Abstract
<p>Public health communication in low and middle-income countries often relies on a unidirectional, expert-driven model that overlooks the socio-cultural complexities of underserved populations such as fisher folk along the islands of Lake Victoria. This paper presents the dual narratives between official health messaging and community-driven discourses in the geographically peripheral fishing communities of Koome Island, Uganda. Drawing on qualitative data from the VAnguard project, we explore how mobile populations create a dual communication landscape where institutional instructions competed with deep-seated local fears about vaccines.We mapped and consulted key stakeholders and conducted ethnographic research to understand community dynamics, local beliefs and misconceptions. Drama skits co-created with communities provided deeper insights into local beliefs, guiding culturally sensitive data collection and message design. By centering community members as co-producers of vaccine knowledge, the research sought to connect the ‘periphery’ of local island life to the ‘center’ of national public health policy.Participants reported receiving vaccine information from both the static clinics and outreach programmes. They also revealed that there was widespread misinformation fueled by poor communication. Participants repeatedly expressed fear that modern vaccines, particularly for COVID-19, Yellow Fever and the Human Papilloma Virus, were intended to kill people or cause long-term infertility. These fears were compounded by participants’ concerns about the improper storage of vaccines during transportation by boat and on-site, and some believed that children were sometimes given expired vaccines. Other barriers such as perceived poor health-worker and patient relationships further reinforced these negative narratives. This research argues that for social change to occur in these contexts, communication ought to move from a one-way dissemination toward a two-way communication model. By acknowledging and integrating community-driven narratives into the design of health communication, this can foster a more equitable dialogue that respects peripheral voices and enhances the legitimacy of preventive public health approaches.</p>