{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T17:04:02Z","timestamp":1790960642132,"version":"4.1.0"},"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["NU2GGH002058"],"award-info":[{"award-number":["NU2GGH002058"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The 2018\u20132020 Ebola Virus Disease (EVD) outbreak in Eastern Democratic Republic of the Congo (DRC) occurred amid armed conflict, institutional mistrust, and fragile health systems. The Ebola vaccine was deployed under emergency pre-licensure use, and concerns about it persisted. This study explored community and healthcare worker (HCW) perceptions of the Ebola vaccine to better understand the sociocultural and structural drivers of vaccine acceptance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a qualitative study in three heavily affected health zones in North Kivu province (Beni, Butembo, and Mabalako) in 2021. Data were collected through thirty-three focus group discussions and 15 key informant interviews with EVD survivors, community members, HCWs, and local leaders, purposively sampled to capture diverse perspectives. Transcripts were analyzed using thematic and content analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Participants reported concerns about the safety of the vaccine, mistrust in the institutions delivering it, and confusion due to rumors and inconsistent communication from the Ebola response. HCWs reported feeling coerced into vaccination rather than making a voluntary choice. Misinformation, logistical barriers, and perceptions of favoritism and stigmatization linked to ring vaccination were cited as preventing acceptance. Religion played a dual role, both fostering skepticism and encouraging acceptance depending on the stance of local faith leaders. Participants emphasized the need for transparent and balanced communication, equitable access, and greater involvement of trusted and competent community figures in vaccination efforts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Ebola vaccine decision-making in Eastern DRC was shaped by complex interactions between institutional mistrust, perceived risk, religion, and access constraints within a broader context of sociopolitical instability. This study provides a critical baseline of perceptions during the vaccine\u2019s pre-licensure phase and highlights the importance of locally grounded engagement strategies. As vaccines become licensed, understanding local perceptions as well as leveraging the influence of trusted religious and community leaders will be essential for improving vaccine uptake.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0346572","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T17:32:02Z","timestamp":1775583122000},"page":"e0346572","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Perceptions of factors influencing Ebola vaccine acceptance among community members, healthcare workers, and response personnel in Eastern Democratic Republic of the Congo"],"prefix":"10.1371","volume":"21","author":[{"given":"Ruth","family":"Kallay","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8344-1802","authenticated-orcid":true,"given":"Pierre","family":"Muhoza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dieula Delissaint","family":"Tchoualeu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Fleming","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Garbern","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel Lwamushi","family":"Makali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9799-3568","authenticated-orcid":true,"given":"Shiromi M.","family":"Perera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rigo","family":"Fraterne\u2010Muhayangabo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arsene Baleke","family":"Ombeni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8202-9402","authenticated-orcid":true,"given":"Alexandra","family":"Tuttle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Aberle-Grasse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Ortiz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reena","family":"Doshi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3982-3824","authenticated-orcid":true,"given":"Adam C.","family":"Levine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eta Ngole","family":"Mbong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,4,7]]},"reference":[{"key":"pone.0346572.ref001","unstructured":"CDC. CDC. 2024 [cited 2025 Aug 13]. Ebola Disease Outbreaks by Species and Size, Since 1976. Available from: https:\/\/www.cdc.gov\/ebola\/outbreaks\/?CDC_AAref_Val=https:\/\/www.cdc.gov\/vhf\/ebola\/history\/chronology.html"},{"key":"pone.0346572.ref002","unstructured":"WHO. WHO. 2020 [cited 2025 Aug 13]. Ebola: North Kivu\/Ituri, Democratic Republic of the Congo, August 2018 - June 2020. Available from: https:\/\/www.who.int\/emergencies\/situations\/Ebola-2019-drc-"},{"key":"pone.0346572.ref003","first-page":"261","article-title":"Meeting of the Strategic Advisory Group of Experts on immunization, April 2019 \u2013 conclusions and recommendations","volume":"94","author":"WHO","year":"2019","journal-title":"Wkly Epidemiol Rec"},{"key":"pone.0346572.ref004","article-title":"Experimental vaccine ready for use in Congo\u2019s Ebola outbreak","volume":"2018","author":"O Dyer","year":"2018","journal-title":"BMJ"},{"key":"pone.0346572.ref005","unstructured":"10th Ebola outbreak in the Democratic Republic of the Congo declared over; vigilance against flare-ups and support for survivors must continue [Internet]. [cited 2025 Aug 14]. Available from: https:\/\/www.who.int\/news\/item\/25-06-2020-10th-ebola-outbreak-in-the-democratic-republic-of-the-congo-declared-over-vigilance-against-flare-ups-and-support-for-survivors-must-continue"},{"key":"pone.0346572.ref006","unstructured":"WHO. Ebola Virus Disease Democratic Republic of the Congo External Situation Report [Internet]. 