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Introduction:  Barriers to vaccination and the important role of healthcare professionals (HCPs) in influencing immunization decisions made by parents/patients have been well documented. Little information describes challenges that HCPs face in carrying out their role as vaccinators. Methods:  We conducted a focus group study asking HCPs to describe their expectations as frontline vaccinators versus the day-to-day reality they faced. Participants described challenges impacting their ability and motivation as vaccinators, and proposed key solutions to the most important challenges. A total of 75 nurses and physicians (sixteen groups of frontline vaccinators) from the United Kingdom, United States, Germany and India participated in 2 hour focus-group discussions. Results:  There was disconnect between how participants viewed their role in preserving population health when they started their career, and the reality of real-world practice today. Challenges experienced and reflected were similar across professional groups and countries. Low patient-level vaccine knowledge, patient miseducation, untimely vaccine information, frequently changing vaccine schedules, time pressures, lack of centralized record systems, pressure to achieve vaccination targets, and in some instances vaccine costs, all impacted the efficiency and enthusiasm of HCPs. Identified solutions by the same providers included improving patient-level information, equipping HCPs with effective information, and practical ways to reduce the vaccination burden by improved administrative processes and centralized recording coupled with delegating vaccinator roles. Conclusion:  This focus group gives unique insights into needs of HCPs to fulfill their role as vaccinators. Supporting and equipping vaccinators is critical to the continuing success of vaccination programs and the proposed life-course immunization strategy. (Supplementary Appendix 1).