Vaccines are only effective if they reach the right target groups: Acceptance, demand, and uptake of vaccines are critical, especially in at-risk groups. In Estonia, for example, there is concern that the flu vaccine does not sufficiently cover older people: in the 2019/2020 season, only 10% of the population aged 65+ decided to get the flu vaccine.

Global data show that the root causes of undervaccination are complex, context-specific, and vary by time, place, and vaccine. Therefore, to develop an effective health promotion intervention, evidence is needed, especially from the local context.

The topic of vaccination is also relevant due to large population movements, due to, for example, natural disasters or wars. Russia’s military war in Ukraine, which began in February 2022, led to the largest such movement in Europe since World War II. More than seven and a half million people have fled to nearby countries, including Estonia. With no end in sight to the war, it is imperative to understand how to better support war refugees who have fled Ukraine and are in Estonia to review and adjust primary health care services, including vaccination. However, the prospects of war refugees receiving adult influenza vaccines are unknown but are considered important for effective implementation.

The study aims to gain a better understanding of:

• the hindering and facilitating factors that influence the vaccination uptake of people aged 60 years and older;
• the hindering and facilitating factors affecting the availability of primary health care services for war refugees from Ukraine.