Barriers to and drivers of vaccination – insights and recommended actions: increasing access to vaccination and primary health care services for Ukrainian refugees in Estonia

Overview

This examination of barriers and drivers influencing the uptake of childhood vaccination and adult influenza vaccination focused on refugees and displaced people from Ukraine living in Estonia. The research examined the perspectives of caregivers, older adults and health workers, guided by the capability-opportunity-motivation for behaviour change (COM-B) framework. Findings revealed that while most caregivers have been able to access health services and adhere to childhood vaccination schedules, a minority faced registration challenges or held misconceptions about vaccine safety. Health workers expressed commitment to delivering equitable care to both Estonian and Ukrainian patients, but noted difficulties such as incomplete medical histories and requests for services not aligned with Estonian practices. For adult influenza vaccination, uptake was low, attributed to limited awareness of free access for individuals aged 60 and older, and misconceptions about vaccine necessity. Key barriers included limited outreach and reminders, and language differences. On the other hand, most caregivers reported trust in the Estonian health-care system and success in accessing needed services, including vaccination. Health workers identified the need for clearer national guidance, better access to medical records of those coming from Ukraine and automated notification systems to improve vaccination rates.