Routine immunization in older adults beyond COVID-19: a qualitative analysis of experiences, perceived barriers and facilitators, and recommendations for improvement

Vaccination remains one of the most cost-effective public health strategies. However, declining immunization rates among older adults pose a growing concern. This qualitative study aimed to unveil the experiences, emotional responses, barriers and facilitators, and recommendations for improvement of the National Immunization Program among older Chileans and international migrants residing in three major urban centers in Chile during and after the COVID-19 pandemic. A qualitative multiple case study design was employed. Using snowball sampling, a purposive sample of 30 participants aged 65+ (15 Chileans and 15 international migrants) were recruited. Semi-structured interviews were conducted online between 01 January 2023 and 30 April 2024 following a pre-defined guide, and lasting 60–90 min. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically. Ethical approval was obtained before the study was conducted. Most participants viewed Chile’s vaccination program for older adults as effective. The influenza and COVID-19 vaccines were the most commonly recognized, while awareness of the pneumococcal vaccine was lower among participants. Experiences and emotional responses were varied. Limited vaccine knowledge was observed among those vaccinated in long-term care facilities or whose vaccinations were managed by family members. Six key barriers were identified: (1) insufficient dissemination of information (2), fear of adverse effects (3), perceived incompatibility with chronic conditions (4), mobility and health-related limitations (5), socioeconomic vulnerability, and (6) migration-specific challenges. Also, four facilitators were noted: (1) proximity of vaccination centers (2), respectful treatment by healthcare personnel (3), strong public campaigns, and (4) improved outreach to migrant communities. Multiple recommendations for improvement of the National Immunization Program emerged. This study revealed that while the national vaccination program is viewed positively, its full potential may be limited by access and information barriers as described by study participants. Participants’ recommendations underscore the need to enhance access to accurate, timely vaccine information, strengthen culturally sensitive service delivery, and promote tailored training for healthcare providers on older people rights and needs.