In this study, we employed a cross-sectional design to identify barriers to vaccine uptake and use among pig farmers. A sequential exploratory qualitative study was done integrating two complementary data sources to identify key actors in Uganda’s pig vaccine supply chain, describe their roles, and profile the challenges they face. The approach included: (1) a systematic literature review and (2) key informant interviews (KIIs) and focus group discussions (FGDs) with relevant actors. In Uganda, farmers generally raise pigs in intensive, semi-intensive, or free-range systems, with minimal use of production inputs. Partly due to this, there is a high incidence of endemic diseases, resulting in low productivity and profitability.

The review focused on literature published between 1995 and 2022. The starting point in 1995 was selected to capture developments following major constitutional and policy reforms in Uganda, which significantly shaped the structure and regulation of the veterinary and animal health sectors. It was assumed that the key actors and institutional frameworks along the pig vaccine supply chain would have remained relatively stable within this temporal window, making it an appropriate scope for trend analysis and actor mapping.

This study received ethical approval from Uganda’s Vector Control Division Research Ethics Committee (VCD REC ref. no. UG-REC-018) and ILRI’s Institutional Review Ethics Committee (ref no. ILRI-IREC2022-41). Written informed consent was obtained from human participants who took part in the study. Information about research participants was anonymised, so no identifying information about participants is presented.

The systematic literature search initially identified 674 articles, from which 53 duplicates were removed. After screening the titles and abstracts of the remaining 621 unique records, 601 were excluded as irrelevant. This left 20 articles for full-text review, of which only four met the eligibility criteria (Figure 2).

Additionally, no articles retrieved from grey literature sources were deemed eligible for inclusion. Data extracted from the retained articles are shown in Table 1.

Table 2 summarises key informants (KIs) and FGDs held, and the number of participants interviewed. In all, a total of 32 key informants (23 males, 9 females) were interviewed, and three FGDs (17 males and 10 females) were held.

Results from KIIs showed that Zoetis™ is the sole importer of pig vaccines in Uganda. Upon importation, pig vaccines are supplied in refrigerated trucks to wholesalers. The wholesalers then supply retail veterinary vaccine/drug shops (VVDSs) across Kampala, Mukono, Wakiso, and Masaka. Retail VVDSs are either supervised by veterinarians or veterinary paraprofessionals. A few affluent farmers (especially large-scale) also directly procure vaccines from wholesalers, on the advice of their veterinarians, and can then store them on-site in refrigerators until use.

Retail VVDSs supply to (1) the pig vaccinators who may be private or government animal health officers (often in the business of pig artificial insemination, also offering vaccination for their clients), and (2) some affluent large-scale pig farmers (Figure 2). The pig vaccinators often transport the vaccines in plastic cool boxes stacked with ice packs. Large-scale pig farms employ veterinarians or para-veterinarians who advise and administer vaccinations.

In some cases, the retail VVDSs, owned by veterinarians and para-veterinarians, buy vaccines from one another, especially during periods of scarcity. Similarly, some animal health workers reported sharing vaccines, especially when one of them acquires a vial of 50 doses that they cannot use before it expires. Some practitioners reported being offered vaccines in reconstituted form, often as single-dose syringes from retailers. The farmers either buy the vaccines directly from VVDSs or invite veterinarians and para-veterinarians to administer them.

Our study identified key barriers to vaccine uptake at each node of the value chain. We identified three regulatory agencies in the pig vaccines value chain. The Ministry of Agriculture, Animal Industry and Fisheries (MAAIF) is mandated to formulate and enforce policies on animal disease control and surveillance; the National Drug Authority (NDA) regulates importation, distribution and monitoring of veterinary drugs and vaccines, while the Uganda Veterinary Council (formally was Uganda Veterinary Board) licences veterinarians and para-veterinarians in public and private practice to ensure professional standards of practice are observed. Farmers (both large- and small-scale) demand veterinary inputs (drugs, vaccines, etc.) and services from veterinary practitioners and are the end users. Based on a systematic review and key informant interviews, we present a schematic representation of the pig vaccine supply chain, from importation to farmers and key barriers to uptake at each value chain node. This study identified key barriers to the uptake of pig vaccines that were related to policy and structural, technical, logistical, and socio-economic factors (Figure 3).

