Abstract / Summary
Abstract Background Vaccination is critical for preventing livestock diseases and is an important strategy for reducing antimicrobial use. However, in many low- and middle-income countries, vaccination performance is shaped by how delivery systems operate from importation to farm use. While constraints such as cold-chain failures, weak oversight, and poor handling are widely recognised, the structural mechanisms that sustain them remain poorly understood. Methods We conducted a qualitative systems mapping study of Uganda’s poultry vaccine delivery system based on 37 key informant interviews with regulatory, commercial, and service-delivery actors. Using systems thinking and system dynamics approaches, we identified system bottlenecks, analysed their interactions, developed causal loop diagrams, and identified key leverage points within the system. Results The delivery system was highly import-dependent, with regulatory oversight concentrated at market entry and limited downstream control. Four interconnected bottlenecks were identified: weak post-market surveillance, cold-chain failures, cost pressures that discouraged investment in storage, transport, and quality assurance, and limited technical capacity at the point of administration. These constraints interact through reinforcing feedback processes linking delivery quality, perceived effectiveness, trust, demand, and reinvestment, thereby sustaining underperformance. Structural inequities in infrastructure, market access, and regulatory presence further exacerbated these challenges. Cold-chain integrity, post-market surveillance, upstream procurement decisions, and vaccine handling at the point of use emerged as key leverage points for intervention. Conclusions Vaccination underperformance in this setting was shaped by delivery-system dynamics rather than access alone. Strengthening key leverage points within the system offers a pathway to improve vaccination effectiveness, enhance poultry health, and reduce reliance on antimicrobials. More broadly, improving vaccination performance requires strengthening the governance and delivery systems that enable reliable disease prevention in livestock production.