Paper: Vaccine hesitancy: Definition, scope and determinants

 Vaccine hesitancy: Definition, scope and determinants

MacDonald, N. E. (2015). Vaccine hesitancy: Definition, scope and determinants. Vaccine, 33(34), 4161-4164.

https://www.sciencedirect.com/science/article/pii/S0264410X15005009

Abstract

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

Definition

While acceptance of vaccination is the norm in the majority of populations globally, a smaller number refuse some vaccines but agree to others and some delay vaccination or accept vaccination but are unsure in doing so. Hesitancy is thus set on a continuum between those that accept all vaccines with no doubts, to complete refusal with no doubts, with vaccine hesitant individuals the heterogeneous group between these two extremes (Fig. 1). While recognizing that hesitant individuals encompass a wide range of people who differ from the very small percentage who refuse all vaccinations and have no doubts about doing this [4,5], the WG concluded that defining vaccine hesitancy on the continuum was not sufficient as it neither defined the scope nor implied the range of factors that influence hesitancy.

Fig. 1. The continuum of vaccine hesitancy between full acceptance and outright refusal of all vaccines.

According to the SAGE Working Group on Vaccine Hesitancy defines vaccine hesitancy is 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 and influenced by some factors, including complacency, convenience and confidence.

Acceptance of vaccinations an outcome behavior resulting from a complex decision-making process that can be potentially influenced by a wide range of factors. 

Review of these models confirmed the complexity of vaccine hesitancy and its determinants. The “3 Cs” model, first proposed to the WHO EURO Vaccine Communications Working Group in 2011 [9], highlights three categories; complacency, convenience and confidence (Fig. 2). As this model was viewed as being the most readily understandable, the concepts were incorporated in the definition.

Fig. 2. “Three Cs” model of vaccine hesitancy

Vaccination complacency exists where perceived risks of vaccine-preventable diseases are low and vaccination is not deemed a necessary preventive action. Complacency about a particular vaccine or about vaccination in general is influenced by many factors, including other life/health responsibilities that may