A GPEI/UNICEF operational plan to address chronic vaccine refusals in Afghanistan's Southeast region, where nearly 30,000 children remained unvaccinated due to refusals in the December 2025 campaign.

The document presents a trust-centred cluster approach targeting 50 high-refusal clusters across Paktika, Khost, Paktya, and Ghazni. Refusals in the region are predominantly hard and chronic (70%), driven by religious misperceptions and misinformation, and concentrated among families whose vaccination decisions are shaped by male authority and local social networks rather than health workers. The approach is structured around a three-step action plan: enhanced evidence generation and social network mapping to identify resistant individuals and influencers at cluster level; relaunching two-tier refusal oversight committees — Provincial (PROC) for strategic direction and District (DROC) for operational delivery; and cluster-focused field interventions before each campaign, including mosque sermons, shura/jirga sessions, madrassa dialogues, and household follow-up.

Messaging is co-created with imams, scholars, and elders to ensure cultural and religious alignment. The roadmap runs from February 2026 through the April campaign cycle, with continuous monitoring via a refusal tracking dashboard. Target outcome is a 25% reduction in refusal-driven missed children.

Best used for: refusal conversion strategies, cluster-level microplanning, religious and community influencer engagement, accountability frameworks for refusal oversight committees.