Review
Attitudes to vaccination: A critical review

https://doi.org/10.1016/j.socscimed.2014.04.018Get rights and content
Under a Creative Commons license
open access

Highlights

  • Coverage rates are likely to underestimate the challenge of sustaining vaccination.

  • Hesitancy is prevalent and includes people who have not yet rejected vaccination.

  • Reasons for hesitancy include mistrust in institutions related to vaccination.

  • Physicians report challenges (time and knowledge) for building trust with patients.

  • Both on-line and off-line presence will be needed in efforts to re-build trust.

Abstract

This paper provides a consolidated overview of public and healthcare professionals' attitudes towards vaccination in Europe by bringing together for the first time evidence across various vaccines, countries and populations. The paper relies on an extensive review of empirical literature published in English after 2009, as well as an analysis of unpublished market research data from member companies of Vaccines Europe. Our synthesis suggests that hesitant attitudes to vaccination are prevalent and may be increasing since the influenza pandemic of 2009. We define hesitancy as an expression of concern or doubt about the value or safety of vaccination. This means that hesitant attitudes are not confined only to those who refuse vaccination or those who encourage others to refuse vaccination. For many people, vaccination attitudes are shaped not just by healthcare professionals but also by an array of other information sources, including online and social media sources. We find that healthcare professionals report increasing challenges to building a trustful relationship with patients, through which they might otherwise allay concerns and reassure hesitant patients. We also find a range of reasons for vaccination attitudes, only some of which can be characterised as being related to lack of awareness or misinformation. Reasons that relate to issues of mistrust are cited more commonly in the literature than reasons that relate to information deficit. The importance of trust in the institutions involved with vaccination is discussed in terms of implications for researchers and policy-makers; we suggest that rebuilding this trust is a multi-stakeholder problem requiring a co-ordinated strategy.

Keywords

Europe
Vaccination
Immunisation
Public health
Choice
Attitude
Perception
Hesitancy

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