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Vaccine hesitancy around the globe: Analysis of three years of WHO/UNICEF Joint Reporting Form data-2015–2017
Abstract and Figures
In order to gather a global picture of vaccine hesitancy and whether/how it is changing, an analysis was undertaken to review three years of data available as of June 2017 from the WHO/UNICEF Joint Report Form (JRF) to determine the reported rate of vaccine hesitancy across the globe, the cited reasons for hesitancy, if these varied by country income level and/or by WHO region and whether these reasons were based upon an assessment. The reported reasons were classified using the Strategic Advisory Group of Experts (SAGE) on Immunization matrix of hesitancy determinants (www.who.int/immunization/sage/meetings/2014/october/SAGE_working_group_revised_report_vaccine_hesitancy.pdf). Hesitancy was common, reported by >90% of countries. The list of cited reasons was long and covered 22 of 23 WHO determinants matrix categories. Even the most frequently cited category, risk- benefit (scientific evidence e.g. vaccine safety concerns), accounted for less than one quarter of all reasons cited. The reasons varied by country income level, by WHO region and over time and within a country. Thus based upon this JRF data, across the globe countries appear to understand the SAGE vaccine hesitancy definition and use it to report reasons for hesitancy. However, the rigour of the cited reasons could be improved as only just over 1/3 of countries reported that their reasons were assessment based, the rest were opinion based. With respect to any assessment in the previous five years, upper middle income countries were the least likely to have done an assessment. These analyses provided some of the evidence for the 2017 Assessment Report of the Global Vaccine Action Plan recommendation that each country develop a strategy to increase acceptance and demand for vaccination, which should include ongoing community engagement and trust-building, active hesitancy prevention, regular national assessment of vaccine concerns, and crisis response planning (www.who.int/immunization/sage/meetings/2017/october/1_GVAP_Assessment_report_web_version.pdf).
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... These policies encompass a range of approaches, from those that allow for personal exemptions based on religious beliefs to those that exclusively accept medical exemptions and impose finan-cial penalties for non-compliance. Nevertheless, the implementation of mandatory vaccination programs does not necessarily result in an increase in vaccine uptake or acceptance (MacDonald et al. 2018;Shachar and Reiss 2020). As highlighted by Ward et al. (2022, p. 233) in their study about the introduction of the Health Pass in France, this measure "has encouraged vaccination of many who were hesitant or reluctant, but it has not reduced hesitancy itself". ...
... This correlation can be attributed to the fact that the primary characteristics of anti-vaccination arguments are not always aligned with traditional religious beliefs. As noted by Lane et al. (2018), globally the characteristics associated with vaccine hesitancy include -besides vaccine safety concerns, gender, culture, and socio-economic factors -religious stances. However, an examination of the relationship between religious affiliation and vaccination skepticism reveals that vaccine refusal is often a reflection of concerns about vaccine safety or individual beliefs "among a social network of people organized around a faith community, rather than theologically based objections per se" (Grabenstein, 2013(Grabenstein, , p. 2011. ...
This chapter is a contribution to the book "Pandemia e vaccinazioni Aspetti economici, sociali e politici nel caso del Covid-19" (ed. by Marco Giansoldati) and published by "Biblioteca della società aperta. Studi e ricerche" (Edizioni Università di Trieste). Here is the link to the book, available in open access: https://www.openstarts.units.it/handle/10077/37031
... The WHO [31,32], Emilie [33], and Louise [34] have all indicated that parental concerns about adverse events following immunization (AEFI) are one of the main reasons for hesitancy regarding childhood vaccinations. Moreover, MMR is the NIP vaccine [35]. ...
Objectives:
Our objectives were to evaluate the safety of the simultaneous vaccination of Japanese encephalitis attenuated live vaccine (JEV-L) and measles, mumps, and rubella combined attenuated live vaccine (MMR) in children and to provide a reference for the implementation of the strategy of simultaneous vaccination with the two vaccines.
Methods:
The data of adverse events following immunization (AEFI) and vaccination for JEV-L and MMR from 2020 to 2023 were extracted through the Guangdong Province Vaccine Distribution and Vaccination Management Information System and the Chinese National AEFI Information System (CNAEFIS). The inclusion criteria were that children were born after 1 October 2019, and received the first dose of JEV-L or MMR after 1 June 2020, in accordance with the starting age for vaccination (8 months). The study used the number of vaccine doses as the denominator to calculate and compare the reporting rates of cases and calculated the relative risk (RR) of adverse reactions and the 95% confidence interval (CI).
