“Every time I had to pay $50, it was adding up, but there was no option”: A qualitative study with parents and primary caregivers in Australia on barriers to timely childhood vaccination

Timely uptake of childhood vaccination in Australia has consistently declined since the COVID-19 pandemic. A 2024 national survey indicated that in addition to parental beliefs and feelings about vaccination, practical obstacles contribute to partial childhood vaccination. The survey did not explore how and why practical barriers interact with other barriers and impact behaviour. Such insights are important to fully understand the declines in childhood vaccination rates. In this qualitative study we sought insights with parents from across Australia. In November 2024, we interviewed parents who reported experiencing practical difficulties vaccinating their child. Participants were recruited by recruitment company. All participants provided informed consent to participate. We combined thematic analysis with a case study approach to capture and explore parents' experiences of barriers and impacts on timely childhood vaccination in the socio-economic context of the participant. There were 13 participants of diverse gender, occupation, jurisdiction and remoteness. We derived three themes: 1. Practical barriers make it difficult for parents to prioritise vaccination; 2. Acceptance barriers can be exacerbated by negative experiences; and 3. Implementing parents' suggestions could improve vaccine accessibility and acceptability. Three Case Studies further illustrate first two themes. Our study shows how pervasive practical difficulties can contribute to vaccination delays, as well as initiate, or exacerbate, acceptance barriers. The case studies illustrate how carers can experience compounding practical and acceptance barriers that delay vaccination of children. We recommend that governments and other immunisation stakeholders investigate childhood vaccination service delivery models in Australia, with a view to making it easier to access for families. This includes reducing the costs of vaccination, increasing availability and flexibility of vaccination appointments, and improving providers' skills in supportive communication about vaccination. Investments in making childhood vaccination easier to access may additionally reduce the risk of parents having negative experiences that lead to entrenched hesitancy. • Interviews with 13 parents in Australia unpack barriers to childhood vaccination. • Practical difficulties include high costs, appointment unavailability, transport, no reminders. • Practical difficulties can impact how parents think and feel about vaccines. • Need free and after-hours vaccine appointments; reminders; support first time parents. • Parents desire supportive vaccination conversations with providers.