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It is against this backdrop that this study aims to describe evolving interactions between health system governance, trust and childhood vaccination in Ukraine across periods of reform and conflict, and the implications for health policy in fragile settings. Drawing on qualitative interviews with key informants and Ukrainian parents, findings show that trust in the health system, with implications for vaccine confidence, has been intertwined with broader perceptions of the legitimacy of state institutions and quality of services. Trust was undermined by corruption and weak governance but reconfigured through reforms that increased accountability and patient choice. The 2022 full\u2010scale invasion disrupted services but also strengthened forms of civic responsibility and engagement with public health. This study contributes to broader scholarship on health system trust and vaccine confidence by situating them within the historical and political evolution of Ukraine. It offers considerations relevant for Ukraine's post\u2010conflict recovery and health governance and illustrates links between vaccine confidence and state\u2010society relations in contexts of political transition and crisis.<\/jats:p>","DOI":"10.1002\/hpm.70128","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T18:02:26Z","timestamp":1787680946000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Political Transition, Health System Reform and Trust in Childhood Vaccination in Ukraine: A Qualitative Case Study"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-5984-2589","authenticated-orcid":false,"given":"Harriet","family":"Dwyer","sequence":"first","affiliation":[{"name":"Department of Global Health and Development London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7777-722X","authenticated-orcid":false,"given":"Jennifer","family":"Palmer","sequence":"additional","affiliation":[{"name":"Department of Global Health and Development London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6336-6531","authenticated-orcid":false,"given":"Luisa","family":"Enria","sequence":"additional","affiliation":[{"name":"Department of Global Health and Development London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anton","family":"Grushetskyi","sequence":"additional","affiliation":[{"name":"Kyiv International Institute of Sociology  Kyiv Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olya","family":"Fokaf","sequence":"additional","affiliation":[{"name":"Independent Researcher"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kateryna","family":"Gatsenko","sequence":"additional","affiliation":[{"name":"Independent Researcher"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"Yahorava","sequence":"additional","affiliation":[{"name":"Independent Researcher"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadine","family":"Beckmann","sequence":"additional","affiliation":[{"name":"Department of Global Health and Development London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/puh2.70073"},{"key":"e_1_2_13_3_1","volume-title":"Ten Threats to Global Health in 2019. 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