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Cited by 530Vaccine Coverage and HesitancyCervical Cancer and HPV ResearchRisk Perception and Management

Vaccine hesitancy around the globe: Analysis of three years of WHO/UNICEF Joint Reporting Form data-2015–2017

Open access
Lane, Sarah, MacDonald, Noni E., Marti, Melanie, Dumolard, Laure·2018·Vaccine
DOI 10.1016/j.vaccine.2018.03.063PMC PMC5999354
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Abstract

In order to gather a global picture of vaccine hesitancy and whether/how it is changing, an analysis was undertaken to review three years of data available as of June 2017 from the WHO/UNICEF Joint Report Form (JRF) to determine the reported rate of vaccine hesitancy across the globe, the cited reasons for hesitancy, if these varied by country income level and/or by WHO region and whether these reasons were based upon an assessment. The reported reasons were classified using the Strategic Advisory Group of Experts (SAGE) on Immunization matrix of hesitancy determinants (www.who.int/immunization/sage/meetings/2014/october/SAGE_working_group_revised_report_vaccine_hesitancy.pdf). Hesitancy was common, reported by >90% of countries. The list of cited reasons was long and covered 22 of 23 WHO determinants matrix categories. Even the most frequently cited category, risk- benefit (scientific evidence e.g. vaccine safety concerns), accounted for less than one quarter of all reasons cited. The reasons varied by country income level, by WHO region and over time and within a country. Thus based upon this JRF data, across the globe countries appear to understand the SAGE vaccine hesitancy definition and use it to report reasons for hesitancy. However, the rigour of the cited reasons could be improved as only just over 1/3 of countries reported that their reasons were assessment based, the rest were opinion based. With respect to any assessment in the previous five years, upper middle income countries were the least likely to have done an assessment. These analyses provided some of the evidence for the 2017 Assessment Report of the Global Vaccine Action Plan recommendation that each country develop a strategy to increase acceptance and demand for vaccination, which should include ongoing community engagement and trust-building, active hesitancy prevention, regular national assessment of vaccine concerns, and crisis response planning (www.who.int/immunization/sage/meetings/2017/october/1_GVAP_Assessment_report_web_version.pdf).

AI snapshot

Written from the paper’s full text.

TL;DR

This analysis of three years of WHO/UNICEF Joint Reporting Form data (2014–2016) found vaccine hesitancy reported by the majority of countries, with reasons varying by country income level and WHO region. Most cited reasons were based on opinion rather than assessment, and only about one-third of countries reported having assessed hesitancy in the previous five years.

Key findings

  • Countries reporting no vaccine hesitancy remained low and consistent: 12 countries (6%) in 2014, 14 (7%) in 2015, and 14 (7%) in 2016.
  • Across 1,110 reasons cited over three years, the top three global reasons were consistently risk–benefit/scientific evidence (22%, 23%, 23%), lack of knowledge and awareness (15%, 13%, 10%), and religion/culture/gender/socioeconomic issues (10%, 9%, 12%).
  • Reasons were predominantly based on opinion rather than assessment: only 36% (50/141) in 2014, 39% (58/150) in 2015, and 38% (57/152) in 2016 reported reasons based on an assessment.
  • Reported assessments of vaccine hesitancy in the previous five years were 29% (56/194) in 2014, 36% (69/194) in 2015, and 33% (63/194) in 2016, with variation by WHO region and country income level.

Methods

  • The study analyzed WHO/UNICEF Joint Reporting Form data for 2014, 2015, and 2016, following methods used by Marti et al. for the 2014 analysis.
  • Responses were categorized using the SAGE Working Group on Vaccine Hesitancy determinants matrix by the same two reviewers for all three years, with a third reviewer consulted for discrepancies.
  • Data were compiled in Microsoft Excel and analyzed in SPSS; income groupings used World Bank Development Indicators, and population data used United Nations Population Data from July 2017.

Limitations

  • The paper states that some cited reasons fit more than one matrix category, and imprecision or paucity of information made category placement challenging.
  • The paper states that classification may have been subject to personal perception, though this was mitigated by independent vetting by two authors and a compiled list to increase consistency; it also notes that limited country assessments meant reasons were predominately based on impressions of JRF completers rather than direct measurements.
  • The paper states that religious reasons may not reflect religious teachings but safety or other concerns, so some responses placed in that category might have fit risk–benefit if more information had been provided; the text also makes evident that 2016 data were incomplete as of June 30, 2017, and that assessment type was not analyzed due to lack of data.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.vaccine.2018.03.063

Cites

9 of 9 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 3 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The top three categories for most cited reasons globally remained relatively consistent over the three years.

