# Measles vaccination perceptions and willingness to consider novel vaccination approaches in Cambodia’s floating villages

## TL;DR

A study in Cambodia's floating villages found strong support for measles vaccination and openness to new methods like self-vaccination, but logistical challenges remain.

## Contribution

The study explores vaccination attitudes in a mobile, isolated population and evaluates openness to novel vaccine delivery approaches.

## Key findings

- High confidence in vaccine safety and effectiveness was reported among Prek Toal residents.
- Respondents showed openness to self-vaccination but preferred healthcare professionals to administer vaccines.
- Logistical barriers, not hesitancy, are key to low vaccination rates in these communities.

## Abstract

Globally, the measles virus is making a comeback. Measles still claims the lives of over 100,000 children annually and remains a leading cause of preventable child mortality. Despite the availability of a highly effective and safe measles vaccine since the late 1960s, challenges in vaccine uptake persist. In 2019, Cambodia experienced a resurgence of measles cases, leading to the loss of its elimination status. Many of these cases were reported in geographically isolated and highly mobile communities, such as the floating villages along the Mekong Delta, including Prek Toal. Due to their mobility and geographical isolation, these villages face unique barriers to routine healthcare access and were directly impacted by the 2019 outbreak. To assess vaccination attitudes in this unique population, the Vaccine Attitudes Examination (VAX) scale was adapted to include specific questions about self-vaccination for measles. The modified survey was translated into Khmer and administered to families or caretakers with children living in the floating villages of Prek Toal. The survey results demonstrated broad support for vaccinations among the Prek Toal community, with most respondents expressing confidence in the safety and effectiveness of vaccines. Additionally, while families showed openness to the concept of self-vaccination, there was a strong preference for vaccines to be administered by healthcare professionals. These findings highlight the positive attitudes toward vaccination within this mobile and geographically isolated population, as well as their willingness to consider novel approaches like self-vaccination. Addressing logistical challenges and preferences for healthcare-administered vaccines will be critical in enhancing vaccination strategies in such hard-to-reach communities, ultimately aiding in the fight against measles resurgence.

Measles is one of the most transmissible human viruses, and sustaining high vaccination coverage is essential for preventing its resurgence. Remote and mobile communities often have limited, intermittent access to routine health services, yet little is known about their perspectives on vaccination or their openness to new delivery approaches. Cambodia’s floating villages represent one such setting, where seasonal changes, mobility, and geographical distance can make routine vaccination more difficult to access. In this study, we examined parental attitudes toward measles vaccination in a floating village and assessed interest in simplified, needle-free vaccination methods. We found high confidence in vaccines and healthcare providers, along with a willingness to consider alternative delivery formats if they are safe and easy to use. These results suggest that logistical challenges rather than hesitancy are key contributors to immunity gaps.