Mapping global trends in vaccine confidence and investigating barriers to vaccine uptake: a large-scale retrospective temporal modelling study
Open accessAbstract
BACKGROUND: There is growing evidence of vaccine delays or refusals due to a lack of trust in the importance, safety, or effectiveness of vaccines, alongside persisting access issues. Although immunisation coverage is reported administratively across the world, no similarly robust monitoring system exists for vaccine confidence. In this study, vaccine confidence was mapped across 149 countries between 2015 and 2019. METHODS: In this large-scale retrospective data-driven analysis, we examined global trends in vaccine confidence using data from 290 surveys done between September, 2015, and December, 2019, across 149 countries, and including 284 381 individuals. We used a Bayesian multinomial logit Gaussian process model to produce estimates of public perceptions towards the safety, importance, and effectiveness of vaccines. Associations between vaccine uptake and a large range of putative drivers of uptake, including vaccine confidence, socioeconomic status, and sources of trust, were determined using univariate Bayesian logistic regressions. Gibbs sampling was used for Bayesian model inference, with 95% Bayesian highest posterior density intervals used to capture uncertainty. FINDINGS: Between November, 2015, and December, 2019, we estimate that confidence in the importance, safety, and effectiveness of vaccines fell in Afghanistan, Indonesia, Pakistan, the Philippines, and South Korea. We found significant increases in respondents strongly disagreeing that vaccines are safe between 2015 and 2019 in six countries: Afghanistan, Azerbaijan, Indonesia, Nigeria, Pakistan, and Serbia. We find signs that confidence has improved between 2018 and 2019 in some EU member states, including Finland, France, Ireland, and Italy, with recent losses detected in Poland. Confidence in the importance of vaccines (rather than in their safety or effectiveness) had the strongest univariate association with vaccine uptake compared with other determinants considered. When a link was found between individuals' religious beliefs and uptake, findings indicated that minority religious groups tended to have lower probabilities of uptake. INTERPRETATION: To our knowledge, this is the largest study of global vaccine confidence to date, allowing for cross-country comparisons and changes over time. Our findings highlight the importance of regular monitoring to detect emerging trends to prompt interventions to build and sustain vaccine confidence. FUNDING: European Commission, Wellcome, and Engineering and Physical Sciences Research Council.
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Reaching required vaccination levels should not be assumed given well-documented evidence of vaccine hesitancy across the world, which is often fuelled by online and offline misinformation.
“Reaching these required vaccination levels should not be assumed given well-documented evidence of vaccine hesitancy across the world 17 , which is often fuelled by online and offline misinformation surrounding the importance, safety or effectiveness of vaccines 18-20 .”
From Measuring the impact of COVID-19 vaccine misinformation on vaccination intent in the UK and USA (2021) · cites this paper as [17]
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- Authors
- de Figueiredo, A., Simas, C., Karafillakis, E., Paterson, P., & Larson, H. J.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- University of Antwerp (BE)
- Corresponding author
- Larson, Heidi J
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2020-09
- Volume
- 396
- Issue
- 10255
- Pages
- 898-908
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC7607345
- OpenAlex
- W3084350025
- Cited by
- 1,143
- References
- 44
- Citations by year
- 2026: 89 · 2025: 115 · 2024: 153 · 2023: 207 · 2022: 273 · 2021: 279 · 2020: 27
- FWCI
- 108.80
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The Lancet (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Spiral (Imperial College London) (submittedVersion, other-oa)
- Funders
- Engineering and Physical Sciences Research Council (EP/N014529/1)
- Wellcome Trust
- European Commission
- Topics
- Social Sciences › Health › Vaccine Coverage and Hesitancy
- Social Sciences › Sociology and Political Science › Misinformation and Its Impacts
- Social Sciences › Sociology and Political Science › Risk Perception and Management
- Keywords
- vaccine confidence, vaccine uptake, vaccine hesitancy, vaccine safety beliefs, vaccine effectiveness perception, religious beliefs and vaccination, socioeconomic status, trust in health information sources
- MeSH terms
- Humans, Health Knowledge, Attitudes, Practice, Public Opinion, Retrospective Studies, Vaccines, Global Health, Mass Vaccination, Trust
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