Understanding the acceptability, barriers and facilitators to implementing the 4CMenB vaccine for the prevention of gonorrhoea in gay, bisexual and other men who have sex with men

Background In November 2023, the Joint Committee on Vaccination and Immunisation advised the UK government that a targeted, opportunistic vaccination programme using 4CMenB to prevent gonorrhoea primarily in gay, bisexual and other men who have sex with men (GBMSM) at higher risk of infection should be introduced in sexual health services (SHSs). Data on the acceptability of 4CMenB vaccination and factors influencing uptake were needed. Methods Three focus group discussions (FGDs) were conducted with 17 GBMSM aged [≥]18 years, resident in England, who self-reported bacterial sexually transmitted infection or [≥]5 sexual partners in the previous 12 months. One FGD with five sexual healthcare professionals (HCPs) was conducted. Data were analysed using reflexive thematic analysis. Themes were organised using the Vaccine Uptake Continuum and interpreted using the Social Ecological Model. Results Acceptability of 4CMenB vaccination was high among GBMSM and HCP participants. GBMSM described vaccination as supporting sexual wellbeing and reducing anxiety about gonorrhoea, particularly when positioned alongside existing prevention strategies like HIV pre-exposure prophylaxis and Doxycycline post-exposure prophylaxis. While the estimated effectiveness of ~30-35% was perceived as modest, it did not deter acceptability, but reduced willingness to actively seek vaccination. Structural constraints, including limited SHS capacity, appointment availability, and restrictive eligibility criteria, were identified as barriers to equitable uptake. Community-based and outreach delivery models were widely supported as strategies to improve access. HCPs drew on experience from mpox vaccination to anticipate implementation challenges, emphasising the need for clear guidance, staff training, and sustainable resourcing. Mixed views were expressed regarding additional protection against meningitis, which was generally considered a secondary influence on decision-making. Conclusions 4CMenB vaccination for gonorrhoea was acceptable for both GBMSM and HCPs; however, uptake is likely to depend on ease of access, clear communication, and system-level support. Addressing structural constraints and supporting community-based delivery may help achieve equitable delivery of 4CMenB.