Table 1 Summary of the results of the thematic analysis

1. Stakeholders’ framings of COVID-19 vaccination

 Vaccination as a public health issue

• Vaccination mitigates transmission of the virus

• Vaccination minimizes COVID-19 morbidity and mortality

• Vaccination halts effects of COVID-19 on health and well-being

• Public health dimension of inoculation policy

• Targeting the aged, vulnerable and those with comorbidities in the vaccination rollout

[25,26,27]

 Gender-centred frame of vaccination

• Prioritizing women in the vaccination rollout

• Giving women greater roles in the vaccination rollout

• Targeting women to eliminate vulnerability to health risk

[25, 28, 29]

 Vaccination as a universal health coverage issue

• Making vaccines available to everyone

• Vaccination as a human right

• Equitable coverage of vaccination

• Redistributive tax (COVID-19 Health Recovery Levy) to finance vaccine needs of all individuals

[30,31,32,33]

2. Issue characteristics of COVID-19 vaccination

 Vaccine safety and hesitancy

• Misinformation about vaccine safety

• Doubts regarding vaccine efficacy

• Distrust in COVID-19 vaccines

• Health workers’ hesitancy to get vaccinated

• Public hesitancy towards vaccination

[8, 15, 34,35,36,37,38,39,40,41]

 Delay in the second jab and change of the vaccination plan

• Irregular dosing intervals

• Delays in receiving and administering the second jab

• Extension of interval between first and second jab by 4 weeks

• Reluctance to receive booster

• Ghana Health Service assurance to the public of protection of the first jab

[16, 42, 43]

 Politically led vaccination campaign

• President assurance to the public of vaccine safety

• President and Vice-President received first jab on live television

• Parliament advocated for inclusive vaccination

• Members of Parliament to receive jabs in their constituencies to engender trust in the vaccines

[33, 39, 43,44,45]

3. Actor power dynamics surrounding COVID-19 vaccination

 Support for local production of vaccines

• President and Health Minister drove support for local vaccines

• President set up committee to explore local production of vaccines

• Political constituents supported local production of vaccines

• Pharmaceutical Manufacturers Association of Ghana (PMAG) supported policy for local production of vaccines

• Development partners supported local production of vaccines

[46,47,48,49,50,51,52]

4. Political context of COVID-19 vaccination

 The politics of vaccine availability

• President resolved to make vaccines available

• Opposition political party criticized poor vaccine availability

• Opposition party criticized government’s approach to vaccination

• Vaccine nationalism affecting vaccine availability

• Political pressure on government to secure more vaccines

[34, 42, 53,54,55,56,57,58]

 The politics of vaccine procurement

• Pressure to secure vaccines led to procurement irregularities

• Vaccines procured above ex-factory price

• Government criticized for using middlemen to procure vaccines

• Health Minister breached established procurement rules in vaccine procurement

• Government justified high unit cost of doses

• Health Minister spurned punitive measures

[32, 34, 35, 59, 60]