    “The top three categories for most cited reasons globally remained relatively consistent over the three years but varied by country income level and by region, emphasizing that hesitancy is not uniform.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The JRF responses provided by countries accurately reflect the actual reasons for vaccine hesitancy in those countries.
    • Rests on an assumption: The top three reasons reported by countries are the most important reasons for vaccine hesitancy in those countries.
  • Findingown data

    Only a small number of responses did not fit into a matrix determinant category: 3.7% in 2014, 4.3% in 2015, and 6.5% in 2016.

    “Only a small number of responses did not fit into a matrix determinant category in each of the three years; 3.7% in 2014, 4.3% in 2015 and 6.5% in 2016.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The JRF responses provided by countries accurately reflect the actual reasons for vaccine hesitancy in those countries.
  • Findingown data

    In 2014 and 2015, for countries that reported having done an assessment, design of vaccination program/mode of delivery was in the top three reasons, along with risk-benefit (scientific evidence) and lack of knowledge and awareness of vaccination.

    “In 2014 and 2015, for those who reported having done an assessment design of vaccination program/mode of delivery was in the top three, i.e. a difference, along with risk–benefit (scientific evidence) and lack of knowledge and awareness of vaccination for countries.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The JRF responses provided by countries accurately reflect the actual reasons for vaccine hesitancy in those countries.
    • Rests on an assumption: The top three reasons reported by countries are the most important reasons for vaccine hesitancy in those countries.
  • Findingown data

    In lower middle income countries, the change in Knowledge/Awareness as a cited reason was less extreme: 17% in 2014, 21% in 2015, and 15% in 2016.

    “In lower middle income countries the change was less extreme; 17% in 2014, 21% in 2015 and 15% in 2016.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The JRF responses provided by countries accurately reflect the actual reasons for vaccine hesitancy in those countries.
    • Rests on an assumption: The top three reasons reported by countries are the most important reasons for vaccine hesitancy in those countries.
  • Findingown data

    In upper middle income countries, risk/benefit (scientific evidence) was the most commonly cited reason across all three years with only slight changes: 19%, 19%, and 23%.

    “In upper middle income countries risk/benefit (scientific evidence) was the most commonly cited reason across all three years with only slight changes; 19%, 19% and 23%.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The JRF responses provided by countries accurately reflect the actual reasons for vaccine hesitancy in those countries.
    • Rests on an assumption: The top three reasons reported by countries are the most important reasons for vaccine hesitancy in those countries.
  • May combine two claims. 26
  • Classified as probably not a substantial claim. 8

  • May combine two claims.

    Findingown data

    Response rates to the first vaccine indicator question were lower than overall JRF response rates but increased each year: 73% (141/194) in 2014, 77% (150/194) in 2015, and 78% (152/194) in 2016.

    “However, the response rates to the first vaccine indicator question were lower but increased each year; 2014 73% (141/194), 2015 77% (150/194) and 2016 78% (152/194).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The countries that responded to the JRF are representative of all WHO Member States for the purpose of estimating global vaccine hesitancy.

  • May combine two claims.

    Findingown data

    The rate of assessments of vaccine hesitancy varied across the six WHO regions and by country income level.

    “The rate of assessments varied across the six WHO regions. (Table 2) and by country income level (Table 3).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The countries that responded to the JRF are representative of all WHO Member States for the purpose of estimating global vaccine hesitancy.

  • May combine two claims.

    Findingown data

    In 2016, the Eastern Mediterranean Region and South East Asia Region reported 'no vaccine hesitancy' relatively more often than other regions: 4/21 (19%) countries from EMR and 4/11 (36%) from SEAR.

    “More recently i.e. in 2016, the Eastern Mediterranean Region (EMR) and South East Asia Region (SEAR) reported “no vaccine hesitancy” relatively more often than in other regions e.g. 4/21 (19%) countries from EMR and 4 /11 (36%) from SEAR.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The countries that responded to the JRF are representative of all WHO Member States for the purpose of estimating global vaccine hesitancy.

