October 2025 — South Sudan was declared wild polio-free in 2020—a major milestone for the country and the global fight against polio. However, in December 2023, the nation faced a resurgence of circulating Vaccine-Derived Poliovirus Type 2 (cVDPV2). In response, the Ministry of Health, with support from UNICEF and partners, rolled out four rounds of the novel oral polio vaccine type 2 (nOPV2) National Immunization Days (NIDs) campaign. The first round, conducted in February 2024, targeted over 3 million children under five years of age, with the fourth and final round completed in February 2025.

The Challenge

In January 2024, a community assessment revealed alarmingly low polio immunization coverage in the two counties where the first cVDPV2 cases were reported. Round 1 vaccination rates were below 75%, with OPV-3 coverage at just 36%.

Low vaccination coverage was compounded by several factors:

• Reliance on traditional healers, who often misattributed polio symptoms to witchcraft.

• Deep-seated vaccine hesitancy fueled by religious and cultural beliefs.

• Widespread misinformation, including fears that vaccines cause infertility or illness.

• Socioeconomic pressures, where families prioritize survival over preventive health.

Approximately 70% of South Sudanese consult traditional healers first, highlighting the need to engage trusted community and faith-based leaders to counter misconceptions and rebuild public confidence in vaccination.

Faith-Based SBC in Action

To tackle low vaccination coverage and rising hesitancy, UNICEF conducted a comprehensive assessment to understand the behavioral and social drivers (BeSD) influencing immunization decisions. Using focus groups, desk reviews, and social listening, 95 community members—including traditional healers, religious leaders, and caregivers—shared insights on barriers to vaccination. At the same time, 80 trained volunteers tracked rumors and collected real-time community feedback, identifying misinformation primarily among religious groups and refugee or returnee populations. These findings guided the design of targeted, context-specific interventions.

Recognizing the influence of religious and traditional leaders, UNICEF, in partnership with The Rescue Initiative South Sudan and the Ministry of Health, mobilized them as trusted champions of the polio campaign. Their involvement became central to the Social and Behavior Change (SBC) strategy, ensuring that vaccination messages were culturally and faith-sensitive.

SBC Strategies and Engagement Models included: 

• Training and Capacity Building: Leaders were trained on polio, vaccine safety, and effective communication, enabling them to confidently address questions and misconceptions.

• Advocacy and Messaging: Influential religious scholars delivered faith-based messages during sermons, gatherings, and community events, countering misinformation and reinforcing vaccine acceptance.

• Social Mobilization: Leaders motivated caregivers to vaccinate their children, transforming the campaign into a community-led initiative.

• Non-compliance Resolution: Trusted leaders engaged directly with hesitant households, addressing objections through dialogue rooted in respect and authority.

• Media Engagement: Community radio programs provided a platform for leaders to answer questions, dispel rumors, and promote open conversations about vaccination.

Results and Impact

The second round of the polio vaccination campaign achieved remarkable success, with coverage increasing from 70% to over 95% in the targeted counties. Religious and traditional leaders were empowered and effectively capacitated to champion vaccination, actively engaging their communities. This leadership contributed to a significant reduction in vaccine refusals, as hesitancy and misconceptions were addressed directly. Communities also demonstrated improved awareness and acceptance of polio vaccination, understanding its benefits more clearly. Additionally, a functional network of religious and traditional influencers was established, providing sustained support for ongoing health promotion initiatives.

Lessons learnt

• Evidence-based strategies: Using BeSD data allowed for targeted and tailored interventions, ensuring strategies addressed specific community needs effectively.

• Engagement of religious and traditional leaders: Integrating these leaders into social mobilization teams proved highly effective in addressing vaccine refusals. Their involvement enabled immediate faith-based counseling, reinforced health messages, and strengthened their authority and credibility within communities.

• Capacity building: Continuous training enhanced leaders’ understanding of vaccination, communication skills, and overall influence, creating a positive feedback loop that elevated their role in broader child health initiatives beyond polio.

• Community trust and feedback mechanisms: Leveraging community mobilizer networks, influencer platforms, and community radio ensured sustained, responsive engagement. Regular feedback allowed for quick responses to questions, concerns, and emerging refusals.

• Contextualized messaging: Aligning vaccination messaging with religious and traditional beliefs, emphasizing protection of life and community wellbeing, made interventions more relevant and acceptable.

• Sustaining relevance: Positioning the work of leaders within a broader child health and rights framework helped maintain community engagement and mitigate fatigue from a singular focus on polio.