How can new TB vaccines be effectively introduced in Indonesia? Insights from diverse stakeholders

New adult tuberculosis (TB) vaccines are in clinical trials and may be licensed as soon as 2028. However, vaccine rollout requires addressing multiple contextual factors beyond clinical trial findings. This study explored stakeholders' perspectives on the introduction of a new TB vaccine in Indonesia. We used a mixed-methods approach combining a stakeholder consultation in Jakarta (13/03/2025) among 28 participants with diverse expertise and follow-up interviews with two of those participants. Participants completed a structured questionnaire (via Slido) consisting of closed- and open-ended questions, adapted into Bahasa. Questions explored factors to be considered regarding vaccine introduction, target populations, delivery strategies, regulatory considerations, and lessons from other vaccine programs. Quantitative data were analysed descriptively, and qualitative responses underwent thematic analysis. All participants agreed on the importance of TB vaccine introduction. Key concerns were minimum efficacy of 50% and comparative effectiveness against other interventions, such as TB preventive treatment. Most agreed that vaccine introduction should not depend on local manufacturing capacity, administration route, or dosage. Critical enablers identified were adequate funding, strong political commitment, and demand generation through public acceptance. Priority target populations included people living with HIV/AIDS, individuals with diabetes, household contacts of TB patients, adolescents, and healthcare workers. Major challenges highlighted were vaccine hesitancy, halal issues, misinformation, and limited healthcare worker knowledge. Opinions diverged regarding the feasibility of vaccine rollout without Interferon-Gamma Release Assay (IGRA) testing: nine opposed vaccinating those with IGRA-negative status, six abstained, and three argued that IGRA-testing was unnecessary and cost-inefficient due to its high price. Regulatory and budgeting processes were cited as additional barriers. Introducing new TB vaccines in Indonesia will be complex and concerns extend beyond efficacy. Its success will depend on coordinated strategies to define target populations, design tailored delivery approaches, address vaccine hesitancy, and navigate regulatory and financing challenges.