Since the introduction of the COVID-19 vaccine in the UK in December 2020, vaccine hesitancy has become a prevalent news subject and health concern. Described as a  behaviour where individuals are reluctant to accept vaccines, vaccine hesitancy was described as one of the 10 threats to global health by the WHO in 2019[1], and is even more prevalent now with the global COVID-19 pandemic bringing it to the forefront. However, vaccine hesitancy can be viewed as something which has ‘never gone away’ since the development of vaccines first started in the 18th century[2]. Social media has influenced recent ideas of vaccine hesitancy, producing stereotypes of vaccine hesitators as ‘crunchy’ and ‘hippie’. Furthermore, vaccine hesitancy is often mistakenly confused with anti-vaccinators, who insist that all vaccines are harmful without any discussion. 

Vaccine hesitancy can be witnessed in events happening today. The increase in measles outbreaks in the UK from the beginning of 2024 onwards was declared a national incident by the UK Health Security Agency[3]. Cases of measles which have increased alarmingly since the beginning of the year, with cases across Europe showing a similar trend[4]. This is due, in part, to increasing levels of unvaccinated children due to concerns about the MMR vaccine and its controversial (but incorrect) side effects. 

What is vaccine hesitancy?

Vaccine hesitancy is people who are wary, resistant, or otherwise unlikely or unwilling to receive vaccines. The 5Cs model of vaccine hesitancy describes the psychological effects which may predict vaccine hesitancy, which are summarised as ‘confidence, complacency, constraints, calculation, and collective responsibility’[5]. Although vaccine hesitancy has received recent attention, it started before the MMR and autism scare in 1998; Edward Jenner, the first person to try vaccination with small pox and cow pox, was ridiculed and his ideas rejected until people saw that they worked. This shows how vaccine hesitancy is a centuries-old phenomenon, and not new, although it has been exemplified by the recent COVID-19 vaccine. 

Although only a small fraction of the population are strongly against vaccines, a study of parents’ attitudes towards vaccinating their children revealed that much of the population is cautious towards vaccines. The study found that 20-30% of parents were classed as hesitant, 2-27% classed as ‘late or selective’ and less than 2% completely refusing vaccines for their children[6]. Vaccine hesitancy is not directly related to the uptake of vaccines[7], meaning that vaccine rates can remain high even when there is doubt present in the population receiving them. 

How does vaccine hesitancy differ from anti-vaccine ideas?

Vaccine hesitancy is a wariness towards vaccines, not an anti-vaccine stance. Anti-vaccinators often become very popular for their ‘exposal’ of the dangers of vaccines, without mentioning the huge benefit to society vaccine have through their reduction of deaths and serious health complications. As a contrast, vaccine hesitators may accept vaccines, but will be wary of them, for a multitude of reasons. Vaccine hesitancy can be shown to exist on a continuum, from complete acceptance at one end, to complete refusal at the other[8].

How should vaccine hesitancy be approached?

People who are wary of vaccines should not be discriminated against. In healthcare settings, these patients should be approached with caution, as the aim is not to put people further away from receiving vaccines. It is beneficial to provide accurate information which includes both positives and negatives of vaccines, such as potential harmful side effects, and not to use fear to coerce people into taking the vaccine. Speaking to hesitators in-person is seen as the most effective method, as it gives them a space to ask questions, and healthcare workers have been seen as a good link between health initiatives and the public. 

How is vaccine hesitancy dealt with in the media?

Vaccines are a ‘hot topic’ in the media in 2024. Vaccine hesitators are confused with anti-vaccine campaigners, when in reality they are hesitant of vaccines for other reasons and may not, or at all, be part of anti-vaccine groups. Recent legal cases of blood clot issues caused by the Astra-Zeneca vaccine in the UK which are now coming into light; these articles are careful to discuss the benefits of the vaccine (6 million lives saved globally in 1 year) against the risks (81 deaths in the UK linked to a reaction to the vaccine)[9].

