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Vaccine Hesitancy

With more than 90% of countries reporting vaccine hesitancy, the World Health Organization declared in January 2019 that it was one of the top ten threats to global health.

According to WHO, vaccine hesitancy is a “delay in acceptance or refusal of vaccines despite availability of vaccination services.” WHO states that addressing vaccine hesitancy requires not just an understanding of the magnitude of this problem but also a diagnosis of the root causes, tailored evidence-based approaches to addressing hesitancy, and monitoring and evaluating the interventions.

Vaccine hesitancy has been an ongoing issue in Low and Middle Income Countries (LMICs), and has recently increased due to concerns about safety and long-term effects. This situation in LMICs, coupled with the growing influence of anti-vaxxers in high income countries, has led to an increase in outbreaks of vaccine-preventable diseases that were once thought mostly eradicated, such as measles, pertussis, and diphtheria around the world.

In addition, with technology and social media booming over the last decade, online platforms have become a go-to outlet for vaccine-hesitant individuals to share misinformation about vaccines. One study found a significant relationship between organized anti-vaccine messaging on social media and public doubts of vaccine safety. In a second study, the authors conclude that as social media platforms gain increasing popularity globally, public health professionals are increasingly concerned regarding the impact of anti-vaccination content on downstream vaccine denial. This further threatens the uptake of emerging vaccines such as COVID-19.

Factors affecting vaccine hesitancy

Social and behavior change (SBC) professionals have often been tasked to find ways to influence knowledge, attitudes, and practices, about vaccines. Now that the COVID-19 vaccines are becoming available worldwide, renewed emphasis and urgency for SBC efforts arise.

To that end, WHO has offered three factors that play a role in vaccine hesitancy, the first two of which can be addressed by SBC:

  • Complacency: Low perceived risk of vaccine-preventable diseases, and vaccination not deemed necessary. Other life/health issues are a greater priority.
  • Confidence: Low levels of trust in vaccines, in the delivery system, and in health authorities
  • Convenience: Barriers related to geographic accessibility, availability, affordability, and acceptability of services

To respond to each of these factors, SBC programs can disseminate correct information in a way that is clear and straightforward.

This Trending Topic

In this Trending Topic we provide a selection of SBC research, tools, and examples that aid in understanding this issue, especially in light of the recent availability of COVID-19 vaccines and the urgency for immunization worldwide.

Do you have materials to contribute?

If you would like to add a resource to this Trending Topic, please fill out this form or contact us.


Photo by Steven Cornfield on Unsplash

Resources

  • Tools
  • Examples

Vaccine Hesitancy and COVID-19: Considerations for Communication

This presentation presents the issues we confront in deciding how to communicate to the public that COVID-19 vaccine recommendations reflect the state of scientific knowledge.

Download

Interpersonal Communication for Immunization (IPC-I)

This website, ipc.unicef.org, is part of a global package of tools and resources designed to support FLWs in their immunization work, with a focus on improving their capacity to effectively use IPC to address barriers to immunization uptake and completion. 

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Vaccine Hesitancy in Low- and Middle-income Countries: Potential Implications for the COVID-19 Response

This article deals with potential issues surrounding the COVID-19 vaccine in low and middle income countries.

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The Best Evidence for How to Overcome COVID Vaccine Fears

Now that the COVID-19 vaccine is becoming available, somewhere between 60 and 90 percent of adults and children must be vaccinated or have antibodies resulting from infection in order to arrive at the safe harbor known as herd immunity, where the whole community is protected.

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Social Media and Vaccine Hesitancy

The authors globally evaluate the effect of social media and online foreign disinformation campaigns on vaccination rates and attitudes towards vaccine safety.

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Vaccine Hesitancy

Vaccine hesitancy refers to delay in acceptance or refusal of vaccines despite availability of vaccination services. Vaccine hesitancy is complex and context specific varying across time, place and vaccines. It includes factors such as complacency, convenience and confidence.

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Behavioural Considerations for Acceptance and Uptake of COVID-19 Vaccines: WHO Technical Advisory Group on Behavioural Insights and Sciences for Health 

This is a report from a meeting held in October 2020 to discuss behavioral considerations relating to vaccine acceptance and uptake.

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We Know How to Curb the Pandemic. How Do We Make People Listen?

A recent report by researchers from Northeastern University and elsewhere found that the number of Americans heeding most recommendations has dropped steadily since April. (Mask-wearing, which has increased, was an exception)

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Catalogue of Interventions Addressing Vaccine Hesitancy

This catalog provides tools and information resources to support EU/EEA countries in addressing the challenging issue of vaccine hesitancy.

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Let’s Talk about Hesitancy: Enhancing Confidence in Vaccination and Uptake

This guide provides practical evidence-based and peer-reviewed advice for public health program managers and communicators involved with immunization services. It identifies ways to enhance people’s confidence in vaccination and addresses common issues which underlie vaccination hesitancy.

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Assessments of Global Drivers of Vaccine Hesitancy in 2014: Looking Beyond Safety Concerns

Measuring vaccine hesitancy and its determinants worldwide is important in order to understand the scope of the problem and for the development of evidence-based targeted strategies to reduce hesitancy.

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Unpacking the Root Causes and Consequences of Vaccine Hesitancy

This is part 2 of a 3-part vaccine series covering the potential of vaccines for infectious diseases, the impact of the antivaccination movement, and the promise of vaccines for cancer treatment.

