Immunization, Vaccines and Biologicals

Addressing Vaccine Hesitancy

Vaccine hesitancy is a complex and rapidly changing global problem that requires ongoing monitoring. WHO definition of vaccine hesitancy:

Vaccine hesitancy refers to delay in acceptance or refusal of vaccines despite availability of vaccination services. Vaccine hesitancy is complex and context specific varying across time, place and vaccines. It includes factors such as complacency, convenience and confidence.

Understanding hesitancy

Addressing vaccine hesitancy requires an understanding of the magnitude and setting of the problem, diagnosis of the root causes, tailored evidence-based strategies to address the causes, monitoring and evaluation to determine the impact of the intervention and whether vaccine acceptance has improved, and ongoing monitoring for possible recurrence of the problem.

When addressing vaccine hesitancy, it must be noted that there are many determinants of vaccine hesitancy. These determinants can be grouped into contextual, individual and group influences and vaccine/vaccination specific issues. Countries need to adequately assess which underlying determinant(s) is the factor driving vaccine hesitancy in their setting.

Resources for assessing and addressing hesitancy

A compendium of survey questions to assess the underlying determinant of vaccine hesitancy was developed by the SAGE Working Group (see Report below), though the need remains for countries to validate these questions in low, middle and high income settings. If doing so, findings should be shared to help inform future development of such tools.

Another useful tool is the WHO EUR Guide to Tailoring Immunization Program (TIP). The TIP framework helps to a) identify and prioritize vaccine hesitant populations and subgroups, b) diagnose the demand and supply–side barriers to vaccination in these populations, and c) design evidence–informed responses to vaccine hesitancy appropriate to the setting, context and hesitant population . This framework is currently being adapted for global use.

There is no single intervention strategy that addresses all instances of vaccine hesitancy. Based on the Systematic Review of Strategies to Address Vaccine Hesitancy, the most effective interventions addressing the outcome of vaccination uptake are multi-component interventions versus single-component. These interventions should be dialogue-based and directly targeted at the unvaccinated or under-vaccinated populations and the specific populations (e.g., local community, HCW).

The interventions should address the specific determinants underlying vaccine hesitancy. Strategies may include:

  • Engagement of religious or other influential leaders to promote vaccination in the community
  • Social mobilisation
  • Mass media
  • Improving convenience and access to vaccination
  • Mandating vaccinations / sanctions for non-vaccination
  • Employing reminder and follow-up
  • Communications training for HCW
  • Non-financial incentives
  • Aim to increase knowledge, awareness about vaccination

Considerations for countries

Countries need to take into consideration that in low vaccine uptake situations, where lack of available services is the major factor impairing adequate vaccination coverage, vaccine hesitancy can be present but is not the priority to address and should not be the focus of their resources.

Countries should incorporate a plan to measure and address vaccine hesitancy into their country’s immunization programme as part of good practice, using and validating the compendium of potential vaccine hesitancy survey questions as this facilitates inter-country comparisons.

Education and training of health care workers should be carried out to empower them to address vaccine hesitancy issues in patients and parents. In addition, vaccine hesitant behaviours within health care workers should be addressed. Relevant training, of nursing, medical and other health care professional students, needs to be included into academic curricula, as educating younger individuals about vaccines could shape future vaccine beliefs and behaviour.

As part of good immunization programme practice, civil society organizations, local communities and health care workers need to be involved in supporting vaccination programs, in enhancing demand for vaccination and in helping to address vaccine hesitancy depending upon the underlying factors.

Country information on vaccine hesitancy and lessons learned should be shared among member states. In addition National Immunization Technical Advisory Groups (NITAGs) may be a valuable resource to address vaccine hesitancy and should give consideration to issues of vaccine hesitancy in their country.

Based on the recommendations of the SAGE Working Group, efforts are now underway to define and develop any additional tools to help understand and develop interventions on hesitancy.

For more information, see the report of the WHO SAGE Vaccine Hesitancy Working Group:

Summary of WHO SAGE conclusions and recommendations on Vaccine Hesitancy


Related links

Survey questions

Last update:

7 June 2016 15:09 CEST