Socio-behavioral barriers and drivers of typhoid conjugate vaccine uptake in Pakistan: a qualitative study using the WHO BeSD framework
- 1Department of Pediatrics and Child Health, Aga Khan University, Pakistan; Corresponding author at: Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, Pakistan.
- 2Department of Pediatrics and Child Health, Aga Khan University, Pakistan
- 3Department of Pediatrics and Child Health, Aga Khan University, Pakistan; School of Population Health, University of New South Wales, Australia
Abstract
Objective: The objective of the study is to explore the socio-behavioral drivers of Typhoid Conjugate Vaccine (TCV) and to understand the barriers and facilitators of Typhoid vaccine uptake in Pakistan. Methods: We conducted a descriptive exploratory study in Karachi, Hyderabad, and Lahore from March–August 2024. In-depth interviews (IDIs) were conducted with lady health workers (LHWs), vaccinators, physicians, community influencers, and program managers from the Expanded Program on Immunization (EPI). Focus group discussions (FGDs) were conducted with parents of children aged 10 months–15 years, LHWs and vaccinators. The interview tool, guided by the WHO Behavioral and Social Drivers (BeSD) framework, used semi-structured questions. Data were analyzed using consensual qualitative research to identify themes influencing vaccination behaviors. Results: We conducted 63 IDIs and 21 FGDs. Four overarching themes emerged from the data: Thinking and Feeling About Typhoid Disease, Social Processes, Practical Issues and Motivation. Caregivers' decisions were influenced by perceptions of disease severity, concerns about side effects, and widespread mistrust, including conspiracy theories about infertility and foreign agendas. Patriarchal authority limiting maternal decision-making and trusted community leaders either facilitating or hindering acceptance. Practical barriers included poor accessibility, long waiting times, fragmented immunization records, and gaps in provider communication, while school-based delivery proved effective. Motivation was strengthened by incentives, skilled vaccinators, and community mobilization, though misinformation and weak systemic coordination undermined confidence. Conclusion: This study highlights communication, cultural, and systemic barriers to TCV and other vaccines delivered under EPI program in Pakistan. Framing TCV as protection against antimicrobial resistance, engaging community leaders and male decision-makers, incentivizing vaccinators, and leveraging social media can build trust. Tailored, sustainable interventions are essential to optimize uptake in Pakistan and other similar setting.
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BibTeX
@article{qamar2026sociobehavioral,
title = {{Socio-behavioral barriers and drivers of typhoid conjugate vaccine uptake in Pakistan: a qualitative study using the WHO BeSD framework}},
author = {Farah Naz Qamar and Naveed Ahmed and Nasreen Mithani and Zubair Latif and Murk Larik and Shazia Sultana and Irum Fatima and Mohammad Tahir Yousafzai},
journal = {Vaccine: X},
year = {2026},
month = oct,
doi = {10.1016/j.jvacx.2026.100924},
url = {https://doi.org/10.1016/j.jvacx.2026.100924},
note = {CC BY},
}
RIS
TY - JOUR
TI - Socio-behavioral barriers and drivers of typhoid conjugate vaccine uptake in Pakistan: a qualitative study using the WHO BeSD framework
AU - Farah Naz Qamar
AU - Naveed Ahmed
AU - Nasreen Mithani
AU - Zubair Latif
AU - Murk Larik
AU - Shazia Sultana
AU - Irum Fatima
AU - Mohammad Tahir Yousafzai
PY - 2026
DA - 2026/10/30
JO - Vaccine: X
DO - 10.1016/j.jvacx.2026.100924
UR - https://doi.org/10.1016/j.jvacx.2026.100924
AB - Objective: The objective of the study is to explore the socio-behavioral drivers of Typhoid Conjugate Vaccine (TCV) and to understand the barriers and facilitators of Typhoid vaccine uptake in Pakistan. Methods: We conducted a descriptive exploratory study in Karachi, Hyderabad, and Lahore from March–August 2024. In-depth interviews (IDIs) were conducted with lady health workers (LHWs), vaccinators, physicians, community influencers, and program managers from the Expanded Program on Immunization (EPI). Focus group discussions (FGDs) were conducted with parents of children aged 10 months–15 years, LHWs and vaccinators. The interview tool, guided by the WHO Behavioral and Social Drivers (BeSD) framework, used semi-structured questions. Data were analyzed using consensual qualitative research to identify themes influencing vaccination behaviors. Results: We conducted 63 IDIs and 21 FGDs. Four overarching themes emerged from the data: Thinking and Feeling About Typhoid Disease, Social Processes, Practical Issues and Motivation. Caregivers' decisions were influenced by perceptions of disease severity, concerns about side effects, and widespread mistrust, including conspiracy theories about infertility and foreign agendas. Patriarchal authority limiting maternal decision-making and trusted community leaders either facilitating or hindering acceptance. Practical barriers included poor accessibility, long waiting times, fragmented immunization records, and gaps in provider communication, while school-based delivery proved effective. Motivation was strengthened by incentives, skilled vaccinators, and community mobilization, though misinformation and weak systemic coordination undermined confidence. Conclusion: This study highlights communication, cultural, and systemic barriers to TCV and other vaccines delivered under EPI program in Pakistan. Framing TCV as protection against antimicrobial resistance, engaging community leaders and male decision-makers, incentivizing vaccinators, and leveraging social media can build trust. Tailored, sustainable interventions are essential to optimize uptake in Pakistan and other similar setting.
SN - 2590-1362
ER -