Results:
In Guangzhou, a total of 214,238 doses of JEV-L were administered to children. JEV-L and MMR were co-administered in 464,009 doses, and MMR was administered separately in 241,150 doses. The overall reporting incidence rates of AEFI (per 100,000 doses) for JEV-L, the simultaneous vaccination group, and MMR were 11.20, 53.02, and 60.96, respectively. Among children aged 8 months in Guangzhou, 57.98% (463,512/799,423) received the simultaneous administration of JEV-L and MMR. In the reported AEFI events, general reactions accounted for 87.50% in the JEV-L group, 88.21% in the simultaneous vaccination group, and 89.80% in the MMR separate group. The incidence rates of common adverse reactions were 9.80, 46.7, and 54.74, respectively. The incidence rates of rare adverse reactions were 0.93, 3.88, and 2.90, respectively. The reporting incidence rates of fever ≥38.6 °C after vaccination were 4.20, 16.16, and 17.83 for the JEV-L separate group, simultaneous vaccination group, and MMR separate group, respectively. There was a significant difference between the simultaneous vaccination group and the JEV-L separate group (RR = 3.848, 95% CI = 1.927, 7.683), while no significant difference was found compared with the MMR separate group (RR = 0.906, 95% CI = 0.623, 1.318). The simultaneous vaccination group showed no significant differences in the reporting incidence rates of local redness and induration compared with the two separate vaccination groups (RR = 1.385, 95% CI = 0.144, 13.315; RR = 0.390, 95% CI = 0.087, 1.743; RR = 0.520, 95% CI = 0.033, 8.314). No significant differences were found in the incidence rates of rare adverse reactions such as maculopapular rash, urticaria, and thrombocytopenic purpura.
Conclusions:
The AEFI reporting incidence rate for the first dose of the simultaneous vaccination of JEV-L and MMR in 8-month-old children in Guangzhou is between the rates of the two separate groups. Compared with the MMR separate group, the simultaneous vaccination group does not increase the risk of adverse reactions.
... While vaccination remains the most medically effective and cost-efficient strategy that prevents 2-3 million deaths annually [2,3] its uptake remains limited [4]. A study showed that more than 90 % of countries members of the World Health Organization (WHO) reported vaccine hesitancy in 2015-2017 [5]. ...
Parental vaccine hesitancy is a global public health issue that leads to lower immunization coverage among children. While vaccine mistrust is increased among racialized adults, whether parental vaccine hesitancy differs by ethnicity in the era of COVID-19 is unknown. Addressing these gaps in the literature, this study explores the factors influencing vaccine hesitancy among a racially diverse and representative sample of Canadian parents of children aged 0 to 12, comparing perspectives across different racial groups. An online survey was administered to a nationally representative sample of Arab, Asian, Black, Indigenous, White, and Mixed-race parents from October to November 2023. Data were collected on demographics, COVID-19 vaccine hesitancy, experience of major racial discrimination, conspiracy beliefs and health literacy. A total of 2528 parents (57.52 % women, 42.29 % men, and 0.20 % identified as non-binary gender) completed the survey. Significant mean differences in vaccine hesitancy were observed among racialized groups, F(7, 2520) = 3.89, p < .001, with Arab parents (M = 23.73, SD = 7.46) reporting higher hesitancy than White parents (M = 21.28, SD = 8.59). Younger participants (14-24 years) showed greater hesitancy (M = 23.98, SD = 8.22) than those aged 55+ (M = 20.26, SD = 7.83), F (4, 2523) = 2.84, p = .023. Regression analyses indicated that conspiracy beliefs (β = 0.48, p < .001) and racial discrimination (β = 0.09, p = .012) are key predictors of vaccine hesitancy. A significant interaction between conspiracy beliefs and discrimination was found among racialized groups (β = 0.24, p < .001). Based on these results, addressing vaccine hesitancy requires nuanced, participatory approaches that foster trust, counter misinformation, and acknowledge systemic racial inequities. As, health literacy, conspiracy beliefs, and racial discrimination significantly shape parental decisions, future policies must integrate culturally and racially tailored strategies to promote vaccination, ensuring that every child in Canada is protected.
... Concerns and hesitancy about vaccines are growing worldwide, and WHO identified it as one of the top ten global health threats in 2019 [10]. In many countries, misinformation and hesitancy about vaccination create fundamental barriers to achieving community coverage and immunity [11,12]. Vaccine acceptance is influenced by several factors, including knowledge of the potential for COVID-19 release, perceived safety of the vaccine, perceived effectiveness of the vaccine, perceived risk as well as negative perceptions, fear of transmission to relatives, fear of long-term side effects, and depression symptoms [11,13]. ...
