This qualitative study examined the political economy variables affecting government financing of vaccines and vitamin A supplementation (VAS) in Burundi, Comoros, Ethiopia, Madagascar, Malawi, and Zimbabwe. Despite shared interests between governments and donors, sustainable government financing remains a challenge. While donor commitment to vaccines and VAS often depends on their own political situations, governments showed commitment to vaccine financing through policy measures like immunisation laws. However, explicit financial commitment to VAS was absent in all six countries. Development partners influenced government financing both directly and indirectly. Government power was exercised through systemic processes such as bureaucracy and budgetary control. Enablers of increased government commitment included emerging reforms, citizen engagement, and economic improvements.
Barriers included political instability, inefficiencies, bureaucracy, leadership changes, and competing needs. Although governments recognised their role in financing vaccines, efforts to increase government financing were limited, with discussions on VAS financing notably absent.
