Migration Dynamics and Vaccine Hesitancy in District Charsadda, Pakistan: A Mixed-Methods Study

Vaccine hesitancy remains a significant hurdle to Pakistan’s immunization efforts, especially in regions with internal migration. In District Charsadda, Khyber Pakhtunkhwa Pakistan - Mixed-Methods A study on impact of migrant population dynamics over vaccine hesitancy. A sample size of 602 study subjects (migrants = 312, of North and South Waziristan, Swat, Dir, Malakand, Bajaur and Mohmand; local residents = 290) were included for the collection of quantitative data through structured questionnaires in addition to qualitative data gathered through In-Depth Interviews [IDIs] (n = 24) and Key-Informant Interviews [KIIs] (n = 6). The results indicate that 43.9% of migrants and 15.9% of locals were not vaccinated (p <. 001). Migration status was found by logistic regression model to be the strongest predictor of refusal (OR = 3.6, 95% CI = 2.2–5.8), after adjusting for education, healthcare access and rumor exposure. Qualitative information provided recurring themes of distrust in government, documentation issues and cultural misinformation. Taken together, our findings show that vaccine hesitancy in Charsadda is spatially and socially clustered among migrant communities who are influenced by displacement, marginalization, and where there is low trust in institutions. The report’s analysis suggests that population mobility is a major contributor to vaccine hesitancy and that focusing on-interventions—like micro-level planning, engaging faith-based organizations, and communicating in Pashto—could help narrow the immunization deficit. These results underscore the necessity of incorporating mobility and identification dimensions in the district-level vaccination plans in Pakistan.