Abstract
<jats:p>Abstract Background The COVID-19 pandemic disrupted Ghana’s health, economic, and social systems, prompting the government to launch a mass vaccination programme in March 2021, targeting 20 million people by the end of 2022, to reduce transmission and mitigate socio-economic strain. This study explored stakeholders’ perspectives on the politics of the COVID-19 vaccination programme, highlighting implementation challenges, political dynamics, and lessons for future pandemics. Methods A qualitative, exploratory, descriptive study was conducted between June and September 2021. Fourteen stakeholders from the Ministry of Health, the Ghana Health Service, academia, political leaders, and professional associations were purposively selected and engaged in key informant interviews. Data were analysed using Braun and Clarke's thematic analysis approach, guided by the Health Policy Triangle and Campos and Reich’s policy implementation framework. Results Three main themes were generated. First, governance and institutional capacity shaped implementation through issues of procurement transparency, communication gaps, donor dependence, and operational constraints in data systems and logistics. Second, the political economy of vaccine procurement and distribution was influenced by leadership politics, bureaucratic dynamics, fiscal constraints, donor priorities, and interest-group influence. Third, stakeholders highlighted lessons for future pandemic preparedness, including strengthening transparent governance, improving public communication, building local vaccine research and manufacturing capacity, enhancing intersectoral coordination, and establishing robust monitoring and evaluation systems. Conclusion The rollout of COVID-19 vaccines in Ghana was shaped not only by technical and logistical considerations but also by complex political and governance dynamics. The study highlights how governance structures, political incentives, and interactions among key stakeholders influence policy implementation in resource-constrained settings. Ghana’s experience underscores the importance of transparent governance, effective multistakeholder coordination, sustainable financing mechanisms, and strategic investment in regional vaccine research and manufacturing as critical pillars of pandemic preparedness. Strengthening these institutional and governance dimensions is essential not only for sustaining immunisation programmes but also for building resilient health systems capable of responding effectively to future global health emergencies.</jats:p>