In January 2019, vaccine hesitancy was named 1 of the top 10 threats to global health by the World Health Organization (WHO). According to WHO, addressing vaccine hesitancy requires not just an understanding of the magnitude of the problem, but also a diagnosis of the root causes, tailored evidence-based approaches to addressing hesitancy, and monitoring and evaluating the interventions.

View Resource

Conversations to Build Trust in Vaccination: A Training Module for Health Workers

This training module is intended to teach health workers how to encourage clients to have trust in vaccination.

Download

Social Media and Vaccine Hesitancy

The authors globally evaluate the effect of social media and online foreign disinformation campaigns on vaccination rates and attitudes towards vaccine safety.

View Resource

Best Practices for Planning a Vaccination Campaign for an Entire Population

These best practices of vaccination campaigns for an entire population have been developed from experiences of polio vaccination campaigns conducted in the Congo, Namibia and Tajikistan.

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Vaccine Acceptance is the Next Hurdle

Research has shown that it is not enough to provide information on vaccines to encourage their uptake. The WHO Technical Advisory Group (TAG) on Behavioural Insights and Sciences for Health has published a report outlining the factors that drive people’s behaviour when it comes to vaccines: an enabling environment, social influences, and motivation.

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What is the World Doing about COVID-19 Vaccine Acceptance?

Even before the COVID-19 crisis, the WHO declared vaccination hesitancy one of the Top 10 threats to global health in 2019. 

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Vaccine Confidence Project

This site serves as a collection of resources from around the world that can be used to gain further information about vaccines and their recommended usage.

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Vaccine Confidence: A Global Analysis Exploring Volatility, Polarization, and Trust

This study reports that there is growing evidence of vaccine delays or refusals due to a lack of trust in the importance, safety, or effectiveness of vaccines, alongside persisting access issues. Although immunization coverage is reported administratively across the world, no similarly robust monitoring system exists for vaccine confidence. In this study, vaccine confidence was mapped across 149 countries between 2015 and 2019.

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Vaccination Communication Strategies: What Have We Learned, and Lost, in 200 Years?

This study compares Australian government vaccination campaigns from two very different time periods, the early nineteenth century (1803–24) and the early twenty-first (2016).

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Report of the Sage Working Group on Vaccine Hesitancy

The SAGE Working Group on Vaccine Hesitancy developed a vaccine hesitancy measure, the Vaccine Hesitancy Scale (VHS). This scale has the potential to aid in the advancement of research and immunization policy but has not yet been psychometrically evaluated.

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COVID-19: Can Behavior Insights Address Vaccine Hesitancy and Increase Take-up?

In efforts to reduce infections by COVID-19, effective vaccines will only contribute to herd immunity if people accept them and follow the correct vaccination course. The take-up rate is a crucial variable to consider in the quest to achieve herd immunity.

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COVID-19 Vaccination Communication Toolkit

This informational guide presents six strategies for immunization coordinators to build vaccine confidence within their health system or clinic.

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Long-Term Care Facility Toolkit: Preparing for COVID-19 Vaccination at Your Facility

This toolkit provides long-term care facility (LTCF) administrators and clinical leadership with information and resources to help build vaccine confidence among healthcare personnel (HCP) and residents.

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COVID-19 Vaccination Communication

This report, which was developed in consultation with leading experts in social and behavioral sciences and public health, outlines evidence-informed communication strategies in support of national COVID-19 vaccine distribution efforts across federal agencies and their state and local partners.

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MEDBOX Vaccination and Strategy Toolbox

This toolbox offers close to 200 resources on vaccination, which the user can sort by language, country, and type of tool.

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Infographics on COVID-19 and Immunization

These infographics from the World Health Organization address the importance of continuing to obtain regular immunizations during the time of COVID-19. These are part of a series of infographics from WHO which can be found on the same page.

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Vaccine Hesitancy: An Overview on Parents' Opinions about Vaccination and Possible Reasons of Vaccine Refusal

Italy

Vaccine hesitancy has increased worldwide with a subsequent decreasing of vaccination rates and outbreaks of vaccine-preventable diseases (i.e. measles, poliomyelitis and pertussis) in several developed countries, including Italy.  

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HHS COVID-19 Public Education Campaign

United States

This is a description of a public campaign to encourage Americans to maintain protective practices and, eventually, to be vaccinated for COVID-19. 

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Tips for Professional Reporting on COVID-19 Vaccines

Journalists play a vital role in informing the public on science, specifically vaccine, developments, in an unprecedented period of scientific publishing. 

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Transforming Immunization Dialogue

This video is part of a package of materials, including other short videos, for health workers, called Interpersonal Communication for Immunization.

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Addressing Rumors or Myths and Role in Vaccine Safety Events

This video is part of a package of materials, including other short videos, for health workers, called Interpersonal Communication for Immunization.

View Resource

Increasing Immunization Uptake through a Rapid Surveillance and Response System Monitoring Trust

Trust is fundamental to the effectiveness of public health programs, including immunization, as it is associated with program adherence. Adherence, in turn, is essential for improving critical public health outcomes.

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COVID-19 Vaccine Communication Strategy, India

India

This communication strategy supports the COVID-19 vaccines rollout in India and seeks to disseminate timely, accurate and transparent information about the vaccine(s) to alleviate apprehensions about the vaccine, ensure its acceptance and encourage uptake.

View Resource
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