Barriers and facilitators to COVID-19 vaccination programme implementation in Ireland: a qualitative study of implementation stakeholders using CFIR

Abstract

Background: Effective vaccine implementation strategies are critical for successful deployment of national vaccination programmes, particularly during public health emergencies such as COVID-19. Reflecting on implementation can facilitate future pandemic preparedness and health system resilience. Aim: This study interviewed key implementation stakeholders to identify factors influencing COVID-19 vaccine implementation in Ireland. Methods: Online semi-structured interviews were conducted with sixteen stakeholders involved in policy or decision-making regarding COVID-19 vaccine implementation at national, regional, and local levels in the Republic of Ireland. The updated Consolidated Framework for Implementation Research (CFIR) guided data collection and framework analysis, to identify perceived implementation barriers and facilitators. Results: Factors across innovation, process, individual, and organisational domains shaped implementation. Delayed or evolving evidence, alongside vaccine design and complexity, presented barriers. Process-related factors were influential, including adapting delivery approaches (e.g. scaling up to mass vaccination centres), engaging vaccine deliverers (e.g. in acute settings, pharmacy, and general practice), engaging recipients, and planning to operationalise vaccination at scale. Individual factors included opinion leaders, motivation and professional capability. Within the inner setting (Irish government and health system), resource availability, organisational infrastructure, policy frameworks, relational connections, communication, and access to information were critical for delivery. Outer setting factors, including partnerships and policy direction, were also influential. Conclusions: COVID-19 vaccine implementation in Ireland was shaped by various system, organisational, and individual factors, alongside rapid adaptation. These findings highlight the importance of sustained investment in staffing, organisational infrastructure, and coordinated policy frameworks to support effective vaccination programmes and strengthen preparedness for future public health emergencies.