  • May combine two claims.

    Findingown data

    The top three reasons for vaccine hesitancy varied by WHO region; the overall top three reasons were not necessarily the top three in every region nor in the same order in all regions where they appeared.

    “Fig. 4 shows that the top three reasons for vaccine hesitancy varied by WHO region. The overall top three reasons (risk/benefit (scientific evidence), knowledge/awareness and Religion/culture/socio-economic) were not necessarily the top three in every region nor in the same order in all regions where these appeared.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The JRF responses provided by countries accurately reflect the actual reasons for vaccine hesitancy in those countries.
    • Rests on an assumption: The top three reasons reported by countries are the most important reasons for vaccine hesitancy in those countries.

  • May combine two claims.

    Findingreasoning

    Discussion with Country A revealed that an intervention to address the halal vaccine concern had been carried out and an assessment had then shown that this was no longer a major concern.

    “Discussion with the country revealed that an intervention to address the halal vaccine concern had been carried out and an assessment had then shown that this was no longer a major concern.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The JRF responses provided by countries accurately reflect the actual reasons for vaccine hesitancy in those countries.

  • May combine two claims.

    Findingown data

    In 2016, 145 (79%) countries out of the 184 WHO Member States that submitted their JRF responded to the second indicator; this was similar for 2015 (80%) and a slight increase from 2014 (77%).

    “In 2016 145 (79%) countries out of the 184 WHO Member States that submitted their JRF responded to the second indicator. This was similar for 2015 (80%) and a slight increase from 2014 (77%).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The countries that responded to the JRF are representative of all WHO Member States for the purpose of estimating global vaccine hesitancy.

  • May combine two claims.

    Findingown data

    In 2015, the top three reasons in no-assessment countries included risk-benefit and religion, and the third reason was influential leaders, immunization programme gatekeepers and anti- or pro-vaccination lobbies.

    “In 2015, the top three reasons in no assessment countries included the same first two (risk benefit and religion) but the third reason cited was influential leaders, immunization programme gatekeepers and anti-or pro-vaccination lobbies.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The JRF responses provided by countries accurately reflect the actual reasons for vaccine hesitancy in those countries.
    • Rests on an assumption: The top three reasons reported by countries are the most important reasons for vaccine hesitancy in those countries.

  • May combine two claims.

    Findingown data

    In 2016, there were no differences in the top three reasons cited between assessment and no-assessment countries, and both groups cited the same top three reasons as overall.

    “In 2016, there were no differences and the top three reasons cited in both sets of countries were the same three as noted above.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The JRF responses provided by countries accurately reflect the actual reasons for vaccine hesitancy in those countries.
    • Rests on an assumption: The top three reasons reported by countries are the most important reasons for vaccine hesitancy in those countries.

  • May combine two claims.

    Findingown data

    The frequency of risk-benefit (scientific evidence) as a cited reason slightly increased from 22% in 2014 to 23% in 2015 and 23% in 2016; knowledge/awareness and religion/culture/gender/socio-economic never had more than a 3% change per year over the three years.

    “The frequency of risk-benefit (scientific evidence) slightly increased from 22% in 2014 to 23% in 2015 and in 2016 and both knowledge and awareness and religion/culture/gender/socio-economic never had more than a 3% change per year over the three years.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The JRF responses provided by countries accurately reflect the actual reasons for vaccine hesitancy in those countries.
    • Rests on an assumption: The top three reasons reported by countries are the most important reasons for vaccine hesitancy in those countries.

  • May combine two claims.

    Findingown data

    In lower middle income countries, there was a shift towards the top three categories looking more like upper middle income and high income countries as by 2016 knowledge/awareness had dropped from being the top category and risk-benefit (scientific evidence) had become more prominent.

    “Additionally, in lower middle income countries there was a shift towards the top three categories looking more like upper middle income and high income countries as by 2016 knowledge/awareness had dropped from being the top category and risk-benefit (scientific evidence) had become more prominent.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The JRF responses provided by countries accurately reflect the actual reasons for vaccine hesitancy in those countries.
    • Rests on an assumption: The top three reasons reported by countries are the most important reasons for vaccine hesitancy in those countries.

  • May combine two claims.