Results from the key informant interviews revealed that no pig vaccines were being manufactured in Uganda. Among the pig vaccines imported by Zoetis to Uganda are FarrowSure^® Plus B, LitterGuard and Fostera. FarrowSure^® Plus B is a multivalent vaccine that targets protection of breeding pigs from poor reproductive performance caused by porcine parvovirus (PPV), erysipelas caused by Erysipelothrix rhusiopathiae, and leptospirosis caused by Leptospira bratislava, L. canicola, L. grippotyphosa, L. hardjo, L. icterohaemorrhagiae, and L. pomona (Table 3).

The LitterGuard^® vaccine is a bacterin prepared from chemically inactivated strains of Escherichia coli, used to vaccinate healthy pregnant sows and gilts to enable passive vertical transfer of protective maternal antibodies to neonates against neonatal diarrhoea caused by enterotoxigenic strains of E. coli with the K99, K88, 987P, or F41 adherence factors. The vaccine is administered to healthy pregnant sows or gilts in 2 doses, 3 weeks apart during the last half of pregnancy, with the second dose given at least 2 weeks before farrowing. The sows can be revaccinated with a single dose at least 2 weeks before each subsequent farrowing.

The Fostera™ PCV MH vaccine is used for healthy pigs 3 weeks of age or older and provides immunity for 23 weeks. It is used to prevent viremia and lymphoid depletion caused by PCV2 and Mycoplasma hyopneumoniae-induced pneumonia.

Typically, distributors apply a 15% transportation charge from the manufacturer to Kampala, with a 30% mark-up profit. Further downstream, drug stockists in districts include an additional 30% markup as their profit. The pig farmer is charged between UGX 15 000.00 – UGX 30 000.00 ($4.00 –$8.00) per dose, depending on how far the farm is from the vaccinator (Online Appendix 1 – supplementary Table 1). Table 3 summarises vaccine types, target pathogens, pig age groups, doses, routes of administration, and storage conditions.

Table 4 summarises key barriers to the uptake of pig vaccines in selected districts in Uganda identified by different study methods. Results show that while the systematic literature review (SLR) identified weaknesses in livestock sector policies, vaccine quality assurance, and reporting mechanisms, KIIs and FGDs revealed actor incoordination (between public and private sector players), weaknesses in institutional arrangements, and knowledge gaps among value chain actors for the delivery of vaccines to end users. All three studies consistently identified knowledge and information gaps as key technical and capacity barriers to vaccine uptake among different value chain actors. Regarding the logistical barriers, a lack of or limited access to vaccine cold chain facilities was highlighted by both the SLR and KI interviews. At the end-user node of the vaccines value chain, the SLR identified a lack of understanding of the socio-cultural barriers to vaccine uptake, while the KIIs and FGDs revealed high delivery costs, a shortage of partners to deliver vaccines to farmers, and misinformation about vaccines.

Our findings reveal barriers in national livestock sector policy, poor enforcement, and weak institutional structures that hinder the uptake of pig vaccines. Unlike vaccines for priority livestock diseases, pig vaccines are not treated as a public good, leaving their distribution to a private monopoly. Under the current animal health policy, the government of Uganda is mandated to control five priority livestock diseases – peste des petits ruminants (PPR), contagious bovine pleuropneumonia, foot and mouth disease, rabies, and anthrax (MAAIF 2022:11). While farmers are required to contribute a fraction of vaccination costs, their costs are subsidised by the government (MAAIF 2022:11). Such policy incoherence makes it difficult to enforce any regulations, since public actors alike rely on a single importer for pig vaccines.

