This document presents the key findings from a comprehensive desk review of vaccination refusals in the southeast region of Afghanistan. It synthesizes available data to identify where refusals are concentrated, the underlying social and behavioral drivers shaping refusal patterns, and the profiles of families most likely to decline vaccination. The analysis also highlights some programmatic areas that limit the effectiveness of current interventions and outlines some strategic considerations to address both the root causes of refusals and the structural constraints within the existing delivery system. Together, these insights aim to inform a more targeted, network-driven, and sustainable approach to reducing persistent refusals in the region-driven, and sustainable approach to reducing persistent refusals in the region.