVID-19 vaccine amongst communities was reported in a majority of FGDs held across the country, with the exclusion of three states: Lakes, Jonglei, and Unity. The level of awareness of the vaccine appeared to be higher amongst male participants and those living in IDP camps, as compared to female participants and people in non-camp settings, which may indicate information gaps amongst these sections of the population.
Vaccine hesitancy was reported to be higher in communities where there was prior awareness of the vaccine. This may be a result of the myriad of rumours and concerns relating to the vaccine circulating within communities, which was also reported by FGD participants. Reported rumours included fears of premature death, infertility or impotence, and catching COVID-19 as side effects of the vaccine. In comparison, participants who heard about the vaccine for the first time in the FGDs commonly stated positive views around the vaccine and higher willingness to be vaccinated.
Findings suggest that communities in camps might have higher levels of awareness of the COVID-19 vaccine and are more willing to receive it. However, participants living in camps also raised difficulties related to accessing the vaccine whilst living in camps.
Findings suggest that female participants are not less willing to be vaccinated, but have higher demands for information about the COVID-19 vaccine in order to make a decision regarding vaccination.
FGD participants (reporting prior awareness of the vaccine) reported that communities believe vaccines are meant for all who are willing to receive it, particularly older/sick people, government officials, and health workers. Some stated that communities also believe that vaccine accessibility to people may not be based on medical eligibility, with concerns raised regarding lack of access faced by poor and vulnerable groups.
Communities were reported to receive information regarding the vaccine primarily through the radio, health workers, friends and family, at churches or through religious leaders, and from humanitarian workers. Information dissemination through social media and phones was also reported primarily by male participants, indicating possibly lower levels of access to phones or technology among women.
FGD participants across the country volunteered their perceptions and recommendations on information-sharing and confidence-building measures that would support and encourage communities to make informed decisions about getting vaccinated. These are detailed in the findings and highlighted in the recommendations sections of this brief.