Title : Stakeholder perspectives on facilitators and barriers to pandemic prevention and preparedness in Tanzania: Qualitative insights

Introduction / Background: Tanzania is one of the countries prone to Pandemics and response is critical. The COVID-19 pandemic catalysed rapid scientific progress and urgent public-health actions. Tanzania being a low-income country, struggled to implement coordinated, evidence-based responses especially among vulnerable populations that were disproportionately affected. The objective of this paper is to explore stakeholders' experiences and perspectives on factors that shaped Tanzania's COVID-19 response and to explore implications for future pandemic response in the country.

Methods: Qualitative data were collected via 2 key informant interviews (KIIs), 9 in-depth interviews (IDIs), and 4 focus group discussions (FGDs) with key stakeholders affected by or were responsible for response. Purposive, maximum-variation sampling engaged stakeholders from government, health sector, vulnerable communities (healthcare workers [HCWs] and older adults). Key informant interviews focused on response measures and coordination systems while with affected communities looked at their experience with COVID-19 and other pandemics in their communities. Thematic analysis was conducted with the aid of NVIVO 14 qualitative analysis software.

Results: Thematic analysis revealed three key themes that summarise facilitators and barriers to pandemic response in Tanzania: (1) Policy level response/structural factors to pandemic response and coordination (e.g. government denialism and response speed); (2) Health systems level factors (e.g. capacity of health care workers, health system capacity and medical resources); (3) Community level factors (e.g. mistrust, stigma of infection, conflicting cultural practices contradicting response efforts, access to prevention services e.g. masks, water, sanitizers).

Participants highlighted future pathways for more equitable and community-centred pandemic prevention, preparedness, and response (PPPR). These included strengthening the capacity of local health facilities; improving transparent and consistent risk communication; and establishing regular feedback mechanisms between health authorities and community leaders. Additionally, promoting participatory research that meaningfully includes community perspectives was identified as critical for identifying context-specific challenges and co-developing locally appropriate solutions to build a more resilient health system.

Conclusion: The Pandemic responses yielded lasting impacts in Tanzanian communities, some of which have been sustained to date. Our findings point to a need to strengthen Tanzania's PPPR through: (1) enhancing local health facility capacity via training, resources, and infrastructure; (2) building trust through effective communication strategies; (3) establishing feedback mechanisms between authorities and community leaders for transparency; and (4) promoting participatory research incorporating community voices to address local challenges. A multifaceted, whole-of-society approach prioritizing collaboration will foster resilience, ensuring effective responses to future pandemics.

Stacy Mshana is an early-career researcher in infectious diseases and pandemic preparedness and response. She holds an MSc in Infection Biology from the University of Glasgow and a BSc in Biochemistry and Molecular Biology. Her work bridges basic biomedical science and public health, with a focus on strengthening health systems, pandemic preparedness, and community-centered responses to infectious disease threats.