GPs play major role in boosting vaccination rates for high-risk communities

Medically high-risk and underserved populations, including people from Indigenous backgrounds, migrants and refugees, older adults, and people living with disability are amongst the least vaccinated. In 2023, general practices delivered 60.9% of vaccinations in Australia, with pharmacy settings contributing a further 18.2%. Primary care providers are thus the central means by which improvement in vaccination coverage will occur. However, in both Australia and Aotearoa New Zealand, the primary care landscape is complex, and providers are already under pressure. Supporting them with practical, evidence-based strategies will be essential to increasing vaccination rates. 

To understand what gets in the way and what works best, we conducted a rapid review of studies from Australia and Aotearoa New Zealand. We aimed to describe barriers and enablers of primary care vaccination coverage and examined the evidence from interventional studies. We looked at the gaps between the challenges people face, what is known to work and what is actually being implemented. There were 42 studies: thirty-seven described barriers and enablers, and 13 were interventions, with some publications containing both. 

What shapes uptake in primary care?

Barriers and enablers fell into three categories: the consumer; the practitioner and practice; and the broader healthcare system. Each affects the others, signalling that to overcome the barriers and leverage the enablers, a coordinated approach is required.

At the consumer level, mistrust, hesitancy, and difficulty accessing vaccination services were common obstacles. Key consumer-based enablers were a high perceived benefit of vaccination and awareness of the risks of not vaccinating. 

At a practitioner-practice level, barriers included competing demands and the ability to cater to at-risk populations. Person centred-practice, positive attitudes towards population health interventions, and collaborative ways of working helped improve coverage. 

At a system level, a lack of culturally informed services and information technology difficulties created barriers that individual efforts alone could not always overcome. Policy-level support for the development of co-designed, patient-centred, culturally informed, and equitable vaccination care pathways were key enablers. 

What works 

There was a mix of interventions, including: 

• automated and tailored SMS reminders sent to patients before or after appointments; personalised vaccination calendars designed for Aboriginal and Torres Strait Islander families;
• structured health assessments for older adults that included vaccination prompts;
• co-designed community vaccine hub for people experiencing homelessness; 
• pharmacy-based maternal pertussis vaccination programs; 
• school-based and outreach influenza programs targeting Māori and Pacific communities; and 
• policy-level measures, including Australia's 'No Jab, No Pay' legislation.

Cutting through that study complexity, the most consistently effective approaches across Australia and Aotearoa New Zealand were simple and low-cost. SMS reminders, structured health assessments, and personalised vaccination schedules designed for priority populations all improved uptake. Tailored SMS messages outperformed generic ones, particularly for child vaccination in underserved communities. Co-designed models, such as a community vaccine hub and pharmacy-based maternal vaccination programs, also showed promise, especially for Māori populations. 

Where to next?

While all included interventions targeted priority populations, when barriers were tackled, few comprehensively addressed vaccination rates across our consumer, practice and health system categories. Yet the persistent barriers we encounter in both countries do not operate independently; thus, our responses to them need to be coordinated and effectively integrated.

Although a comprehensive approach thus requires a lot more systems thinking, there are changes general practices can implement now to improve vaccination rates. Practices can set up automated SMS reminders before appointments, build vaccination checks into existing health assessments for older patients, and for Aboriginal and Torres Strait Islander families, use personalised vaccination calendars and send tailored SMSs with educational content.

When GPs encounter hesitancy, our review suggests they acknowledge and address hesitancy directly, using clear, culturally informed language and the therapeutic relationships they have worked hard to build. Pharmacists can extend that reach by working alongside GPs to co-deliver maternal vaccinations, particularly for patients in rural areas or those who struggle to attend a clinic. Practice managers can contribute by running regular audits to identify overdue patients, activating recall systems, and making sure vaccination status is visible inpatient records before every appointment. However, workflow changes alone are unlikely to meaningfully reduce inequity in vaccination coverage. 

Our study shows that we have to look beyond the syringe, the dose and the individual patient. Interventions that purposefully attend to and integrate consumer, practice and system level efforts, are tailored to local contexts, and are developed through genuine collaboration with medically high-risk and underserved communities are most effective. Primary care is central to this work, but it cannot carry it alone.

Delivering effective preventative care, such as vaccinations, is often perceived as an isolated task: a doctor or pharmacist meets a patient and administers an injection. However, modern clinical practice proves otherwise. Reversing declining immunization rates is not a solo effort — like every other facet of high-quality healthcare — it is inherently a team sport.

Tina Vickery is a PhD Candidate with the Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University.

Georgia Fisher is a Research Fellow with the Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University.