"We did the best we could with what we had": A Qualitative Study of the Pandemic Vaccine Response in Belize

The COVID-19 pandemic had an unprecedented global impact, making the rapid development of vaccines critical. Belize, a small, middle-income country in Central America and the Caribbean, displayed COVID-19 vaccination rapidly. However, to date, no study had been conducted to understand in-depth actions, barriers and facilitators shaping vaccine implementation in this context. This study aimed to explore the experiences and perspectives of individuals involved in Belizes COVID-19 public health response, with a particular focus on the national COVID-19 vaccine introduction strategy, to generate insights that may inform ongoing health system strengthening efforts and future pandemic preparedness in the region. The methodology for this qualitative study comprised 29 semi-structured interviews with strategic actors held virtually or face-to-face, and 10 ethnographic field observations in clinical settings, urban and rural public spaces, and vaccination points in four cities across Belize. Data collection took place in late 2024. Data were integrated into thematic analysis conducted by two independent researchers. Ethical approval was obtained from the corresponding Ethics Committee on July 11th, 2024. Four main results were obtained: government leadership and mobilization of international agencies were essential for COVID-19 vaccines access; multisectoral coordination was key in policy development and implementation; health system adaptability was critical amid limited human and financial resources; and communication and community-based strategies contributed to public engagement.