Understanding the acceptability, barriers and facilitators to implementing the 4CMenB vaccine for the prevention of gonorrhoea in gay, bisexual and other men who have sex with men
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Background
In November 2023, the Joint Committee on Vaccination and Immunisation advised the UK government to introduce a targeted, opportunistic vaccination programme using 4CMenB in sexual health services to prevent gonorrhoea primarily in gay, bisexual and other men who have sex with men (GBMSM) at higher risk of infection. Evidence on the acceptability of 4CMenB vaccination was required.
Methods
Three focus group discussions (FGDs) were conducted with 17 GBMSM aged ≥18 years, resident in England, who selflZlreported bacterial sexually transmitted infection or ≥5 sexual partners in the previous 12-months, alongside one FGD with five sexual healthcare professionals (HCPs). Data were analysed using reflexive thematic analysis, and organised and interpreted using the Vaccine Uptake Continuum and the Social Ecological Model.
Results
Acceptability of 4CMenB was high among GBMSM and HCP participants. GBMSM described vaccination as supporting sexual wellbeing and reducing anxiety about gonorrhoea. While the estimated effectiveness (30-35%) was perceived as modest, it did not deter acceptability but reduced willingness to actively seek vaccination. Structural constraints (e.g. limited appointment availability) and restrictive eligibility criteria were identified as barriers to equitable uptake. Community-based delivery models were supported to improve access. HCPs drew on mpox vaccination experience to anticipate implementation challenges and emphasised clear guidance and sustainable resourcing. Additional protection against meningitis was generally a secondary influence.
Conclusions
4CMenB vaccination for gonorrhoea was acceptable to GBMSM and HCPs; however, uptake is likely to depend on ease of access, clear communication, and system-level support. Addressing structural constraints and supporting community-based delivery may help achieve equitable delivery of 4CMenB.
