Sense-Making During the RTS,S Malaria Vaccine Pilot Implementation in Ghana

The pilot implementation of the RTS,S/AS01E (Mosquirix) malaria vaccine marked a significant step in addressing one of Africa's leading causes of mortality by providing essential data that led to its approval for use in children under two years old in malaria-endemic regions. However, little attention has been given to the lived experiences of caregivers and how they made decisions about participating in the vaccine pilot implementation. This paper takes an interpretive phenomenological analysis lens to understand caregivers' process of negotiating participation in the pilot implementation. I conducted 11 in-depth interviews with caregivers in the RTS,S pilot implementation site in the Assin North district in Ghana. Findings reveal that participants engaged in three overarching sense-making processes to negotiate their involvement in the pilot. These were <i>questioning the vaccine</i>, <i>considering political and socio-economic concerns</i>, and <i>biting the bullet.</i> Embodied within these themes are how agency, power, politics, trust in healthcare workers, and knowledge of vaccines undergird respondents' decision-making regarding the pilot implementation. The study evidenced the need for a holistic approach to engaging community members in pilot sites to guide their vaccine decision-making. By identifying the complex decision-making processes that individuals go through, we can better inform vaccine policy and public messaging to guide vaccine decision-making.