Addressing the social nature of vaccination hesitancy in humanitarian immunization programs. An experience of developing a qualitative assessment tool on vaccination decision making in Médecins Sans Frontières, MSF

Background: The conceptual framework behind the concept of vaccination hesitancy draws significantly from research in public health, behavioral sciences, and psychology, and places a particular emphasis on the individual or psychological dimensions of human behaviors to explain the patterns of population resistance to vaccination. The RQA_VAX tool for Rapid Qualitative Assessment on Vaccination is a tool developed by Médecins Sans Frontières to gain a deeper understanding of the social, cultural, political, and historical dynamics surrounding populations practices toward vaccination.Method: Between 2021 and 2023, MSF's operational centre in Brussels has been developing an applied qualitative assessment tool as well as training material to enable non-specialists to collect and analyze data on the vaccination decision making process. We describe in the method section how the tool was developed and the theoretical framework where it is rooted. We also describe the use of the tool and the integration of the experiences of the users during the trial period.Results: The RQA_VAX tool, piloted by MSF in Tshwane, revealed that vaccine hesitancy among undocumented migrants stemmed primarily from mistrust of government institutions, not misinformation. This insight shifted staff perceptions, moving from an infodemic approach to recognizing deeper social issues.Conclusion: The RQA_VAX tool represents an attempt to apply social science to humanitarian vaccination programs. Despite its limitations, experiences showed it can contribute to a better comprehension of the vaccination decision-making process, thereby facilitating a more effective incorporation of the community perspective in the formulation of their strategy.