Abstract
Seasonal immunization is essential for safeguarding public health by preventing the spread of infectious disease and reducing the burden on healthcare systems. However, changes in vaccination policy may have significant implications on public confidence and vaccine uptake. This qualitative thematic analysis aimed to understand how changing government policy on vaccination eligibility impacted decision making among 50-64 y olds in England and Scotland. Semi-structured interviews were conducted with 40 adults aged 50 to 64 residing in England or Scotland, including both vaccinated and unvaccinated individuals for influenza and COVID-19, representing diverse socio-demographic backgrounds. Four key themes emerged (1) perceived importance of seasonal vaccines with notable differences between COVID-19 and influenza vaccines; (2) knowledge gaps and confusion regarding eligibility criteria; (3) influences on vaccine uptake such as convenience, trust and social factors; and (4) consideration for future policy, emphasizing consistency, clear rationale, and responsible use of National Health Service (NHS) resources. While trust in the NHS was generally high, policy inconsistencies diminished confidence and created uncertainty about vaccine necessity. These findings provide critical insights into specific strategies policymakers should adopt such as habitual versus intention vaccination, wider perceptions linked to vaccination necessity, and the need for clear rationale and consistent messaging. Addressing these factors could help improve public trust, clarify rationale around eligibility and increase overall vaccine uptake.