Implementation barriers and facilitators for COVID-19 vaccination promotion policies and practices

Background

COVID-19 vaccinations remain critical for preventing severe disease and reducing mortality, yet uptake across Europe remains suboptimal. Vaccine hesitancy is a key driver of low uptake, driven by misinformation, low perceived risk, growing complacency as COVID-19 becomes endemic, and increasing societal polarization around vaccination. These challenges impact effective health communication and policy implementation. This study assesses implementation barriers and facilitators for improving COVID-19 vaccine uptake across Europe.

Methods

This study employs qualitative expert interviews to complement earlier desk reviews and data collection with healthcare professionals and academics. 12 semi-structured online interviews were conducted with representatives of the pharmaceutical industry, decision-makers, and experts at European, national, and local implementation levels. Thematic analysis was performed using the Consolidated Framework for Implementation Research.

Results

The study identifies actionable policy and practice recommendations uptake across European settings targeting healthcare professionals and the general population. For healthcare professionals, priorities include strengthening vaccination-related communication skills such as refutational interviews, embedding vaccinology in basic training and continuing professional development, and expanding vaccination services to other healthcare professionals such as medical specialists or pharmacists. For the general population, recommendations highlight sustained investment in community engagement, targeted and aligned communication tailored to specific population groups and including pre-and debunking, and integration of combined influenza and COVID-19 vaccination into a seasonal vaccination.

Conclusions

Findings provide actionable priorities for strengthening vaccination strategies across European contexts. Identified good practices need rigorous evaluation and scaling to leverage vaccination uptake.

Key messages

• Improved and aligned communication about vaccination is a joint mission of healthcare professionals and public health specialists targeting single patients, communities and the population at large.

• Identified good practices highlighted skills building, partner alignment, sustained support and sometimes legal changes as important implementation factors, while in need for evaluation and scaling.