The State of Vaccine Confidence 2016: Global Insights Through a 67-Country Survey
Open accessAbstract
BACKGROUND: Public trust in immunization is an increasingly important global health issue. Losses in confidence in vaccines and immunization programmes can lead to vaccine reluctance and refusal, risking disease outbreaks and challenging immunization goals in high- and low-income settings. National and international immunization stakeholders have called for better monitoring of vaccine confidence to identify emerging concerns before they evolve into vaccine confidence crises. METHODS: We perform a large-scale, data-driven study on worldwide attitudes to immunizations. This survey - which we believe represents the largest survey on confidence in immunization to date - examines perceptions of vaccine importance, safety, effectiveness, and religious compatibility among 65,819 individuals across 67 countries. Hierarchical models are employed to probe relationships between individual- and country-level socio-economic factors and vaccine attitudes obtained through the four-question, Likert-scale survey. FINDINGS: Overall sentiment towards vaccinations is positive across all 67 countries, however there is wide variability between countries and across world regions. Vaccine-safety related sentiment is particularly negative in the European region, which has seven of the ten least confident countries, with 41% of respondents in France and 36% of respondents in Bosnia & Herzegovina reporting that they disagree that vaccines are safe (compared to a global average of 13%). The oldest age group (65+) and Roman Catholics (amongst all faiths surveyed) are associated with positive views on vaccine sentiment, while the Western Pacific region reported the highest level of religious incompatibility with vaccines. Countries with high levels of schooling and good access to health services are associated with lower rates of positive sentiment, pointing to an emerging inverse relationship between vaccine sentiments and socio-economic status. CONCLUSIONS: Regular monitoring of vaccine attitudes - coupled with monitoring of local immunization rates - at the national and sub-national levels can identify populations with declining confidence and acceptance. These populations should be prioritized to further investigate the drivers of negative sentiment and to inform appropriate interventions to prevent adverse public health outcomes.
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Earlier studies revealed regional variability in perceiving the safety and effectiveness of vaccination.
“Earlier studies that assessed attitudes towards vaccines revealed the existence of regional variability in perceiving the safety and effectiveness of vaccination [12,26,27].”
From COVID-19 Vaccine Hesitancy Worldwide: A Concise Systematic Review of Vaccine Acceptance Rates (2021) · cites this paper as [27]
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- Authors
- Larson, H. J., de Figueiredo, A., Xiahong, Z., Schulz, W. S., Verger, P., Johnston, I. G., Cook, A. R., & Jones, N. S.
- Affiliations
- University of Washington (US)
- London School of Hygiene & Tropical Medicine (GB)
- Inserm (FR)
- University of Birmingham (GB)
- National University of Singapore (SG)
- Imperial College London (GB)
- Corresponding author
- Larson, Heidi J.
- Venue
- EBioMedicine
- Publisher
- Elsevier BV
- Published
- 2016-10
- Volume
- 12
- Pages
- 295-301
- ISSN
- 2352-3964 (ISSN-L)
- PMC
- PMC5078590
- OpenAlex
- W2519901476
- Cited by
- 1,264
- References
- 33
- Citations by year
- 2026: 75 · 2025: 104 · 2024: 104 · 2023: 177 · 2022: 186 · 2021: 236 · 2020: 142 · 2019: 106 · 2018: 78 · 2017: 50 · 2016: 6
- FWCI
- 105.61
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- EBioMedicine (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- HAL (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, cc-by-nc-nd)
- Spiral (Imperial College London) (submittedVersion, other-oa)
- Funders
- EPSRC (EP/N014529/1, EP/I005986/1)
- Topics
- Social Sciences › Health › Vaccine Coverage and Hesitancy
- Social Sciences › Sociology and Political Science › Risk Perception and Management
- Social Sciences › Sociology and Political Science › Misinformation and Its Impacts
- Keywords
- vaccine confidence, vaccine hesitancy, vaccine refusal, vaccine safety beliefs, vaccine effectiveness perception, educational attainment, health care access, cross-national comparison
- MeSH terms
- Geography, Humans, Immunization, Population Surveillance, Socioeconomic Factors, Vaccination, Vaccines, Global Health, Odds Ratio, History, 21st Century
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