Factors Influencing the Potential Introduction of a Gonorrhoea Vaccine in South Africa

Abstract

Gonorrhoea is a major public health concern due to its high prevalence, rising antimicrobial resistance (AMR), and the limits of current syndromic treatment (SM) in low- and middle- income countries (LMICs). As such, it is essential to develop vaccines to control and prevent gonorrhoea. This qualitative study sought to explore health system perspectives on factors most likely to influence the introduction of a gonorrhoea vaccine. Purposive sampling was used to conduct in-depth interviews with health care providers (n = 6) and key informants (n = 6) with expertise in vaccines and/or STI prevention and control. Participants discussed gonorrhoea incidence, challenges with detecting asymptomatic cases, and the importance of AMR for vaccine development. They identified potential barriers to gonorrhoea vaccine introduction included sexually transmitted infections (STIs) related stigma, insufficient healthcare infrastructure, vaccine hesitancy, and financial resources. Integrating a vaccine into current immunization platforms like the Expanded Programme on Immunisation (EPI) and school- based HPV vaccination, might boost practicality, while a phased rollout focusing on high-risk groups could refine tactics for broader deployment. Precise, localized disease surveillance and intersectoral coordination are crucial to improve logistical preparation and policy support. Overall, the study suggests that a gonorrhoea vaccine could be used to lower gonorrhoea rates and limit AMR in South Africa if stakeholders address finance, healthcare capacity, and societal acceptability. By identifying these enablers and impediments, this study provides useful insights that will guide strategic planning for the future introduction of a gonorrhoea vaccine in South Africa.