'We don’t routinely check vaccination background in adults': A national qualitative study of barriers and facilitators to vaccine delivery and uptake in adult migrants through UK primary care

BackgroundThe COVID-19 pandemic has highlighted shortfalls in the delivery of vaccine programmes to some adult migrant groups; however, little is known around care pathways and engagement of these older cohorts in routine vaccinations in primary care, including catch-up programmes. Guidelines exist, but the extent to which they are put into practice and prioritised is unclear.ObjectivesTo explore the views of primary care professionals around barriers and facilitators to catch-up vaccination in adult migrants (defined as foreign born; over 18 years) with incomplete or uncertain vaccination status and for routine vaccines to inform development of future interventions to improve vaccine uptake in this group and improve coverage.DesignQualitative interview study with purposive sampling and thematic analysisSettingUK primary care, 50 included practices.Participants64 primary care professionals (PCPs): 48 clinical including GPs, Practice Nurses and healthcare assistants (HCAs); 16 administrative staff including practice managers and receptionists (mean age 45 years; 84.4% female; a range of ethnicities).ResultsParticipants highlighted direct and indirect barriers to catch-up vaccines in adult migrants who may have missed vaccines as children, missed boosters, and not be aligned with the UK’s vaccine schedule, from both a personal and service-delivery level, with themes including: lack of training and knowledge of guidance around catch-up vaccination among staff; unclear or incomplete vaccine records; and lack of incentivization (including financial reimbursement) and dedicated time and care pathways. Adult migrants were reported as being excluded from many vaccination initiatives, most of which focus exclusively on children. Where delivery models existed they were diverse and fragmented but included a combination of opportunistic and proactive programmes. PCPs noted that migrants expressed to them a range of views around vaccines, from positivity to uncertainty, to refusal, with specific nationality groups reported as more hesitant to get vaccinated with specific vaccines, including MMR.ConclusionsWHO’s new Immunization Agenda (IA2030) has called for greater focus to be placed on delivering vaccination across the life-course, targeting under-immunised groups for catch-up vaccination at any age, with UK primary care services therefore having a key role to play. Vaccine uptake in adult migrants could be improved through implementing new financial incentives or inclusion of adult migrant vaccination targets in QOF, strengthening care pathways and training, and working directly with local community groups to improve understanding around the benefits of vaccination at all ages.