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South Africa is at the forefront of TB vaccine research, with involvement in the clinical trials of leading candidates. We sought to understand what the priorities and implementation approach of a potential new TB vaccine in South Africa would be. We conducted semi-structured interviews with 26 stakeholders with different expertise during April and May 2025. Deductive analysis was used to develop a coding framework for thematic content analysis of the data. Stakeholders supported introducing a new TB vaccine in South Africa due to the high disease burden, but feasibility of the roll out was said to depend on vaccine price, cost-effectiveness, efficacy, regulatory approval, and implementation logistics. Efficacy below 50% could raise concerns unless supported by robust modelling demonstrating significant public health impact and cost-effectiveness. Stakeholders preferred a cheaper vaccine course to enable a broad population-based introduction. Priority populations for vaccination included adolescents and adults for a broad population approach, and high-risk groups such as, people living with HIV, healthcare workers and TB household contacts. Whilst a national broad population-based approach was preferred, constraints may result in a phased introduction in high-burden areas and\/or targeted vaccination to high-risk groups first. Strong advocacy, detailed cost effectiveness assessments, regulatory alignment, and integrated service delivery were seen as essential to successful implementation. With the introduction of a new TB vaccine potentially as early as 2030, this study provides valuable insights, particularly regarding target populations, that can be utilised for the implementation of a new TB vaccine in South Africa to ensure a successful introduction. Further research is required on vaccine acceptability, TB infection prevalence and modelling to estimate cost effectiveness and budget impact.<\/jats:p>","DOI":"10.1371\/journal.pgph.0005047","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T18:42:41Z","timestamp":1769798561000},"page":"e0005047","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Insights on the implementation strategies for a potential new tuberculosis vaccine in South Africa"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3436-0728","authenticated-orcid":true,"given":"Katherine 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