Barriers to adult vaccination: Findings from a national survey of healthcare professionals

BACKGROUND: Adult vaccination rates are consistently below national targets in the United States (US). A national survey was conducted to quantify and rank the relative importance of barriers to vaccination reported by a range of US healthcare professionals (HCPs), providing actionable insights for targeted intervention and policy efforts to improve adult vaccine uptake. METHODS: A total of 1227 HCPs across office- and pharmacy-based settings participated in a quantitative survey in which barriers were ranked from a list of individual-, interpersonal-, community-, and policy-level challenges following the Socio-Ecological Model. HCPs were defined as actively vaccinating clinicians and healthcare decision-makers. A MaxDiff (Best-Worst Scaling) analysis was performed to identify top barriers. RESULTS: Interpersonal barriers, particularly patient hesitancy and vaccine refusal, were the most frequently cited challenges. Policy-level concerns, including reimbursement limitations and Medicare Part D complexities, emerged among primary care physicians and pharmacists. Community-level issues, such as staffing shortages, workflow constraints, and fragmented immunization records, were especially prominent for pharmacists and healthcare decision-makers. Individual-level concerns, including HCP reluctance to recommend vaccines or concerns about co-administration, were also reported. CONCLUSIONS: These findings highlight how adult vaccination is hindered by a complex, multilevel set of challenges. Addressing barriers will require targeted interventions at the practice and policy levels.