2018 Jul [cited 2025 Aug 14]. Report No.: 14. Available from: https:\/\/iris.who.int\/bitstream\/handle\/10665\/272997\/SITREP_EVD_DRC_20180701-eng.pdf"},{"issue":"5","key":"pone.0346572.ref007","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/S1473-3099(19)30063-5","article-title":"Institutional trust and misinformation in the response to the 2018-19 Ebola outbreak in North Kivu, DR Congo: a population-based survey","volume":"19","author":"P Vinck","year":"2019","journal-title":"Lancet Infect Dis"},{"issue":"2","key":"pone.0346572.ref008","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2017-000410","article-title":"Trust, fear, stigma and disruptions: community perceptions and experiences during periods of low but ongoing transmission of Ebola virus disease in Sierra Leone, 2015","volume":"3","author":"A Nuriddin","year":"2018","journal-title":"BMJ Glob Health"},{"issue":"12","key":"pone.0346572.ref009","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(20)30454-X","article-title":"Vaccination of contacts of Ebola virus disease survivors to prevent further transmission","volume":"8","author":"RH Doshi","year":"2020","journal-title":"Lancet Glob Health"},{"issue":"4","key":"pone.0346572.ref010","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1038\/s41591-021-01313-w","article-title":"The need for a new strategy for Ebola vaccination","volume":"27","author":"DG Bausch","year":"2021","journal-title":"Nat Med"},{"issue":"19","key":"pone.0346572.ref011","doi-asserted-by":"crossref","first-page":"2150","DOI":"10.1016\/j.vaccine.2014.01.081","article-title":"Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: A systematic review of published literature, 2007\u20132012","volume":"32","author":"HJ Larson","year":"2014","journal-title":"Vaccine"},{"issue":"34","key":"pone.0346572.ref012","doi-asserted-by":"crossref","first-page":"4161","DOI":"10.1016\/j.vaccine.2015.04.036","article-title":"Vaccine hesitancy: Definition, scope and determinants","volume":"33","author":"SAGE Working Group on Vaccine Hesitancy","year":"2015","journal-title":"Vaccine"},{"issue":"1","key":"pone.0346572.ref013","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1177\/1525822X05282260","article-title":"Using Mixed-Methods Sequential Explanatory Design: From Theory to Practice","volume":"18","author":"NV Ivankova","year":"2006","journal-title":"Field Methods"},{"key":"pone.0346572.ref014","doi-asserted-by":"crossref","first-page":"1080700","DOI":"10.3389\/fpubh.2023.1080700","article-title":"Ebola vaccine uptake and attitudes among healthcare workers in North Kivu, Democratic Republic of the Congo, 2021","volume":"11","author":"RH Doshi","year":"2023","journal-title":"Frontiers in Public Health"},{"issue":"1","key":"pone.0346572.ref015","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0002566","article-title":"Perceptions toward Ebola vaccination and correlates of vaccine uptake among high-risk community members in North Kivu, Democratic Republic of the Congo","volume":"4","author":"SM Perera","year":"2024","journal-title":"PLOS Glob Public Health"},{"issue":"4","key":"pone.0346572.ref016","doi-asserted-by":"crossref","first-page":"638","DOI":"10.9745\/GHSP-D-20-00272","article-title":"Prevention of COVID-19 in Internally Displaced Persons Camps in War-Torn North Kivu, Democratic Republic of the Congo: A Mixed-Methods Study","volume":"8","author":"KM Claude","year":"2020","journal-title":"Glob Health Sci Pract"},{"issue":"9","key":"pone.0346572.ref017","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0223104","article-title":"Social resistance drives persistent transmission of Ebola virus disease in Eastern Democratic Republic of Congo: A mixed-methods study. Schieffelin J, editor","volume":"14","author":"K Masumbuko Claude","year":"2019","journal-title":"PLoS ONE"},{"issue":"1","key":"pone.0346572.ref018","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0002566","article-title":"Perceptions toward Ebola vaccination and correlates of vaccine uptake among high-risk community members in North Kivu, Democratic Republic of the Congo","volume":"4","author":"SM Perera","year":"2024","journal-title":"PLOS Glob Public Health"},{"issue":"11","key":"pone.0346572.ref019","doi-asserted-by":"crossref","first-page":"783","DOI":"10.2471\/BLT.20.285258","volume":"99","author":"C Decouttere","year":"2021","journal-title":"Bull World Health Org"},{"issue":"2","key":"pone.0346572.ref020","doi-asserted-by":"crossref","first-page":"288","DOI":"10.3390\/vaccines11020288","article-title":"Mitigating Vaccine Hesitancy and Building Trust to Prevent Future Measles Outbreaks in England","volume":"11","author":"S Thompson","year":"2023","journal-title":"Vaccines (Basel)"},{"issue":"7","key":"pone.0346572.ref021","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2019.e02016","article-title":"Vaccination hesitancy: fear, trust, and exposure expectancy of an Ebola