Voices from the Frontline: Understanding the Barriers and Enablers to Vaccination in Aged Care Facilities in Sydney, Australia

Background/Objectives: Vaccination is a critical public health measure for older adults in residential aged care facilities (RACFs). In Australia, COVID-19, influenza, pneumococcal, and shingles vaccines are recommended and funded for this group. However, vaccination coverage remains suboptimal, with limited understanding of the underlying causes. Methods: Surveys and semi-structured interviews were conducted with in-reach geriatric teams, general practitioners (GPs), RACF staff, residents and family members. Data were analysed using thematic analysis, with manual, iterative coding to develop themes. Key quotes illustrate findings, and the prevalence of barriers and enablers was also quantified. Results: Input was gathered from seven in-reach geriatric staff, 40 GPs, 90 RACF staff, 17 RACF residents and 84 family members of residents. Barriers and enablers were grouped under four headings: operational, communication, coordination and financial. RACF staff identified limited access to vaccination histories as the most significant barrier and relied on external providers to upload data to the Australian Immunisation Register (AIR). On-site clinics were essential, but organisational policies prevented nursing staff from vaccinating. Most RACFs stored only influenza vaccines and depended on external providers for others. Gaps in translated materials contributed to vaccine hesitancy. Healthcare provider endorsement was valued, but RACF staff were often expected to discuss vaccination despite feeling ill-equipped. Consent processes were burdensome, and responsibility for tracking vaccination schedules was unclear with calls for streamlined processes. Low provider remuneration was also noted, with calls for increased government support. Conclusions: This work identifies key barriers and enablers to resident vaccination in RACFs. Improving delivery requires organisational policy change, staff support, digital access, and continued advocacy. The approach is replicable for other vulnerable groups.