... 3,4,5 An analysis of the three-year WHO/UNICEF (United Nations Children's Fund)Joint Reporting Form data (2015)(2016)(2017) found that vaccine hesitancy was common, with 90% of reporting countries detecting hesitancy. 6 Vaccination is one of the most cost-effective ways to prevent disease. Healthcare professionals remain the most trusted advisers and sources of influence on vaccine decisions and must be supported to provide reliable, credible information about vaccines. ...
Aim: This research aims to assess vaccine hesitancy among medical students. Method: This descriptive study was conducted with 615 students in years 1, 2, 3, 4, 5, and 6 at a medical faculty in Istanbul. The first nine questions of the online survey developed by the researchers focused on socio-demographic characteristics, while the next 14 questions were prepared to address vaccine hesitancy. A significance level of p < 0.05 was considered in all analyses. Results: The participants in the study were between the ages of 17 and 29; 58% were female. General vaccine hesitancy was observed in 7.6% of the students. The frequency of hesitancy regarding the COVID-19 (Coronavirus disease 2019) vaccine among the participants was 17.4%, and a higher rate of indecision regarding the COVID-19 vaccine was found (18.9%). The frequency of general vaccine hesitancy in preclinical students was higher than in clinical students (p < 0.05). Conclusions: In this study, COVID-19 vaccine acceptance rates were higher compared to the general population, and general vaccine hesitancy was significantly lower in clinical term students compared to preclinical students. Vaccine information and advocacy training starting from the first year of medical education could help future physicians guide society.
Vaccination hesitancy remains a prominent global health concern, as recognized by the World Health Organization (WHO). This quantitative study, conducted on a representative sample of the Belgian population ( n = 1,030), explores consumer segmentation concerning vaccination attitudes during the COVID-19 pandemic in 2021, identifying five distinct clusters. While 39.6% of the surveyed consumers broadly accepted the COVID-19 vaccine (Convinced Pro-Vaxxers), our analysis revealed that 17.1% were skeptical (Skeptics), 12.7% were fearful of the inoculation procedure (Fearful Doubters), and 7.1% were fully opposed to vaccination (Anti-Vaxxers). Nearly one in four participants (Indifferent Pro-Vaxxers) showed little interest in the pandemic yet remained largely favorable toward vaccination. The variation in cluster size, attitudes, beliefs, and sociodemographic traits highlights the complexity of vaccine hesitancy, indicating it is not a binary issue. These findings underscore the importance of tailored health communication and vaccination campaigns to address hesitancy and improve vaccine uptake.
Importance
Multiple studies have identified an association between COVID-19 vaccination and menstrual disturbances. Data on whether menstrual health is impacted by other vaccines are needed to counsel individuals about what to expect and to address vaccine hesitancy.
Objective
To assess the association of changes in length of the menstrual cycle with influenza vaccination, with or without concurrent receipt of a COVID-19 vaccine.
Design, Setting, and Participants
This global retrospective cohort study prospectively collected menstrual cycle data from April 25, 2023, to February 27, 2024 (4-5 cycles per individual), among international English-speaking users of a digital birth control application. Participants included individuals aged 18 to 45 years, not using hormonal contraception, and with average cycle lengths of 24 to 38 days in 3 consecutive cycles before receipt of vaccines.
Exposure
Seasonal influenza vaccination with or without concurrent receipt of COVID-19 vaccine.
Main Outcome and Measure
The primary outcome consisted of adjusted mean within-individual changes of menstrual cycle length assessed by vaccination group. Secondary analysis evaluated the phase of menstrual cycle at time of vaccination.
Results
A total of 1501 individuals met the inclusion criteria, of whom 791 were vaccinated for influenza only and 710 were concurrently vaccinated for influenza and COVID-19. By race and ethnicity, 1 participant (0.1%) was American Indian or Alaska Native; 10 (0.7%), Asian; 3 (0.2%), Black; 15 (1.0%), Hispanic or Latina; 1 (0.1%), Middle Eastern or North African; 368 (24.5%), White; and 19 (1.3%), other; and 1084 (72.2%), missing. Most of the cohort was younger than 35 years (1230 [82.0%]), had at least a college degree (1122 [74.8%]), and was located in the US or Canada (938 [62.5%]). Individuals vaccinated for influenza alone experienced an adjusted mean increase of 0.40 (95% CI, 0.08-0.72) days, while those vaccinated concurrently for influenza and COVID-19 experienced a mean increase of 0.49 (95% CI, 0.16-0.83) days ( P = .69 for difference between vaccine groups). A total of 37 individuals (4.7%) experienced a change in cycle length of at least 8 days with influenza vaccine only and 42 (5.9%) with concurrent receipt of both vaccines ( P = .28). In the postvaccination cycle, both vaccination groups returned to their prevaccination cycle lengths. Menstrual cycle changes occurred with vaccination in the follicular phase but not the luteal phase.
