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Even after half a century of vaccination programmes, many African communities still resist vaccines, with the view that they are foreign interventions that conflict with traditional beliefs about health. Dr Frankline Sevidzem Wirsiy, a global public health professional, explores how indigenous knowledge and cultural dynamics influence immunisation.
“One of the most overlooked factors in immunisation programmes is the level of trust communities place in traditional healers and indigenous health systems,” says Dr Wirsiy. “These beliefs should not be treated only as barriers. Instead, they should be understood as systems that can be studied and aligned with immunisation goals.”
In his research paper titled ‘The role of indigenous knowledge and cultural dynamics in immunisation uptake in Africa’, Dr Wirsiy developed the LET framework to integrate traditional beliefs and cultural dynamics into vaccine campaigns.
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Dr Frankline Sevidzem Wirsiy is a global public health and development professional with over 12 years of experience. He has published over 51 peer-reviewed articles and worked in areas including global health security, community engagement, immunisation and health system strengthening. His professional philosophy revolves around “light bulb advocacy”, which focuses on sparking awareness, inspiring communities, driving equity and sustaining transformative leadership in global health.
Q: What inspired your research on incorporating indigenous knowledge and cultural dynamics in immunisation programmes in Africa?
The research, the role of indigenous knowledge and cultural dynamics in immunisation uptake in Africa, was inspired by the fact that Africa’s Expanded Programme on Immunisation (EPI) has been in existence for over 50 years, yet vaccine uptake remains inconsistent across many parts of the continent. Data clearly show that significant gaps persist.
This led us to ask an important question: after 50 years, what is still missing? We wanted to explore whether indigenous knowledge systems and cultural dynamics could help explain why some communities remain hesitant or resistant to vaccination.
Our aim was to understand how traditional beliefs, customs, and health-seeking behaviours interact with modern vaccination programmes, and how this interaction shapes people’s perceptions of vaccines. This line of thinking led us to develop what we later termed the LET framework, which provides a structured way of integrating indigenous knowledge and cultural dynamics into immunisation programmes.
Q: Can you give an example where indigenous knowledge directly improved immunisation coverage?
A clear example comes from Cameroon during the introduction of the malaria vaccine in 2024. Initially, there was considerable hesitancy when the vaccine was first introduced in some communities. The government and its partners had to step back and ask what could be done differently.
One key strategy was to integrate vaccination messages into existing cultural practices. Outreach was aligned with local customs through door-to-door visits, messages delivered in churches, community gatherings and ‘loan drift meetings’ or ‘savings’ groups commonly known as “Jangi” groups in Cameroon.
A particularly strong example also involves the use of traditional child-naming ceremonies commonly called ‘born house’ in Cameroon, which usually take place seven to eight days after the birth of a child. These ceremonies bring together family members, elders, and traditional leaders to bless and celebrate the child. Vaccination was incorporated into this context and presented as a symbol of protection for the child, aligning with the cultural belief in safeguarding newborns.
Health programmes also leveraged major cultural festivals. In my own community, for instance, when the Ngonso festival was celebrated annually, during this festival, vaccination promotion was embedded through health talks, announcements by traditional rulers, and storytelling sessions. There were also community screenings where people were educated about immunisation, possible side effects, and how they could be managed.
Another example is the Ngoun festival among the Bamoun people, a UNESCO-recognised event that promotes harmony and self-reliance. These festivals attract large crowds and therefore provide opportunities for group education and culturally framed messaging about immunisation. In these contexts, vaccination has been presented as part of collective wellbeing rather than as an external medical intervention.
Q: From your research, what is the most overlooked cultural factor affecting vaccine acceptance?
One of the most overlooked factors is the level of trust communities place in traditional healers and indigenous health systems. In many settings, vaccination is perceived as an alien or foreign intervention that conflicts with traditional beliefs about healing and protection.
I experienced this directly during the COVID-19 response when I was deployed as an epidemiologist with the United Nations Office for the Coordination of Humanitarian Affairs to Bafoussam, in the West region of Cameroon. I visited a community where even a healthcare worker publicly stated that he did not trust the COVID-19 vaccine. When such a message comes from someone expected to support vaccination, it has a profound influence on community perceptions.
In many rural and remote areas, people prioritise local practitioners over formal health facilities. I have worked in forested regions where health centres receive fewer than ten patients in a month, while traditional healers remain central to healthcare decisions. Misinformation often grows from these cultural narratives, including beliefs that natural herbs are safer or that vaccines cause harm.
Our research shows that these beliefs should not be treated only as barriers. Instead, they should be understood as systems that can be studied and aligned with immunisation goals. Religion, socio-cultural influence, and traditional explanations of illness must be acknowledged rather than dismissed.
Q: Your research suggests the LET framework to incorporate indigenous knowledge in immunisation. What is it and how does it work?
The LET framework is a three-pronged approach: L stands for Leveraging cultural events, E stands for Engaging traditional elders and healers, and T stands for Training community health workers.
Leveraging cultural events means integrating vaccination activities into ceremonies, festivals, naming rituals, and initiation rites, so vaccines become part of cultural life and not a separate government directive.
Engaging traditional elders and healers involves building respectful partnerships with community leaders, chiefs, healers, and religious figures. These actors are not merely gatekeepers; they are gate-openers. When equipped with accurate vaccine information, they can promote immunisation within their trusted social structures.
Training community health workers means equipping frontline workers to understand and respect local cultural contexts and communicate effectively with diverse populations. This also means moving away from purely volunteer models and integrating community health workers into formal health systems.
The LET framework reframes immunisation as an extension of community-based healing traditions and promotes ownership and trust in health products.
Q: How can vaccination programmes work with community leaders without undermining their authority?
Programmes must involve leaders from the outset, during planning rather than after decisions have already been made. When leaders feel excluded, they perceive interventions as a challenge to their authority.
They should be equipped with accurate, evidence-based information about vaccines, including possible side effects and how they can be managed. This allows them to communicate effectively using familiar language.
For example, during malaria vaccine introduction in Cameroon, leaders were supported to conduct risk communication and dialogue in rural areas rather than relying on mass media alone. This respected their authority and strengthened their role as trusted intermediaries.
Q: Beyond vaccination coverage, how can the impact of integrating cultural knowledge be measured?
Although coverage data are important, impact should also be measured through qualitative and community-level indicators. These include reductions in hesitancy and stronger community ownership of immunisation programmes.
Another indicator is the sustained use of cultural practices such as storytelling or naming ceremonies for health promotion. Long-term impact can be assessed through behavioural change and community feedback on whether vaccination aligns with their values. Measurement must go beyond percentages to capture social acceptance and cultural resonance.
Q: What key lesson from COVID-19 and your research can improve future vaccination campaigns?
A key lesson from COVID-19 is that ignoring cultural dynamics and failing to engage community leaders early amplifies misinformation and hesitancy.
I observed situations where cultural directives fuelled doubt and reduced uptake. In contrast, vaccination efforts that empowered leaders to conduct risk communication were more successful in overcoming delays caused by the pandemic.
Future campaigns must proactively leverage cultural events, empower traditional leaders and healers as partners, and train healthcare workers in culturally sensitive communication. Combining modern science with indigenous knowledge can create more inclusive and resilient health systems and help prevent future infodemics.