    Findingown data

    There were differences overall in the top three reasons cited between countries that reported having done an assessment versus no assessment in 2014 and 2015, but not in 2016.

    “There were differences overall in the top three reasons cited between those who reported having done an assessment versus no assessment in 2014 and 2015 but not in 2016.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The JRF responses provided by countries accurately reflect the actual reasons for vaccine hesitancy in those countries.
    • Rests on an assumption: The top three reasons reported by countries are the most important reasons for vaccine hesitancy in those countries.

  • May combine two claims.

    Findingown data

    The top three categories for most cited reasons varied by country income level and by region.

    “The top three categories for most cited reasons globally remained relatively consistent over the three years but varied by country income level and by region, emphasizing that hesitancy is not uniform.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The JRF responses provided by countries accurately reflect the actual reasons for vaccine hesitancy in those countries.
    • Rests on an assumption: The top three reasons reported by countries are the most important reasons for vaccine hesitancy in those countries.

  • May combine two claims.

    Findingown data

    The number of countries reporting no vaccine hesitancy remained relatively consistent over 2014-2016 and was low overall: 12 countries (6%) in 2014, 14 (7%) in 2015, and 14 (7%) in 2016.

    “The number of countries that reported no hesitancy remained relatively consistent over the 3 years and overall was low; 2014 – 12 countries (6%), 2015–14 countries (7%) and 2016–14 (7%).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The countries that responded to the JRF are representative of all WHO Member States for the purpose of estimating global vaccine hesitancy.

  • May combine two claims.

    Findingown data

    Overall JRF response rates were similar over 2014-2016: 95% (185/194) in 2014, 98% (190/194) in 2015, and 95% (184/194) in 2016.

    “The overall JRF response rates were similar over the three years; 2014 95% (185/194), 2015 98% (190/194) and 2016 95% (184/194).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The countries that responded to the JRF are representative of all WHO Member States for the purpose of estimating global vaccine hesitancy.

  • May combine two claims.

    Findingown data

    Review of all responses at the individual country level revealed similarities in reported reasons over the three years in many countries, but in some major changes had occurred.

    “Review of all responses at the individual country level revealed similarities in reported reasons over the three years in many countries but in some major changes had occurred.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The JRF responses provided by countries accurately reflect the actual reasons for vaccine hesitancy in those countries.

  • May combine two claims.

    Findingown data

    Knowledge/Awareness was the number one reason for hesitancy in low income countries in 2014 and 2015, but its rate fell from 23% to 11% and by 2016 had fallen to 6% and into fourth place.

    “Knowledge/Awareness was the number one reason in low income countries in 2014 and 2015 but the rate fell from 23% to 11% and by 2016 had fallen to 6% and into fourth place as the most cited reason.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The JRF responses provided by countries accurately reflect the actual reasons for vaccine hesitancy in those countries.
    • Rests on an assumption: The top three reasons reported by countries are the most important reasons for vaccine hesitancy in those countries.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Review of 'other' responses revealed most could not be categorized due to the brevity of response.

    “Review of these “other” responses revealed most could not be categorized due to the brevity of response.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The JRF responses provided by countries accurately reflect the actual reasons for vaccine hesitancy in those countries.

  • May combine two claims.

    Findingown data

    The increase in response rates to the first vaccine indicator question was not consistent across WHO regions; between 2015 and 2016 response rates increased in the African Region with only slight changes in other regions.

    “The increase was not consistent across the WHO regions as shown in Fig. 1. For example, between 2015 and 2016 the response rates increased in the African Region (AFR) with only slight changes in the other regions.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The countries that responded to the JRF are representative of all WHO Member States for the purpose of estimating global vaccine hesitancy.

  • May combine two claims.

    Findingown data

    In Country A, from 2014 to 2015 there were no major changes in the top three reasons for vaccine hesitancy, but in 2016 'practice homeopathic medications' was in the top three without any mention of halal concerns.

    “For example in Country A from 2014 to 2015 there was no major changes in the top three reasons for vaccine hesitancy, (“skeptical about the effectiveness of vaccines”, “no halal certification of vaccines” and “skeptical about the safety of vaccines”) but in 2016 “practice homeopathic medications” was now in the top three reasons without any mention of halal concerns.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The JRF responses provided by countries accurately reflect the actual reasons for vaccine hesitancy in those countries.

