The global health challenge of counterfeit vaccination certificates: The case of yellow fever vaccination among travelers departing from Khartoum International Airport in Sudan

Abstract

Background: Counterfeit travel vaccination certificates pose a significant threat to public health and compromise disease control measures. We investigated the self-reported vaccination status, the validity of yellow fever vaccine (YFV) certificates (ICVPs), and knowledge and perception about the disease and its vaccine among Sudanese travelers departing through the Khartoum International Airport (KIA). Methods: This was a cross-sectional survey using a non-probability convenience sampling technique among Sudanese travelers departing through KIA between October and November 2021. We assessed the self-reported uptake of YFV and subsequently verified the ICVPs among those reported to be vaccinated. We also assessed participants’ knowledge about the disease in addition to their knowledge and perception of YFV. Results: Four hundred travelers were interviewed. Most participants (88.0%) reported being vaccinated. However, two-thirds of their ICVPs (63.0%) were counterfeit. More than one-third of the participants (35.3%) had poor knowledge of YF and YFV. Carrying a valid ICVP was associated with participants' overall good level of knowledge about YFV (p = 0.030), knowledge about the nature of infection (p-value = 0.008), disease transmission (p = 0.016) and prevention (p = 0.028), and countries that require a mandatory YFV proof (p = 0.005). Many participants perceived YFV as important (93.3%), safe (86.5%), and effective (82.0%). Conclusion: The proportion of counterfeit ICVPs was high. Many of the participants had a poor level of knowledge about YF and YFV. Counterfeit ICVPs have grievous implications for YF prevention and control in Sudan and other countries. There is an urgent need to revisit the implementation of the International Health Regulations in Sudan to leverage recent technological advancements in immunization information systems such as electronic certification.