Vaccine Hesitancy: Towards a Better Understanding of Drivers and Barriers to Awareness, Acceptance and Activation

This special issue of Vaccine, stemming from an annual meeting on vaccine confidence and coverage, builds on an increasing body of empirical evidence seeking to identify the determinants of vaccine acceptance and uptake. It also echoes changes in this field, by moving beyond understanding to action, highlighting a number of social and behaviour change interventions that have been designed and tested for impact with regard to vaccine hesitancy.

The opening editorial highlights the key points from the contributing articles and their implications for designing effective communication and intervention strategies to increase vaccine acceptance and uptake. Below are some excerpts from this editorial:

1. "Communicating your reasons are not enough:...The research included in this issue highlights that vaccine hesitancy has numerous possible demographic and socio-psychological root causes, many of which are not knowledge-related. The development of effective strategies to sustain trust in vaccination programs requires an understanding of the particular social and psychological factors that determine the vaccination decisions of different populations with different vaccines..."
2. "Saying it is not enough: Target your communications to the needs of your audience. Communication is important to sustaining uptake in any vaccination program, and while the content should be evidence-based, the development and implementation of communication is not always grounded in communication science principles. As a result, when vaccination communication strategies are tested for efficacy in terms of intentions to vaccinate they may often be ineffective, or may even backfire..."
3. "Communicating to people is not enough: Listen to and engage healthcare professionals [HCPs] too....While HCPs are usually the most trusted source of information on vaccines, they themselves may be unsure about vaccination or vaccination conversations with their patients....Equipping HCPs with tools to communicate with their patients may also contribute to establish a more trusting and constructive dialogue..."
4. "Communicating is not enough: Design culturally targeted interventions to improve access to vaccines" - Vaccine hesitancy is only one possible determinant of under-vaccination.

Table of Contents (many, but not all, of the articles are open access):

