BACKGROUND:
Older adults living in long-term care are among the populations most at risk of severe illness, hospitalization, and death from vaccine-preventable diseases. Age-related immune decline, high levels of comorbidity, and congregate living conditions increase vulnerability. Despite this risk, vaccination policies and practices in long-term care remain inconsistently prioritized across countries. Strengthening access to immunization in these settings is essential to supporting healthy ageing and protecting the rights, health, and dignity of older people.

METHODS:
This qualitative study examined vaccination policy and practice in long-term care across ten countries. Semi-structured interviews were conducted with long-term care providers, academics, advocates, and experts in ageing and immunization. Interviews explored governance structures, delivery models, access to vaccines, data systems, and perceived barriers and enablers to uptake. Survey findings were analyzed using a thematic approach to identify shared challenges, contextual differences, and examples of promising practice.

RESULTS:
Across countries, findings revealed persistent gaps between policy and practice. Common barriers included vaccine hesitancy among residents, families, and providers; limited data collection for adult vaccination; workforce and capacity constraints; and fragmented oversight between health and social care systems. Access barriers related to cost and limited availability of on-site vaccinators were also frequently reported. In contrast, settings with centralized coordination, clear standards, expanded vaccinator roles, and publicly funded vaccines demonstrated stronger and more consistent uptake.

CONCLUSIONS:
Protecting the health and dignity of older adults, especially those in long-term care, requires sustained investment in both policy and practice. Strengthening immunization infrastructure in LTC is not only a matter of disease prevention but also a broader commitment to healthy ageing, equity, and social justice.