Barriers and levers to vaccination of the elderly: results of a qualitative study

Although vaccination is an essential element in the prevention of infections in the elderly, vaccination coverage in this population is low. In this population, there is less data concerning the levers and obstacles to vaccination than in the general population. The aim here is to identify the levers and obstacles to recommended vaccinations in the 65 years and over group, but also to shed light on the possible arguments that could play a role in the commitment to new vaccination behaviour. A qualitative survey based on 14 semi-structured interviews was conducted with people aged 65 and over, living at home in the Auvergne Rhône-Alpes region (France) from March to May 2022. The interviews were recorded, transcribed in their entirety and then subjected to a thematic content analysis by two independent persons. The participants interviewed were generally in favour of vaccination. The fears and motivations for vaccination reported by the participants are similar to those of the general population. We find the following obstacles: the low effectiveness of certain vaccines, potential side effects, lack of confidence in the government and health authorities and in pharmaceutical laboratories. As far as levers are concerned, free health care, limits on health expenditure, prevention of infections or even their eradication, and collective action are elements that are found in the discourse of the seniors. The general practitioner is at the centre of their vaccination decision, he is a person of trust and knowledge with a paternalistic vision and yet sometimes he is the one who does not recommend a vaccine. Moreover, the past experience of polio epidemics has left its mark on the seniors because of its impact on their autonomy and their bodies. The analysis of a common experience of the patient-doctor relationship and of poliomyelitis made it possible to support the hypothesis of a ‘generation effect’ in the relationship to vaccination among seniors. KEY MESSAGES: • The general practitioner has a central role in the vaccination of the elderly. • the past experience of polio epidemics has left its mark on the seniors because of its impact on their autonomy and their bodies.