A Situational Analysis of the Contextual Factors Influencing Vaccine Uptake on Koome Island, Lake Victoria, Uganda

Background Vaccine uptake in Uganda remains below target, especially in hard-to-reach places such as Koome Island, a fishing community in Lake Victoria’s Mukono District. Although national immunization efforts have made progress, social and structural barriers limit access to and trust in vaccines. As part of the NIHR Global Health Research Group on Vaccines for Vulnerable People in Africa (VAnguard), we conducted a situational analysis to understand the local factors influencing vaccination attitudes and practices on Koome Island. Methods Using the socioecological model as a framework, we employed qualitative methods, including community dialogues, stakeholder consultations, transect walks, informal conversations, and field observations, from November 2022 to October 2023. The participants included community members, health workers, local leaders, and district officials. The data were thematically analysed to capture influences on vaccine uptake across multiple social and structural levels. Findings: Despite longstanding Ministry of Health efforts, vaccine uptake remains limited in remote areas such as Koome Island. Structural challenges such as long distances to health centres, poor infrastructure, and frequent vaccine stockouts restrict access. These are worsened by high transport costs, gendered caregiving roles, limited awareness of the full immunization schedule, and persistent myths and misinformation, for example, fears that vaccines cause infertility or goitre. These findings shaped the stakeholder mapping and community engagement approaches for VAnguard and guided the design of a follow-up survey in three districts to further explore the complex social, biological, and structural factors affecting vaccine equity. Conclusion The analysis underscores the need to ground vaccine research and interventions in local realities. It informs culturally sensitive, systems-aware strategies and supports participatory approaches aimed at strengthening vaccine uptake in underserved communities.