Preparing for future Shigella vaccine introduction in Pakistan: a multi-stakeholder qualitative study of policy readiness and implementation

The study examined the views of Pakistani communities and stakeholders on the future introduction of a Shigella vaccine, which is an important cause of diarrhea in children and contributes to antimicrobial resistance in lower-income countries. The research included six focus group discussions with caregivers of children under five years and 16 interviews with experts including healthcare providers, immunization program officials, and policymakers. Findings showed that while childhood diarrhea is generally recognized, awareness of Shigella as a specific pathogen is limited. Participants expressed conditional acceptance of a future vaccine, depending on trust, perceived safety, and recommendations from healthcare providers and community leaders. Stakeholders emphasized the need for local evidence on disease burden and cost-effectiveness, while identifying Pakistan's existing immunization infrastructure as a strength. Some participants preferred combination vaccines to reduce injections, while others emphasized the importance of improving water, hygiene, and sanitation.