  • May combine two claims.

    Findingown data

    A total of 1110 reasons for hesitancy were given over the three years: 352 in 2014, 376 in 2015, and 382 as of June 30, 2016.

    “A total of 1110 reasons were given for hesitancy over the three years; 352 in 2014, 376 in 2015 and 382 as of June 30, 2016.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The 2016 JRF data available as of June 30, 2017 are sufficiently complete for the analysis.

  • May combine two claims.

    Findingown data

    By 2016, in low income countries, knowledge and awareness had dropped out of the top three category for vaccine hesitancy, and religion/culture/gender/socioeconomic had moved up.

    “By 2016, in low income countries, knowledge and awareness had dropped out of the top three category for vaccine hesitancy, and religion/culture/gender/socioeconomic had moved up.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The JRF responses provided by countries accurately reflect the actual reasons for vaccine hesitancy in those countries.
    • Rests on an assumption: The top three reasons reported by countries are the most important reasons for vaccine hesitancy in those countries.

  • May combine two claims.

    Interpretationown data

    Vaccine hesitancy is complex and variable globally.

    “However, overall even the most frequently cited categories (risk-benefit (scientific evidence)) only accounted for less than one quarter of all categories cited emphasizing the complexity and variability of hesitancy globally.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    This three-year JRF review confirms that hesitancy is present in the majority of countries globally, with less than 10% reporting no hesitancy.

    “This three year JRF review confirms that hesitancy is present in the majority of countries globally with less than 10% reporting no hesitancy.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The countries that responded to the JRF are representative of all WHO Member States for the purpose of estimating global vaccine hesitancy.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Imprecision and paucity of the information provided raised challenges in some instances for category placement.

    “Imprecision and paucity of the information provided, as noted above, raised challenges in some instances for category placement.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    A UNICEF WHO definition of vaccine demand has been developed, but this was not included as part of the 2016 newly introduced JRF demand question.

    “While a UNICEF WHO definition of vaccine demand has been developed [10], this was not included as part of the 2016 newly introduced JRF demand question.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [10] Hickler B, MacDonald NE, Senouci K, Schuh HB and the informal Working Group on Vaccine Demand (iWGVD) for the Strategic Advisory Group of Experts on immunization (SAGE) Working Group on Decade of Vaccines. Efforts to monitor Global progress on individual and community demand for immunization: development of definitions and indicators for the Global Vaccine Action Plan Strategic Objective 2. Vaccine 2017; 35(28): 3515–9. 28536028

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Across the globe, countries appear to understand the SAGE vaccine hesitancy definition and are able to report on it.

    “In summary, across the globe countries appear to understand the SAGE vaccine hesitancy definition and are able to report on it.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The JRF responses provided by countries accurately reflect the actual reasons for vaccine hesitancy in those countries.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    As noted by Grabenstein, religious reasons may not be based upon religious teachings but may reflect safety and other concerns.

    “Fourthly, as noted by Grabenstein in his review of world religions and vaccines, religious reasons may not be based upon religious teachings but may reflect safety and other concerns [8].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Grabenstein

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Different countries may have interpreted the demand question in different ways.

    “Thus different countries may have interpreted the demand question in different ways.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    The classification of the provided reasons may have been subject to personal perception, although this was mitigated to some extent by independent vetting by two authors and the use of the compiled list to increase consistency year over year.

    “Secondly, the classification of the provided reasons may have been subject to personal perception although this was mitigated to some extent by the independent vetting by two authors and the use of the complied list to increase consistency year over year.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The three-year hesitancy JRF results have shown that hesitancy is common but the list of cited reasons is long.

    “The three year hesitancy JRF results have shown that hesitancy is common but the list of cited reasons long.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The countries that responded to the JRF are representative of all WHO Member States for the purpose of estimating global vaccine hesitancy.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    When categorizing cited reasons using the WHO matrix of determinants, in some instances answers fit into more than one category.

    “First, when categorizing the cited reason using the WHO matrix of determinants, in some instances answers fit into more than one category.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Vaccine hesitancy is only one component of vaccine demand in the Global Vaccine Action Plan.

