With the early arrival of the flu season in the UK, vaccination remains the best protection we have against the virus. Yet uptake is still low. Research carried out by Liverpool John Moores University (LJMU), in collaboration with The Pandemic Institute and funded by CSL Seqirus, worked with ethnically minoritised communities in Liverpool to understand barriers to flu vaccination and how to improve access to reliable information so that the needs of diverse communities can be met.

The research, led by Professor Cathy Montgomery, Dr Anna Powell, Professor Marie Claire Van Hout and Deborah Connors, and published in PLOS One, explored attitudes toward flu vaccination among nearly 100 people from across the city, including community members, healthcare professionals, policy experts, and engagement workers. The team found that many of the same barriers seen during the COVID-19 pandemic, such as mistrust, misinformation, and poor access to reliable information, are also driving low flu vaccine uptake.

A continuing public health challenge

Each year, seasonal influenza causes around 15,000 deaths in the UK, and thousands more people are hospitalised. In the 2024–25 flu season, hospital pressures reached record levels, with more than 20 NHS Trusts declaring critical incidents. Liverpool was among the hardest-hit cities, with one of the highest mortality rates from flu and pneumonia in the country.

Vaccination against influenza effectively reduces disease burden and death, with estimates suggesting that influenza vaccination prevents between 200,000–600,000 cases and 6,000–10,000 premature deaths yearly in England. Although the flu vaccine is offered free to those most at risk, such as older adults, pregnant women, and people with long-term health conditions, uptake remains below national targets. Rates are even lower among ethnically minoritised and disadvantaged communities, who also experience worse outcomes if they do catch the flu.

Key themes behind vaccine hesitancy

Through interviews and focus groups, researchers identified six main themes that help explain why some people are reluctant to get the flu jab:

• Beliefs
• Trust
• Accessibility
• Community
• Healthcare
• Alliance

Many participants questioned whether the vaccine was safe or necessary, often confusing flu with milder illnesses like the common cold. Others worried about side effects or believed that natural remedies or religious practices would offer enough protection.

Trust emerged as a key issue. Participants said they were more likely to believe health information if it came from familiar or trusted figures, such as community leaders or known healthcare workers, rather than from official government or NHS channels. Historical and ongoing experiences of racism, poor communication, and inconsistent messaging during the COVID-19 pandemic had also eroded trust in healthcare systems.

Accessibility was another challenge. Language barriers and limited digital access made it harder for many people to find accurate vaccine information. Some community members misunderstood the flu vaccine’s components, with concern about pork-derived ingredients or confusion between the flu and COVID-19 vaccines circulating widely.

The role of community organisations

Despite these challenges, the study found strong potential solutions within the communities themselves. Local organisations, many led by multilingual staff or volunteers, were trusted sources of information and already played an active role in promoting health. However, these groups often lacked stable funding and resources to continue their work long term.

Healthcare staff, meanwhile, reported wanting to engage more effectively with culturally diverse patients but said they needed more time, support, and training to do so confidently.

Dr Anna Powell, lead researcher on the study, said “This research shows that people want to make informed decisions about their health, but they need trusted relationships, clear communication, and systems that reflect their communities. We need to co-create health messages with community members to ensure they are culturally relevant and accessible.”

Professor Cathy Montgomery, who led the research team, said: “Liverpool is a city with a strong sense of community, and this is one of our greatest assets in delivery of trusted and equitable health care messaging. We’ve used these insights to further develop resources and public health messages that are currently being used in our communities to increase knowledge around flu and help people to make decisions about their health care”.

The work was carried out as part of a five-year influenza research partnership between The Pandemic Institute and CSL Seqirus – a global leader in influenza prevention. Funded work has been exploring both the threat of seasonal influenza and the development of innovative approaches to pandemic preparedness and response. For more information on the programme of work go to https://www.ljmu.ac.uk/flu.

You can read the full journal article here: A thematic analysis of flu vaccine hesitance in ethnically minoritised communities in Liverpool | PLOS One