Vaccine Acceptance and Hesitancy in Public Health

Vaccine acceptance and hesitancy manifest as a spectrum of attitudes and behaviours that profoundly influence the success of immunisation programmes worldwide. Acceptance reflects the willingness to receive recommended vaccines, whereas hesitancy encompasses delay, doubt or refusal despite availability. Drivers operate at multiple levels: individual beliefs about personal risk and vaccine safety, social influences such as peer norms and health-care provider recommendations, contextual factors including policy frameworks and service accessibility, and structural determinants such as equity of access and cost. Psychological constructs—trust in institutions, perceived efficacy, fear of adverse effects and risk salience—interact with information environments shaped by traditional media and social platforms. Recent events have underscored how sociocultural dynamics, misinformation and waning confidence can lead to pockets of under-immunised populations and outbreaks of vaccine-preventable diseases. Conversely, tailored interventions that address specific drivers—through transparent communication, community engagement and incentive design—can bolster uptake and reinforce herd immunity. The global significance of understanding acceptance and hesitancy lies in optimising public health strategies, informing policy on immunisation scheduling, and ensuring resilience against emerging infectious threats.

Research from Nature Portfolio

Large-scale experimental work in a European setting has examined the unintended consequences of offering monetary rewards for vaccination. Findings indicate that financial incentives for initial uptake do not erode trust, moral norms or future vaccine decisions, challenging concerns that payments undermine intrinsic motivation and public confidence. The study integrates randomised exposure to different incentive levels with population-wide vaccination records and attitudinal surveys, demonstrating no measurable negative impact on subsequent immunisation behaviour or perceptions of safety.

Complementing behavioural economics approaches, an investigation into psychological profiles across two Western populations has delineated factors associated with reluctance or refusal of a novel vaccine. By analysing nationally representative survey data, researchers identified that mistrust of authoritative sources, limited information seeking via traditional channels and distinct sociodemographic correlates underpin hesitancy. The study outlines a framework for segmenting populations by psychological antecedents, offering actionable insights for bespoke communication strategies and targeted public health campaigns.

Vaccine Acceptance and Hesitancy in Public Health publication trend

The graph below shows the total number of articles in vaccine acceptance and hesitancy in public health across all publications each year (not limited to Nature Index journals).

Technical terms

Vaccine hesitancy: Delay in acceptance or refusal of vaccinations despite their availability, influenced by confidence, complacency and convenience.

Vaccine acceptance: Readiness to receive recommended vaccines when offered, reflecting positive attitudes and perceived benefits.

Confidence: Trust in the safety, efficacy and delivery systems of vaccination programmes.

Complacency: Low perceived risk of vaccine-preventable diseases, leading to undervaluing immunisation.

Financial incentives: Monetary rewards provided to individuals to encourage timely vaccination uptake.

Psychological antecedents: Mental and emotional factors—such as trust, perceptions and motivations—that precede vaccination behaviour.

References

1. Financial incentives for vaccination do not have negative unintended consequences. Nature (2023).
2. Psychological characteristics associated with COVID-19 vaccine hesitancy and resistance in Ireland and the United Kingdom. Nature Communications (2021).
3. Mapping global trends in vaccine confidence and investigating barriers to vaccine uptake: a large-scale retrospective temporal modelling study. The Lancet (2020).
4. Strategies for addressing vaccine hesitancy – A systematic review. Vaccine (2015).
5. Vaccine hesitancy: Definition, scope and determinants. Vaccine (2015).