Findings from the systematic review and key informant interviews revealed that all vaccine distributors and most veterinary practitioners involved in the pig vaccines trade were private dealers. Such arrangements make it difficult to regulate their field practice. At the import node, no structures or mechanisms were established to obtain feedback on vaccine performance from practitioners and farmers. KIIs revealed that there was little to no coordination between public and private sector players, and that weak institutional arrangements existed to ensure collective demand and bargaining for pig vaccines. While NDA is legally mandated to monitor vaccine adverse effects, institutional structures were weak, poorly facilitated, or nonfunctional. Results from the systematic review and KIIs reported that some veterinary drug shop owners engaged in malpractices such as selling vaccines directly to pig farmers. While their prices were lower than those of veterinary practitioners, such malpractice is risky, as farmers lack the knowledge to safely transport and administer vaccines to pigs. Such malpractice occurs only in situations where regulations are weakly enforced. The consequences of such poor vaccine handling practices have been observed among poultry farmers, where vaccine adoption rates are higher than in pigs. A policy change that requires enhanced coordination between public and private vaccine value chain actors could improve regulatory oversight and monitoring of vaccine performance in the field.

Technical and capacity barriers were identified across all vaccine value chain nodes in this study. At the importation node, importers lack knowledge of the epidemiology of endemic pig diseases, which is needed to inform their choices of vaccine types to import. Such knowledge gaps were highlighted by both KIIs and FGDs. While previous studies demonstrated the occurrence of vaccinatable diseases such as porcine circovirus type 2 (PCV2), Mycoplasma pneumoniae (M. hyo), and porcine reproductive and respiratory syndrome virus (Oba 2023; Wilfred et al. 2018). Such information did not inform the importer’s vaccine choices but was instead based on demand. At the wholesale/retail node, a systematic literature review identified knowledge gaps among practitioners and farmers on vaccines and pig diseases (Table 4). For example, KIIs revealed that some practitioners used incorrect routes for vaccine administration, under-dosed pigs or misused vaccines (e.g. using vaccines not indicated for the ages or physiological state of pigs), which calls for refresher training, licensing and stronger regulation. As stated, ‘Veterinarians don’t know about pig vaccines; sometimes some of them use LitterGuard to vaccinate older pigs’ (Key informant from Masaka). A new regulation by the Uganda Veterinary Council (UVC) requiring veterinarians and para-veterinarians to undergo further continuous professional development to obtain an annual practice licence may help close this knowledge gap.

In this study, most FGD respondents were unaware of the availability and benefits of pig vaccines. As one FGD observed, ‘As farmers, we do not know how those vaccines can benefit our pigs’ (FGD participant, Mukono district). Among those who attempted to vaccinate their pigs, some reported cases of abortions. Such negative experiences discourage other farmers. In Kenya and Uganda, high direct and indirect costs, fear of vaccine side effects, and limited information have been identified as key barriers to uptake of Rift Valley Fever vaccines (Mutua et al. 2019:7–9). Partly due to a lack of subsidies for pig vaccines, farmers are not supported in accessing the necessary knowledge and information (e.g. through training) to make informed choices. At the import node, the importer has limited knowledge of the epidemiology of endemic pig diseases, which is needed to inform their vaccine choices for import. Such knowledge gaps were highlighted by both the KIIs and FGDs. To address technical and capacity barriers to vaccine uptake, there is a need to build the capacity among various actors (Bugeza et al. 2017; Donadeu et al. 2019).

Logistical infrastructure for safe vaccine handling, such as fridges, cool boxes, and reliable electricity supply for veterinary practitioners, was found to be inadequate or lacking. This not only disincentivises vaccine uptake but also increases operational costs for practitioners. The KIIs and systematic review observed that during power cuts, some dealers continue to sell vaccines to practitioners and farmers without regard to their safety and efficacy. In addition, limited access to fridges and cool boxes by private veterinary practitioners raises concerns about vaccine viability and efficacy, which likely explains the poor results experienced by some farmers. This problem was noted to discourage vaccine uptake, even among farmers who would otherwise be willing to adopt vaccination.