    “Vaccine hesitancy is only one component of vaccine demand in the Global Vaccine Action Plan [9].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] World Health Organization. Global Vaccine Action Plan 2011-2020. <http://www.who.int/immunization/global_vaccine_action_plan/GVAP_doc_2011_2020/en/> [accessed Dec 11, 2017].

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Some of the reports placed in the religion category might have fitted into the risk-benefit (scientific evidence) category if more fulsome information had been provided.

    “Hence some of the reports placed in this category might well have fitted into the risk-benefit (scientific evidence) category if more fulsome information had been provided.”
    Quote in the paperNot a substantial claim
33 of 33

  • The paper relies on this without support.

    The JRF responses provided by countries accurately reflect the actual reasons for vaccine hesitancy in those countries.

    “Thirdly, the limited number of country assessment means the reasons were predominately based upon the impressions of those completing the JRF not on specific direct measurements.”

  • The paper relies on this without support.

    The countries that responded to the JRF are representative of all WHO Member States for the purpose of estimating global vaccine hesitancy.

    “The overall JRF response rates were similar over the three years; 2014 95% (185/194), 2015 98% (190/194) and 2016 95% (184/194).”

  • The paper relies on this without support.

    The 2016 JRF data available as of June 30, 2017 are sufficiently complete for the analysis.

    “All available data as of June 30, 2017 was used in the analysis. Of note, based upon previous years JRF reporting an additional 10–12 countries will likely submit final 2016 data by the end of 2017.”

  • The paper relies on this without support.

    The top three reasons reported by countries are the most important reasons for vaccine hesitancy in those countries.

    “Question 1: what are the top three reasons for not accepting vaccines according to the national schedule?”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • In many countries, vaccine hesitancy and misinformation present substantial obstacles to achieving coverage and community immunity.

    “In many countries, vaccine hesitancy and misinformation present substantial obstacles to achieving coverage and community immunity5,6.”

    From A global survey of potential acceptance of a COVID-19 vaccine (2021) · cites this paper as [6]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • 2016 assessment percentage is rounded incorrectly in the text

    Minor

    The text reports 63 of 194 countries as 33%, whereas this is approximately 32.47%, which rounds to 32% as shown in Table 1.

    Reported 33 · recomputed 32.474227

  • Table 1 category counts exceed the number of responding countries

    Minor

    For 2016, the three Table 1 categories total 194 countries, but the table says only 184 responded to at least one vaccine-hesitancy question. The same mismatch occurs in 2014 and 2015: the categories total 194 in each year, versus 185 and 190 respondents, respectively.

    Reported 184 · recomputed 194

  • Conflicting cutoff dates for the 2016 analysis

    Minor

    The reasons count is described as current to June 30, 2016, but the methods state that all available data through June 30, 2017 were used in the analysis.

3 of 3

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Authors
Lane, S., MacDonald, N. E., Marti, M., & Dumolard, L.
Affiliations
  • Dalhousie University (CA)
  • World Health Organization (CH)
Corresponding author
MacDonald, Noni E.
ORCID
Venue
Vaccine
Publisher
Elsevier BV
Published
2018-06
Volume
36
Issue
26
Pages
3861-3867
ISSN
0264-410X (ISSN-L)
DOI
10.1016/j.vaccine.2018.03.063
PMC
PMC5999354
OpenAlex
W2794683609
Semantic Scholar
897118702938324cb35fd1c769cfdd7360c44220
Cited by
530
References
9
Citations by year
2026: 20 · 2025: 33 · 2024: 66 · 2023: 81 · 2022: 120 · 2021: 124 · 2020: 59 · 2019: 20 · 2018: 7
FWCI
55.54
Type
journal article
Language
en
Open access
Licence
Locations
  • Vaccine (publishedVersion, cc-by-nc-nd)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
  • World Health Organization
  • Dalhousie University
  • IWK Health Centre
Topics
  • Social Sciences › Health › Vaccine Coverage and Hesitancy
  • Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
  • Social Sciences › Sociology and Political Science › Risk Perception and Management
Keywords
vaccine hesitancy, reasons for vaccine hesitancy, vaccine safety concerns, country income level, WHO regions, Global Vaccine Action Plan, community participation, trust building, crisis response planning
MeSH terms
Vaccination Coverage, Humans, Patient Acceptance of Health Care, United Nations, Vaccination, Vaccines

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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