Conclusions and Relevance
In this cohort study of individuals with regular menstrual cycles, influenza vaccine given alone or in combination with a COVID-19 vaccine was associated with a small but temporary change in menstrual cycle length. These findings may help clinicians confirm the utility of vaccination for patients with concerns about menstrual adverse effects of vaccination.
This study aims to understand the perspectives and experiences of people in Alanya, Türkiye, who intentionally chose not to receive the COVID-19 vaccine. The study used Actor-Network Theory (ANT) as its methodological framework to clarify the causes of vaccine hesitancy. The primary justification for the preference for ANT lies in the multitude and intricate nature of actors within the network of vaccine hesitancy. Through a qualitative research design, the study conducted in-depth interviews with the individuals who intentionally chose not to receive the COVID-19 vaccine in Alanya. In the first phase, the text identified the key actors and intermediaries involved and how they participate in the COVID-19 vaccine hesitancy network. After analysing the key actors and intermediaries involved in the network of vaccine hesitancy, we attempted to identify the mediators that transform the meaning or elements that actors seek to convey. Identifying mediators helped us to examine how key actors and intermediaries participate in the network and around which realities they come together. In this aspect, we have identified four mediators when analysing the network of vaccine hesitancy in the context of ANT: laboratory, pandemic, media, and knowledge. Our findings identify the actors/actants that have come to the fore in the COVID-19 pandemic and played an active role in the vaccination process and reveal how they reinforce and complicate the network of vaccine hesitancy. Our article is a pioneering study in the field of medical sociology in terms of analysing the phenomenon of vaccine hesitancy using ANT.
Introduction
Vaccination has substantially reduced the spread and severity of infectious diseases. Despite its efficacy, vaccine hesitancy remains a global challenge, often linked to inadequate health literacy and unfavorable vaccine attitudes. Understanding the mechanisms through which health literacy influences vaccine-related attitudes is crucial because it could inform policy interventions aimed at fostering more favorable vaccine attitudes.
Method
The present cross-sectional study of Slovenian adults (n = 3,360) examined the impact of health literacy on vaccine attitudes, focusing on the mediating role of beliefs in vaccine myths and the moderating effects of gender, education, economic status, healthcare training, and self-rated health.
Results
Using mediation and moderated mediation models, we found that health literacy positively influences vaccine attitudes both directly and indirectly by reducing beliefs in myths. The relationship between health literacy and vaccine attitudes is moderated by healthcare training, with stronger positive effect among individuals with such training. Additionally, the negative effect of health literacy on beliefs in myths is stronger among individuals with higher education.
Discussion
Our findings indicate that broader educational inequalities should be addressed to ensure that the positive effect of health literacy on vaccine attitudes is distributed more equitably across groups with different educational levels and fields of expertise.
The Second Strategic Objective of the Global Vaccine Action Plan, “individuals and communities understand the value of vaccines and demand immunization as both their right and responsibility”, differs from the other five in that it does not focus on supply-side aspects of immunization programs but rather on public demand for vaccines and immunization services. This commentary summarizes the work (literature review, consultations with experts, and with potential users) and findings of the UNICEF/World Health Organization Strategic Objective 2 informal Working Group on Vaccine Demand, which developed a definition for demand and indicators related to Strategic Objective 2. Demand for vaccines and vaccination is a complex concept that is not external to supply systems but rather encompasses the interaction between human behaviors and system structure and dynamics.
Vaccine hesitancy has become the focus of growing attention and concern globally despite overwhelming evidence of the value of vaccines in preventing disease and saving the lives of millions of individuals every year.
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.
Two indicators to assess vaccine hesitancy were developed to capture its nature and scope at the national and subnational level to collect data in 2014: 1) The top 3 reasons for not accepting vaccines according to the national schedule in the past year and whether the response was opinion- or assessment-based and 2) Whether an assessment (or measurement) of the level of confidence in vaccination had taken place at national or subnational level in the previous 5 years.
