The vaccination paradox: how East Africa’s success in Ebola vaccine preparedness may be creating new public expectations for future outbreaks

This perspective synthesizes published evidence on Ebola vaccination and outbreak preparedness in Africa. Successful vaccination against Zaire ebolavirus has strengthened vaccine-based outbreak control but may also create a preparedness risk when public expectations exceed species-specific vaccine availability. We propose the Vaccine Expectation Gap, Vaccine Anticipation and Species-Specific Vaccine Literacy as linked, hypothesis-generating constructs, supported by a Preparedness Trust Contract for practical implementation. The framework draws on expectation-disconfirmation and crisis and emergency risk communication theories and distinguishes established evidence from interpretation and testable hypotheses. Recent Sudan virus and Bundibugyo virus outbreaks illustrate the relevance of this gap because licensed vaccines remain species-specific. Evidence is concentrated in Uganda, making broader East African application a hypothesis requiring empirical testing. If validated, the framework could strengthen risk communication, community trust and regional health-security planning.