• Strategies to increase vaccine acceptance and uptake: From behavioral insights to context-specific, culturally-appropriate, evidence-based communications and interventions - Angus Thomson, Gaëlle Vallée-Tourangeau, L. Suzanne Suggs. Pages 6457-6458 [Editorial]
• [Research article] 'Hesitant compliers': Qualitative analysis of concerned fully-vaccinating parents - Stephanie L. Enkel, Katie Attwell, Thomas L. Snelling, Hayley E. Christian. Pages 6459-6463 [Research article]
• What is 'confidence' and what could affect it?: A qualitative study of mothers who are hesitant about vaccines - Judith A. Mendel-Van Alstyne, Glen J. Nowak, Ann L. Aikin. Pages 6464-6472 [Research article]. See a CI summary here.
• Vaccine decision-making begins in pregnancy: Correlation between vaccine concerns, intentions and maternal vaccination with subsequent childhood vaccine uptake - M.H. Danchin, J. Costa-Pinto, K. Attwell, H. Willaby, K. Wiley, M. Hoq, J. Leask, K.P. Perrett, Jacinta O'Keefe, M.L. Giles, H.Marshall. Pages 6473-6479 [Research article]. See a CI summary here.
• Sharing knowledge about immunisation (SKAI): An exploration of parents’ communication needs to inform development of a clinical communication support intervention - Nina J. Berry, Margie Danchin, Lyndal Trevena, Holly O. Witteman, Paul Kinnersley, Tom Snelling, Penelope Robinson, Julie Leask. Pages 6480-6490 [Research article]. See a CI summary here.
• Innovative vaccine delivery strategies in response to a cholera outbreak in the challenging context of Lake Chilwa. A rapid qualitative assessment - Leonard W. Heyerdahl, Bagrey Ngwira, Rachel Demolis, Gabriel Nyirenda, Maurice Mwesawina, Florentina Rafael, Philippe Cavailler, Jean Bernard Le Gargasson, Martin A. Mengel, Bradford D. Gessner, Elise Guillermet. Pages 6491-6496 [Research article]. See a CI summary here.
• A rapid qualitative assessment of oral cholera vaccine anticipated acceptability in a context of resistance towards cholera intervention in Nampula, Mozambique - Rachel Démolis, Carlos Botão, Léonard W. Heyerdahl, Bradford D. Gessner, Philippe Cavailler, Celestino Sinai, Amílcar Magaço, Jean-Bernard Le Gargasson, Martin Mengel, Elise Guillermet. Pages 6497-6505 [Research article]. See a CI summary here.
• Hearts, minds, nudges and shoves: (How) can we mobilise communities for vaccination in a marketised society? - Katie Attwell, David T. Smith. Pages 6506-6508 [Discussion]
• Lessons from an online vaccine communication project - Gary Finnegan, Daphne Holt, Peter M. English, Steffen Glismann, Angus Thomson, David M. Salisbury, Hugues Bogaerts, Paolo Bonanni. Pages 6509-6511 [Discussion]
• Flu vaccination communication in Europe: What does the government communicate and how? - Anne Wiebke Ohlrogge, L. Suzanne Suggs. Pages 6512-6519 [Research article]
• Identification of preliminary core outcome domains for communication about childhood vaccination: An online Delphi survey - Jessica Kaufman, Rebecca Ryan, Simon Lewin, Xavier Bosch-Capblanch, Claire Glenton, Julie Cliff, Angela Oyo-Ita, Artur Manuel Muloliwa, Afiong Oku, Heather Ames, Gabriel Rada, Yuri Cartier, Sophie Hill. Pages 6520-6528 [Research article]. See a CI summary here.
• Vaccine hesitancy communication: What counts as evidence - John Parrish-Sprowl. Pages 6529-6530 [Research article]
• Midwives' attitudes, beliefs and concerns about childhood vaccination: A review of the global literature - K. Attwell, K.E. Wiley, C. Waddington, J. Leask, T. Snelling. Pages 6531-6539 [Review article]. See a CI summary here.
• Motors of influenza vaccination uptake and vaccination advocacy in healthcare workers: Development and validation of two short scales - Gaëlle Vallée-Tourangeau, Marianne Promberger, Karis Moon, Ana Wheelock, Miroslav Sirota, Christine Norton, Nick Sevdalis. Pages 6540-6545 [Research article]. See a CI summary here.
• Motors of influenza vaccination uptake and vaccination advocacy in healthcare workers: A comparative study in six European countries - George Kassianos, Ernest Kuchar, Aneta Nitsch-Osuch, Jan Kyncl, Andrey Galev, Isme Humolli, Oana Falup-Pecurariu, Angus Thomson, Christina Klein, Gaëlle Vallée-Tourangeau. Pages 6546-6552 [Research article]
• Motivational interviewing: A promising tool to address vaccine hesitancy - Arnaud Gagneur, Virginie Gosselin, Ève Dubé. Pages 6553-6555 [Discussion]. See a CI summary here.
• Vaccine hesitancy, refusal and access barriers: The need for clarity in terminology - Helen Bedford, Katie Attwell, Margie Danchin, Helen Marshall, Paul Corben, Julie Leask. Pages 6556-6558 [Research article]. See a CI summary here.
• Factors associated with routine childhood vaccine uptake and reasons for non-vaccination in India: 1998–2008 - Mark Rohit Francis, Hanna Nohynek, Heidi Larson, Vinohar Balraj, Venkata Raghava Mohan, Gagandeep Kang, J. Pekka Nuorti. Pages 6559-6566 [Research article]. See a CI summary here.
• A cluster randomized trial to determine the effectiveness of a novel, digital pendant and voice reminder platform on increasing infant immunization adherence in rural Udaipur, India - Ruchit Nagar, Preethi Venkat, Logan D. Stone, Kyle A. Engel, Praneeth Sadda, Mohammed Shahnawaz. Pages 6567-6577 [Research article]. See a CI summary here.