Background: The world is witnessing the highest level of forced displacement on record leading to a global rise in refugees requiring resettlement. Children under the age of 18 make up more than half the total number of refugees globally. Children with refugee backgrounds are at high risk of acquiring vaccine preventable diseases (VPDs) due to a complex set of factors, one being under-immunisation both before and after resettlement. All children under 18 years are eligible to receive funded scheduled vaccinations in Aotearoa New Zealand (NZ) regardless of their immigration status. In NZ, reported age-appropriate vaccination rates are suboptimal among children with migrant and refugee backgrounds.

Methods: A qualitative interpretive description study was undertaken to explore factors associated with access and uptake of immunisations and develop strategies to improve age-appropriate vaccinations among refugee children post-resettlement in NZ. Semi-structured interviews were conducted with primary healthcare providers (nurses and doctors) (N = 14) across seven resettlement locations in NZ. Collected data was transcribed verbatim and thematically analysed.

Results: Findings suggest there is considerable variability across the resettlement locations regarding the provision of immunisation services for refugees. Five themes were derived from the data, which demonstrate the interrelated factors that influence vaccination uptake across the refugee caregiver, health provider and system level: 1) resettlement priorities and challenges describes caregiver challenges in the early resettlement phase including lack of knowledge of vaccines and health services in NZ, access barriers and competing resettlement priorities 2) knowledge as a driver for change describes how possessing or lacking knowledge about refugee concerns has corresponding positive or negative impacts on forming therapeutic relationships with, and delivering health services to, former refugees 3) working within the system includes system level factors that influence access to and provision of immunisation services, such as resourcing, resettlement policies, system inefficiencies and missed opportunities 4) to understand and be understood describes the capacity of caregivers and health providers to navigate communication barriers in order to understand each other 5) the service needs to change describes how participants were highly motivated to improve the system. Strategies were suggested to overcome commonly mentioned barriers and included the provision of culturally and linguistically appropriate resources, education campaigns, reducing access barriers (e.g., after-hours clinics), and improving system efficiencies.

Conclusion: These findings highlight root factors that impact immunisation uptake among children with refugee backgrounds. To reduce the burden of VPDs, broad system level changes are required to address the barriers to vaccine uptake faced by both families of refugee backgrounds and health providers.