Addressing the ten top root causes of covid-19 vaccine hesitancy among household heads in fragile and conflictscontexts: Beni City, Eastern Drc

Coronavirus Disease 2019 continues to threaten mankind and new variants entail uncertainty. Vaccination, a critical public health strategy for Coronavirus Disease 2019 prevention and control has been compromised by Coronavirus Disease 2019 vaccine hesitancy. The root causes of Coronavirus Disease 2019 vaccine hesitancy and strategies for its reduction are poorly understood in Beni City. This study aimed to identify them and to describe strategies to address them among Beni inhabitants. We conducted a qualitative study using Focus Group Discussions among local experts from the health, development, and humanitarian sectors on August 2022. The following strategies were identifiedto address the ten top root causes of Coronavirus Disease 2019 Vaccine Hesitancy: “Vaccination sites implementation closer to the people”, “Proactive and permanent communication for health”, “Targeted sensitization of potential vaccination models” “Awareness about health autonomy” “Awareness about reciprocal protection during outbreaks”, ”Communication about health workers’ profession” “Involvement of community trusted members ”, “Evaluating, training and arising awareness among CHWs”, “Implementing lessons from experience”, “Peace restoration”, “Government policy based on meeting the needs of the population”, “political communication”, “Motivation of actors”, ”Community involvement planning”. We argue that no root cause was sufficient to explain Coronavirus Disease 2019 vaccine hesitancy and a one-size-feats-all strategy would not work; multi-component interventions are recommended, mainly in fragile setting.