Context Matters: How to Research Vaccine Attitudes and Uptake after the COVID-19 Crisis

"The boom in research on vaccine attitudes and behaviors during the COVID-19 pandemic provides an important opportunity to advance knowledge on vaccination social science and public health."

The COVID-19 pandemic dramatically accelerated research on vaccine attitudes and uptake, a field that mobilises researchers from the social sciences and humanities as well as biomedical and public health disciplines. This perspective article assesses the development of the field of social science of immunisation during COVID-19, exploring progress while emphasising a lack of attention paid to national and local contexts. As the authors argue, this lack of contextual attention limits the progress of research and hinders our capacity to learn from the COVID-19 crisis. They outline three concrete responses.

To begin, the authors explore the history of research on vaccine attitudes and uptake, which includes opinion surveys conducted as far back as the 1930s. Academic interest in vaccine attitudes and behaviours has not only sprung organically from within the social science communities: It was fueled by renewed concern regarding infectious diseases in the public health community following epidemics. This real-world demand underscores the dynamic of the field's interdisciplinarity. In particular, the concept of vaccine hesitancy has helped to facilitate the circulation of ideas, stimulating debate between different research communities interested in vaccination attitudes and uptake. It helps vaccination social science to benefit from advances in broader domains of social and human sciences and vice versa.

During COVID-19, research on vaccine attitudes and behaviours ramped up, and many papers published in disciplinary and interdisciplinary journals in the social science and humanities stimulated debates on topics such as the circulation of disinformation and the expression of vaccine attitudes on social media. Many public health and biomedical journals also opened their pages to articles on social and human aspects of vaccination. Nevertheless, as the authors observe, "one important obstacle remains to the literature realizing its full potential: attention to national or even more local contexts."

Specifically, the authors argue that understanding vaccine attitudes and behaviours requires articulating structural and contextual factors - yet context plays a marginal role in most publications. Vaccine controversies vary greatly between countries and also over time, as policies and society evolve. How universal mechanisms unfold (or don't) in specific events and places depends upon local cultural, social, political, and policy contexts. However, most publications during COVID-19 might present the results of a questionnaire survey carried out in one country or another but barely mention contextual elements, such as previous vaccine controversies, health scandals, relations with public authorities, or issues relating to differential access to health in local populations (equity gaps for vulnerable groups). Another issue is that most data and scholarship emanate from high-income countries.

"How might we explain these failings to include context and to recognize and account for global diversity and complexity? One answer may lie in the publication formats and norms of many medical and interdisciplinary journals. These include stringent word limits and a tendency to apply epidemiological or medical modes of reasoning to social issues. But this also stems from a general tendency to focus on universal cognitive explanations of vaccine hesitancy."

Putting context at the centre "can bring further understanding of the local specificities of vaccination campaigns, of the place of vaccination within national public health, and of the complexities of scientific discourses and controversies surrounding vaccines. All are crucial dimensions influencing both collective and individual engagement with vaccines. To improve the integration of national and local contexts in the analysis of the COVID-19 experience and future vaccination campaigns," the authors suggest three pathways:

1. Building and recognising new publishing formats for reporting and synthesising studies at a country level - Researchers, universities, and funders will need to find ways to resource the work and ensure the professional recognition of those who produce valuable impact outside the peer-review process.
2. Establishing country-level interdisciplinary networks to connect research and praxis - Such networks, which already exist in some countries, can connect scholars who are focusing on individual behaviour with those who are working on broader context (media, policymaking, mobilisation, ethics), and likewise facilitate connections between those in the public health/biomedical disciplines and those in the social sciences and humanities.
3. Strengthening international comparative survey work by enhancing the focus on local contextual factors - Instruments could be developed that focus on public debate and discourse or consider how states create the conditions in which people do or do not vaccinate.

In conclusion: "it is crucial to capitalize on the lessons from the pandemic to better integrate social sciences and humanities expertise into public health and biomedical sciences. Research on the social aspects of vaccination should be informed by a larger reflection on equity in health, future health disaster preparedness, trust in science and information, adaptation to climate changes and many more of the current challenges the world is facing. Such research - done well and with close attention to the role of local and national contexts - can also contribute to resolving these challenges."