The most frequently cited reasons for vaccine hesitancy globally related to (1) the risk-benefit of vaccines, (2) knowledge and awareness issues, (3) religious, cultural, gender or socio-economic factors. Major issues were fear of side effects, distrust in vaccination and lack of information on immunization or immunization services. The analysis revealed that 29% of all countries had done an assessment of the level of confidence in their country, suggesting that vaccine confidence was an issue of importance.
Monitoring vaccine hesitancy is critical because of its influence on the success of immunization programs. To our knowledge, the proposed indicators provide the first global snapshot of reasons driving vaccine hesitancy and depicting its widespread nature, as well as the extent of assessments conducted by countries.
The SAGE Working Group on Vaccine Hesitancy concluded that vaccine hesitancy refers to delay in acceptance or refusal of vaccination despite availability of vaccination services. Vaccine hesitancy is complex and context specific, varying across time, place and vaccines. It is influenced by factors such as complacency, convenience and confidence. The Working Group retained the term 'vaccine' rather than 'vaccination' hesitancy, although the latter more correctly implies the broader range of immunization concerns, as vaccine hesitancy is the more commonly used term. While high levels of hesitancy lead to low vaccine demand, low levels of hesitancy do not necessarily mean high vaccine demand. The Vaccine Hesitancy Determinants Matrix displays the factors influencing the behavioral decision to accept, delay or reject some or all vaccines under three categories: contextual, individual and group, and vaccine/vaccination-specific influences.
Copyright © 2015. Published by Elsevier Ltd.
Despite relatively high vaccination coverage rates in the European Region, vaccine hesitancy is undermining individual and community protection from vaccine preventable diseases. At the request of its European Technical Advisory Group of Experts on Immunization (ETAGE), the Vaccine-preventable Diseases and Immunization Programme of the WHO Regional Office for Europe (WHO/EURO) developed tools to help countries address hesitancy more effectively. The Guide to Tailoring Immunization Programmes (TIP), an evidence and theory based behavioral insight framework, issued in 2013, provides tools to (1) identify vaccine hesitant population subgroups, (2) diagnose their demand- and supply-side immunization barriers and enablers and (3) design evidence-informed responses to hesitancy appropriate to the subgroup setting, context and vaccine. The Strategic Advisory Group of Experts on Immunization (SAGE) through its Working Group on Vaccine Hesitancy has closely followed the development, implementation, use and evolution of TIP concluding that TIP, with local adaptation, could be a valuable tool for use in all WHO regions, to help address countries' vaccine hesitancy problems. The TIP principles are applicable to communicable, noncommunicable and emergency planning where behavioral decisions influence outcomes.
Copyright © 2015. Published by Elsevier Ltd.
For millennia, humans have sought and found purpose, solace, values, understanding, and fellowship in religious practices. Buddhist nuns performed variolation against smallpox over 1000 years ago. Since Jenner developed vaccination against smallpox in 1796, some people have objected to and declined vaccination, citing various religious reasons. This paper reviews the scriptural, canonical basis for such interpretations, as well as passages that support immunization. Populous faith traditions are considered, including Hinduism, Buddhism, Jainism, Judaism, Christianity, and Islam. Subjects of concern such as blood components, pharmaceutical excipients of porcine or bovine origin, rubella strain RA 27/3, and cell-culture media with remote fetal origins are evaluated against the religious concerns identified.
Although vaccination uptake is high in most countries, pockets of sub-optimal coverage remain posing a threat to individual and population immunity. Increasingly, the term 'vaccine hesitancy' is being used by experts and commentators to explain sub-optimal vaccination coverage. We contend that using this term to explain all partial or non-immunisation risks generating solutions that are a poor match for the problem in a particular community or population. We propose more precision in the term 'vaccine hesitancy' is needed particularly since much under-vaccination arises from factors related to access or pragmatics. Only with clear terminology can we begin to understand where the problem lies, measure it accurately and develop appropriate interventions. This will ensure that our interventions have the best chance of success to make vaccines available to those who want them and in helping those who are uncertain about their vaccination decision.
Vaccine hesitancy, refusal and access barriers: the need for clarity in terminology
- H Beford
- K Atwell
- M Danchin
- H Marshall
- P Corben
- J Leask
Beford H, Atwell K, Danchin M, Marshall H, Corben P, Leask J. Vaccine
hesitancy, refusal and access barriers: the need for clarity in
terminology. Vaccine 2017 Aug 19. pii: S0264-410X(17)31070-8.
http://doi.org/10.1016/j.