Informing future Seasonal Influenza and Covid-19 Vaccination Campaigns based on past experience: A mixed-method approach with eligible populations and healthcare professionals

Jorge Oliveira¹Bárbara Gonzalez^1,2*Mendes, T.¹Paula Paulino^1,2Rui Gaspar¹Bruna António¹Diana Costa³Leonor Quelhas Pinto³Andreia Costa^4,5,6Miguel Telo De Arriaga³

• ¹Digital Human-Environment Interaction Lab, Lusophone University, Lisbon, Portugal
• ²Research Center for Psychological Science, Faculty of Psychology, University of Lisbon, Lisbon, Portugal
• ³Directorate-General of Health (DGS), Lisboa, Portugal
• ⁴Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, Lisbon, Portugal
• ⁵Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
• ⁶Laboratório para a Sustentabilidade do Uso da Terra e dos Serviços dos Ecossistemas – TERRA, Lisbon, Portugal

Background: Seasonal vaccination campaigns against influenza and COVID-19 are critical for protecting vulnerable populations. Scientific evidence on past campaigns is essential for the effectiveness of future campaigns. This study aims to: 1) assess predictors of influenza and COVID-19 vaccination intentions 2) explore perceived barriers and facilitators of 2023-2024 seasonal vaccination campaign. Methods: A cross-sectional study employing both quantitative and qualitative methods was conducted. The quantitative study involved a sample of 231 respondents from Portugal, including healthcare professionals and vaccination eligible population: individuals over 60 years of age, and individuals with chronic diseases. Quantitative data were collected via an online survey to assess vaccination literacy, attitudes, and future vaccination intention. The qualitative study consisted of four focus groups with a total of 17 participants: vaccinated/unvaccinated individuals and healthcare professionals. Thematic analysis was used to explore perceptions of eligible populations about this vaccination campaign. Results: Quantitative analysis revealed that attitudes towards vaccination and factors related to personal/family health predicted future vaccination intentions for influenza and COVID-19. Thematic analysis identified key facilitators, such as positive perceptions of pharmacies as vaccination sites and an early start of the campaign specifically for vaccinated groups. Barriers were related to campaign communication, fear of side effects, vaccination fatigue, and the co-occurence of high temperatures during the campaign start. Unvaccinated individuals expressed lower perceived susceptibility and severity. Conclusions: The study highlights the importance of clear communication, addressing vaccination fatigue, and considering environmental factors. Improving proximity between health professionals as trusted information sources and the population, alongside customized communication, may also enhance vaccination uptake among the eligible population. The potential influence of weather conditions on the acceptance of vaccination campaigns is a topic that deserves further consideration in the future, within the scope of climate changes.