Dear Dr. Powell,

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Kind regards,

Ilhem Berrou, PhD

Academic Editor

PLOS ONE

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Additional Editor Comments:

Thank you for submitting this well written manuscript.

In addition to the comments raised by reviewers, please also address the following:

Introduction

Provide relevant data on vaccine uptake among racially minoritised communities in UK and a comparison with global patterns.

Provide information to the international reader about how influenza vaccine is offered/ can be accessed in UK (or just England).

You provide data on Liverpool population which is the context of this paper. It will be helpful to compare vaccine uptake in other cities e.g. London or Manchester other others with similar ethnic mix.

It would be helpful to theme the barriers to vaccine uptake to ensure clarity on the role/ impact of those barriers. Some barriers relate to the service and how it is offered, others relate to the individual, community or the relationship certain communities have with the local system e.g. historical links to slavery, racism etc...

Methods

Please justify including adult (aged 18+) members of the public who self-identified as being part of an ethnically minoritised group and eligible for a seasonal influenza vaccine (or had an eligible child). Childhood vaccination via schools may be different to adult flu vaccination service, and the considerations will be different. This difference should also be addressed in the results/ analysis.

Results and Discussion

The figure summarising the themes is great. Could the authors consider mapping the themes and the various barriers identified the influenza vaccine programme highlighting where these barriers may rise and may be addressed.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

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2. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: N/A

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3. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: No

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4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

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Reviewer #1: Thank you for submitting a good and timely article. The topic is highly relevant, and the manuscript has the potential to make a valuable contribution to the literature. With a few revisions to improve clarity and depth in key sections, this work would be well-positioned for publication.

Introduction:

The introduction could be strengthened to provide a more compelling rationale for the study. For instance, in lines 40–41, global influenza-related mortality is mentioned, but no reference is made to UK-specific data. While global statistics offer important context, they may not directly support the case for the study’s relevance within the UK healthcare system. Consider rephrasing this section to better reflect the local context.

In line 42, the statement regarding the reduction in mortality and morbidity through vaccination would be more impactful if supported by specific figures. Additionally, incorporating UK-specific data—especially broken down by ethnicity—would enhance the rationale for the study. For example, how do influenza outcomes differ between ethnic minority groups and the White British population? Quantifying this disparity could help justify the focus and scope of the research.

Methods:

The Methods section would benefit from greater clarity. The study design should be explicitly stated (e.g., qualitative, quantitative, or mixed-methods). More information is needed on the sample size—specifically how it was calculated or justified. It would also be helpful to describe the sampling strategy in more detail, including how participants were selected and whether any bias may have been introduced.

Furthermore, please include information about who conducted the interviews and what training or experience they had in qualitative research, as this can impact the quality and reliability of the data collected. Providing the interview schedule or guide would also strengthen transparency. Additionally, clarifying how many interviews were conducted individually versus in focus groups would improve understanding of the data collection approach.

Results and Discussion:

In the Results section, consider clearly identifying the most commonly reported themes to help readers grasp the key findings more readily. It would also be valuable to explore whether participants of different age groups expressed distinct concerns or priorities, as this could inform age-specific public health messaging.

In the Discussion, it would be helpful to compare your findings with those from studies on other ethnic minority groups, both within the UK and internationally. If there are findings that appear unique to the Liverpool context, please consider discussing the local factors that might explain these. This will help readers understand how widely the findings might apply beyond the study setting.

Additionally, drawing parallels with vaccine hesitancy related to other vaccines—such as COVID-19 or MMR—could add depth and context to your interpretation. If a particular theme emerged as especially dominant, it would be useful to explore its implications in greater detail, particularly in relation to future intervention strategies or research directions.

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Reviewer #1: No

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A thematic analysis of flu vaccine hesitance in ethnically minoritised communities in Liverpool

PONE-D-25-20640R1

Dear Dr. Powell,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Ilhem Berrou, PhD

Academic Editor

PLOS ONE