Previous studies emphasised the importance of involving local veterinary officials and support infrastructure in the eradication of rinderpest (Acosta, Hendrickx & Mckune 2019:5–6; Mariner et al. 2012:1309–1312). Enhancing the cooperation and coordination between public and private veterinary practitioners through the sharing of logistics, such as fridges and cool boxes, could help reduce the costs of vaccine delivery and improve uptake by farmers, as proposed in a previous study (Ilukor et al. 2015). A vaccine delivery model in which few veterinarians leveraged on large numbers of community animal health workers to deliver vaccines to remote areas was effective in rinderpest eradication (Mariner et al. 2012:1309–12). Designing effective vaccination campaigns requires a good understanding of the structure of veterinary services, technical competencies and logistical capacities (Ayebazibwe et al. 2022:71–73; Ilukor, Birner & Nantima 2025:18–20).

The use of vaccines in remote areas where most smallholder farmers live was virtually non-existent because there were no vaccine distribution outlets. While the SLR highlighted gaps in understanding of the economic and socio-cultural contexts in which vaccines are to be applied, KIIs and FGDs revealed high transaction costs, a lack of partners, and misinformation about vaccines. For example, farmers need to know the benefits of vaccines to encourage uptake, yet they lacked this knowledge and information. At the distribution node, KIIs revealed fewer practitioners in the field and the remoteness of farmers. A lack of understanding of the socio-cultural context of vaccine uptake was highlighted by the systematic literature review, while the FGDs reported misinformation about vaccines. Key informant respondents reported high import taxes levied on veterinary drugs and vaccines, which increased downstream costs and ultimately discouraged vaccine uptake among end users. This finding agreed with a previous study (Ilukor et al. 2025:18–20). It was reported that high transaction costs for distribution and inadequate supply are a major hindrance to vaccine use by farmers (Ayebazibwe et al. 2022). Socio-cultural factors such as ethnicity, gender, and remote location were cited as markers of exclusion and marginalisation in accessing livestock vaccines in the Karamoja region (Arvidsson et al. 2022; Serra et al. 2022). The involvement of women and youths through gender-sensitive and inclusive delivery models has been observed to improve vaccine access and reduce transaction costs (Mutua et al. 2019:7–8). When planning and designing vaccination campaigns, it is critical to consider socio-cultural and gender-responsive approaches that increase women’s participation in the vaccine value chain (Njiru et al. 2024:9–10; Serra et al. 2022:1–2). Such strategies have been shown to improve vaccine coverage in hard-to-reach areas and foster more sustainable and equitable animal health systems.

This study was limited to pig vaccine value chain actors, mainly in the central region of Uganda. Because of the small number of actors involved and interviewed per district, this limited the assessment of any differences in vaccine uptake levels between districts. The systematic literature review was based on only a few published studies, which limited the generalisability of its findings. However, overall, this study highlights key barriers to the uptake of pig vaccines and presents a fair picture of the pig vaccines supply chain in Uganda, as the studied districts are where major pig vaccines value chain actors are based.

This survey describes the structure, barriers, and challenges faced by various actors in Uganda’s pig vaccine supply chain. It highlights an urgent need for the government of Uganda to strengthen the regulation and control of pig vaccines. Given that policy, structural, technical, logistical, and socio-economic barriers exist across the different nodes of the value chain, specific interventions are needed to address them. There is a need for policy and structural review, capacity building of value chain actors – especially veterinary practitioners and farmers on the safe use and benefits of vaccines, and improving monitoring of vaccines. The vaccine supply chain actors would benefit from increased investments in infrastructure, such as cold chain facilities, by public- and private-sector players. Future studies to understand the epidemiology of important vaccine-preventable pathogens and on vaccine efficacy are recommended.