Barriers to and Drivers of Vaccination among Ukrainian Refugees in Estonia

Introduction

The full-scale invasion of Ukraine in 2022 triggered the largest population movement in Europe since WWII, with over 63,000 refugees registering for protection in Estonia by late 2024. Maintaining high immunization coverage is critical for public health, yet initial data indicated childhood vaccination rates among Ukrainian refugees (79%) lagged behind Estonian averages (90%).

Context and Aims

This study explored the behavioural and societal factors influencing health-seeking behaviours regarding childhood and adult influenza vaccinations among Ukrainian refugees. It aimed to identify specific barriers and drivers to provide actionable insights for tailoring primary health care (PHC) services to refugee communities.

Methodology

Guided by the COM-B (Capability, Opportunity, Motivation, Behaviour) framework, this qualitative study involved 24 semi-structured interviews conducted between February and April 2024. Participants included Ukrainian mothers of children aged 6–24 months, older adults (60+), and Estonian health workers (GPs and nurses).

Findings

Research revealed that while caregivers generally trust the Estonian system, barriers included a lack of automated reminders, missing medical records, and challenges navigating a different system. For older adults, influenza uptake was hindered by low awareness of free programs and misconceptions about vaccine necessity. Health workers expressed high motivation but noted challenges with overfilled patient lists and language differences.

Innovative Contribution to policy

This research contributes a unique dual perspective - refugee and provider - to the literature on crisis-affected populations. It moves beyond quantitative coverage data to offer a plan of action that includes AI-powered translation tools, refugee health mediators, and migration-data-driven registry updates to optimize PHC capacity and equity.

Key messages

• Vaccination gaps among Ukrainian refugees in Estonia were driven more by system‑navigation and information barriers than by lack of trust in health services.

• Tailoring PHC for refugees—through reminders, language support and better data systems—can improve vaccination uptake and strengthen health system equity.