A qualitative study on vaccination program accessibility for the elderly and medical risk groups in the south of the Netherlands

Elderly and medical risk patients face an increased risk of vaccine-preventable infectious diseases. However, their vaccination rates are on a decreasing trend in the Netherlands, contrary to public health recommendations. The current vaccination landscape for Dutch adults is complex, with separate programs and many stakeholders involved such as general practitioners (GP), municipal public health (GGD), and hospital specialists. This contributes to reduced access and vaccination rates. This study sought to gain stakeholder insight on how to improve the accessibility and sustainability of vaccine programs for the elderly and medical risk population in Limburg. Nine semi-structured interviews with vaccination stakeholders such as GPs, GGD, academic experts, specialist doctors and patient organizations were conducted. Four vaccine accessibility themes were identified: barriers to access, Limburg particularities, stakeholder roles and responsibilities, and adjustments to improve access and sustainability. Key barriers were vaccine hesitancy, program rigidity and fragmentation, lack of a data-sharing system, complex reimbursement, lack of stakeholder collaboration and trust, and complacency of different parties. Particularities of Limburg that should be considered are its geographical uniqueness and lower education and socioeconomic conditions. Finally, potential improvements were also identified, mainly: centralising to one vaccination stakeholder through GP and GGD collaboration, improving communication to patients, creating a patient data-sharing system, and maximising vaccination opportunities and convenience. Stakeholders held diverse perspectives on barriers to vaccination access. However, their views converged on centralisation at GGD and collaboration with GPs, a solution that may eliminate their weaknesses and combine their strengths. A focus on how to increase collaboration with GPs, trust, and convenience while centralising vaccination is to be prioritised in future research. Furthermore, an online vaccine registry and patient data-sharing system is desired by all parties. These solutions have the potential to reduce program fragmentation, enhance patient convenience and ultimately increase vaccine uptake among high-risk Dutch adult populations.