How is vaccine hesitancy influenced by social factors? 

Research suggests that social norms influence influencing individuals’ perception of vaccines and their likelihood to receive them. The influence of gender, ethnicity, and factors such as political incline on vaccine uptake have been examined[10], and it has been found that people with a lower education rate and a lower income are less likely to accept vaccines[11]. This suggests that the socioeconomic status of a person influences whether they will be hesitant towards vaccines or not, and that vaccine hesitancy solutions should be targeted towards the areas where they will be the most effective. 

Where does global health come in?

Vaccines are a global health intervention, and are often distributed and supported by global health initiatives, particularly in third world countries. Although the chances of catching polio or smallpox are low, meningitis and other diseases are becoming more common, especially in university students. Understanding vaccine hesitancy allows for a greater understanding of the links between society, culture, and medicine. Medical and social anthropology can contribute greatly to improving the health and wellbeing of people around the globe, not just eradicating diseases. Understanding the social and cultural context of a person, and how this influences their decisions, can greatly improve the outcomes of global health initiatives, as well as improving the wellbeing of a person. 

[1] Rada Akbar (2019) Ten health issues WHO will tackle this year. Available at: https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019 (Accessed: 6 June 2024).

[2] Jacobson, R.M., St. Sauver, J.L. and Finney Rutten, L.J. (2015) ‘Vaccine Hesitancy’, Mayo Clinic Proceedings, 90(11), pp. 1562–1568. Available at: https://doi.org/10.1016/j.mayocp.2015.09.006.

[3] UK Health Security Agency (2024) National Measles Standard Incident - measles epidemiology (from October 2023), GOV.UK. Available at: https://www.gov.uk/government/publications/measles-epidemiology-2023/national-measles-standard-incident-measles-epidemiology-from-october-2023 (Accessed: 16 May 2024).

[4] BBC News (2024) ‘Measles: Why are cases rising and what is the MMR vaccine?’, 18 January. Available at: https://www.bbc.com/news/uk-england-birmingham-68007804 (Accessed: 6 June 2024).

[5] Betsch, C. et al. (2018) ‘Beyond confidence: Development of a measure assessing the 5C psychological antecedents of vaccination’, PLOS ONE, 13(12), p. e0208601. Available at: https://doi.org/10.1371/journal.pone.0208601.

[6] Leask, J. et al. (2012) ‘Communicating with parents about vaccination: a framework for health professionals’, BMC Pediatrics, 12(1), p. 154. Available at: https://doi.org/10.1186/1471-2431-12-154.

[7] Dubé, E. et al. (2013) ‘Vaccine hesitancy: An overview’, Human Vaccines & Immunotherapeutics, 9(8), pp. 1763–1773. Available at: https://doi.org/10.4161/hv.24657.

[8] Dubé, E. et al. (2013) ‘Vaccine hesitancy: An overview’, Human Vaccines & Immunotherapeutics, 9(8), pp. 1763–1773. Available at: https://doi.org/10.4161/hv.24657.

[9] Robert Mendick (2024) ‘AstraZeneca admits its Covid vaccine can cause rare side effect in court documents for first time’, The Telegraph, 28 April. Available at: https://www.telegraph.co.uk/news/2024/04/28/astrazeneca-admits-covid-vaccine-causes-rare-side-effect/ (Accessed: 16 May 2024).

[10] Jaffe, A.E. et al. (2022) ‘The role of perceived social norms in college student vaccine hesitancy: Implications for COVID-19 prevention strategies’, Vaccine, 40(12), pp. 1888–1895. Available at: https://doi.org/10.1016/j.vaccine.2022.01.038.

[11] Troiano, G. and Nardi, A. (2021) ‘Vaccine hesitancy in the era of COVID-19’, Public Health, 194, pp. 245–251. Available at: https://doi.org/10.1016/j.puhe.2021.02.025.