outbreak","volume":"5","author":"GS Mesch","year":"2019","journal-title":"Heliyon"},{"key":"pone.0346572.ref022","first-page":"58","article-title":"Perceptions and Rumors About the Ebola Virus Disease Vaccine in the Ituri and Kivu Provinces of the Democratic Republic of Congo","author":"I Igwe","year":"2023","journal-title":"J Immunol Sci"},{"issue":"1","key":"pone.0346572.ref023","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s13031-024-00569-6","article-title":"Not only vaccine hesitancy, but also vaccination campaign hesitancy drives measles epidemics in conflict-torn eastern DR Congo","volume":"18","author":"D Van Brusselen","year":"2024","journal-title":"Confl Health"},{"issue":"1","key":"pone.0346572.ref024","doi-asserted-by":"crossref","DOI":"10.1136\/bmjph-2024-001035","article-title":"Challenges with achieving and maintaining oral cholera vaccine coverage: insights from serial cross-sectional representative surveys in a cholera-endemic community in the Democratic Republic of the Congo","volume":"3","author":"A Koyuncu","year":"2025","journal-title":"BMJ Public Health"},{"issue":"7","key":"pone.0346572.ref025","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.3390\/vaccines10071066","article-title":"Drivers of Routine and Outbreak Vaccination Uptake in the Western Democratic Republic of Congo: An Exploratory Study in Ten Health Zones","volume":"10","author":"L Peckeu-Abboud","year":"2022","journal-title":"Vaccines (Basel)"},{"key":"pone.0346572.ref026","article-title":"Understanding perceptions towards COVID-19 vaccination and strategies to increase vaccine uptake among Ebola-affected communities in North Kivu, Democratic Republic of the Congo: a qualitative study","author":"EN Mbong","year":"2026","journal-title":"BMC Public Health"},{"issue":"5","key":"pone.0346572.ref027","doi-asserted-by":"crossref","DOI":"10.3390\/vaccines11050973","article-title":"COVID-19 Vaccine Perceptions among Ebola-Affected Communities in North Kivu, Democratic Republic of the Congo, 2021","volume":"11","author":"SC Garbern","year":"2023","journal-title":"Vaccines"},{"issue":"44","key":"pone.0346572.ref028","doi-asserted-by":"crossref","first-page":"5562","DOI":"10.1016\/j.vaccine.2008.08.002","article-title":"The ethics of mandatory vaccination against influenza for health care workers","volume":"26","author":"JJM van Delden","year":"2008","journal-title":"Vaccine"},{"key":"pone.0346572.ref029","doi-asserted-by":"crossref","first-page":"916062","DOI":"10.3389\/fpubh.2022.916062","article-title":"Engaging faith communities in public health messaging in response to COVID-19: Lessons learnt from the pandemic in Ituri, Democratic Republic of Congo","volume":"10","author":"A Baba","year":"2022","journal-title":"Front Public Health"},{"issue":"5","key":"pone.0346572.ref030","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1016\/j.vaccine.2019.11.024","article-title":"Religious affiliation and immunization coverage in 15 countries in Sub-Saharan Africa","volume":"38","author":"JC Costa","year":"2020","journal-title":"Vaccine"},{"issue":"2","key":"pone.0346572.ref031","doi-asserted-by":"crossref","first-page":"332","DOI":"10.9745\/GHSP-D-21-00144","article-title":"New Mixed Methods Approach for Monitoring Community Perceptions of Ebola and Response Efforts in the Democratic Republic of the Congo","volume":"9","author":"G Earle-Richardson","year":"2021","journal-title":"Glob Health Sci Pract"},{"issue":"4","key":"pone.0346572.ref032","article-title":"Continuous Community Engagement Is Needed to Improve Adherence to Ebola Response Activities and Survivorship During Ebola Outbreaks","volume":"12","author":"GN Soke","year":"2024","journal-title":"Glob Health Sci Pract"},{"issue":"10396","key":"pone.0346572.ref033","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/S0140-6736(23)01171-6","article-title":"Addressing disparities and challenges in global health from an LMIC perspective","volume":"402","author":"H Munshi","year":"2023","journal-title":"Lancet"},{"issue":"16","key":"pone.0346572.ref034","doi-asserted-by":"crossref","first-page":"360","DOI":"10.15585\/mmwr.mm7316a1","article-title":"Use of Ebola Vaccines \u2014 Worldwide, 2021\u20132023","volume":"73","author":"R Kallay","year":"2024","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"12","key":"pone.0346572.ref035","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0208601","article-title":"Beyond confidence: Development of a measure assessing the 5C psychological antecedents of vaccination","volume":"13","author":"C Betsch","year":"2018","journal-title":"PLoS One"},{"issue":"4","key":"pone.0346572.ref036","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1027\/1015-5759\/a000663","article-title":"Measuring the 7Cs of Vaccination Readiness","volume":"38","author":"M Geiger","year":"2022","journal-title":"European Journal of Psychological Assessment"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0346572","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T17:32:08Z","timestamp":1775583128000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0346572"}},"subtitle":[],"editor":[{"given":"Franck Katembo","family":"Sikakulya","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,4,7]]},"references-count":36,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,7]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0346572","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,7]]}}}