This working paper explores the social dynamics of immunisation delivery and acceptance in the Republic of Guinea. The paper takes an anthropological approach to vaccination demand and supply issues, viewing them as interrelated and both culturally and politically embedded. The paper focuses on urban and rural sites in the Republic of Guinea, and examines 3 key areas that affect vaccination demand and supply issues including, how vaccine delivery is influenced by the wider context of the health care system, how vaccination demand is shaped by socially-differentiated knowledge and political identities, and how interactions with delivery institutions and their frontline health workers unfold.

The authors contend that in the specific areas studied, factors often cited as discouraging vaccination, such as secondary effects and rumours, do not appear to be highly significant. On the contrary, problems in vaccination coverage are linked less to demand than to issues concerning the organisation of services and their financing. These delivery problems lead in turn to problems in the interaction between mothers and vaccination service providers, which can deter their demand for vaccination.

The paper highlights the reasons for problems in vaccination coverage, and identifies ways to address these problems. One such suggestion is the need to improve communication between health personnel and communities, so that health agents better understand parents’ motivations for vaccination as well as the factors that can lead to non-attendance. This communication could help to increase health agents’ tolerance of mothers’ occasional lateness and failure to keep appointments – thus reducing the instances of reproach which so often put mothers off future attendance.