Nepal has successfully demonstrated rapid roll out of COVID-19 vaccination across the country. This study aims to explore relevant behavioural and social drivers among poor and marginalized populations that have profound implications to access COVID-19 vaccines in the communities. It was a community-based qualitative research which was conducted from July, 2022- August, 2022 in Makwanpur, Mustang and Kailali. The sample populations (>100) and the sites (3) were purposively selected with a specific criteria that aimed to include the poor and marginalized populations in terms of their vulnerabilities to access the vaccines in the selected districts. The methods for data collection were primarily participant observations, participatory resource mapping (3), key informant interviews (25), focus group discussions (10) and case studies (6). The overall analysis approach was based on the WHO’s behavioural and social drivers of vaccination framework (BeSD: 2022). Access to and utilization of the COVID-19 vaccines among poor and marginalized populations largely depend on the local context of community and health systems. In the diverse context of prevailing social, cultural, economic, ethnic, psychological and gender considerations, the motivation for vaccine uptake among poor and marginalized populations is primarily driven by the perceived disease risks, vaccine confidence that includes perceived benefits, safety and trust, and the governing socio-cultural processes such as social values, norms, beliefs and support systems in the families and communities at large. Local community and health systems need to effectively consider social and behavioral drivers in order to increase the COVID-19 vaccine uptake among poor and marginalized populations whose health needs are still unmet. This approach will greatly enhance availability, accessibility, affordability, service quality of the COVID-19 vaccines, and respect from both the communities and health workers in managing the vaccinations.
