Challenges to equitable COVID-19 vaccine distribution in Ethiopia: lessons and recommendations for future pandemic preparedness

Abstract Background The COVID-19 pandemic has posed unprecedented global health challenges, disproportionately affecting low- and middle-income countries. Vaccination is a key public health strategy; however, inequities in vaccine distribution have limited access, particularly in Ethiopia, where logistical, infrastructural, and socio-cultural barriers have hindered the COVID-19 vaccination rollout. This study explores stakeholders’ perspectives on vaccine distribution, delivery mechanisms, and strategies to enhance equitable access. Methods A qualitative study was conducted using purposive sampling to interview 21 key informants, including government officials, NGO representatives, and civil society actors involved in COVID-19 vaccine distribution in Ethiopia. Data were collected through face-to-face and online interviews, transcribed verbatim, translated into English, and analyzed thematically using NVivo 12. Ethical approval was obtained, and confidentiality was maintained throughout the study. Results Participants highlighted multiple challenges affecting vaccine distribution, including global supply inequities, limited cold chain infrastructure, logistical constraints, inadequate health infrastructure, and vaccine hesitancy. Geographical barriers, conflict-affected areas, and socio-cultural factors, particularly gender norms, further exacerbated inequitable access, leaving rural populations and women disproportionately underserved. Effective multisectoral collaboration, political commitment, and public-private partnerships facilitated distribution, Key recommendations include strengthening cold chain systems, enhancing health infrastructure, implementing gender-sensitive strategies, to improve equitable vaccine delivery and preparedness for future pandemics. Conclusion Ethiopia’s COVID-19 vaccination campaign faced complex logistical, infrastructural, and socio-cultural challenges that impeded equitable distribution. Addressing these barriers requires a comprehensive approach integrating strengthened logistics, gender-sensitive outreach, stakeholder coordination, and robust surveillance systems. Lessons from this study can inform national pandemic preparedness plans and support more resilient, equitable vaccination strategies in low-resource settings.