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Although previous studies have demonstrated an association between vaccine attitudes and cognitive biases, often resulting in vaccination hesitancy, the exact contribution of rationality has not been fully clarified. We tested two hypotheses regarding the impact of rationality on vaccine attitudes stemming from bounded and expressive rationality. We focused on parental vaccine attitudes operationalized by the affective, behavioral, and cognitive attitude components and investigated how these are influenced by disillusionment toward authorities and ability to engage in rational thinking operationalized using cognitive reflection and heuristics and biases tasks. The study was of a cross-sectional correlational design with a non-probabilistic sample of 823 volunteer participants surveyed online in April and May 2018 in Croatia. The results identified disillusionment toward authorities as a predictor of all components. Furthermore, performance on heuristics and biases tasks also predicted the affective and cognitive, but not the behavioral component, whereas cognitive reflection had no impact on vaccine attitudes. Next, a moderation effect of disillusionment toward authorities on the association between the omission bias task and all attitude components was identified. Parents with low disillusionment demonstrated positive vaccine attitudes regardless of their rationality, whereas for parents with high disillusionment a significant positive correlation between performance on the omission bias task as assessed with a vaccination vignette and attitudes was identified. This suggests that the ability to resist vaccine specific omission bias, that is, higher rationality, can decrease the negative effects of disillusionment, which supports the bounded rationality hypothesis.

Despite extensive research evidencing child vaccination is safe and effective, we are witnessing a trend of increasing vaccine hesitancy which is listed among the top ten global health threats. Although some countries incorporate mandatory vaccination programs, no particularly efficient strategies for addressing vaccine avoidance have so far been identified. Within this study we investigated perceptions and reasoning of vaccine hesitant parents from Croatia where child vaccination is mandatory. The aims were to reveal different strategies by which they avoid mandatory vaccination schedules and hypothetical situations in which they would reconsider vaccinating, as well as to identify features of related decision-making. We conducted 25 semi-structured interviews with vaccine hesitant parents and analyzed the data using the framework of thematic analyses. The identified themes were related to the parents' decision-making process, reflection as well as justification of their decision, avoidance behavior of mandatory vaccination schedules and related consequences, dealing with outcomes of the decision and reconsidering vaccinating. The results support and extend previous findings regarding vaccine reasoning, linking hesitancy with the experientially intuitive thinking style and social intuitionist model of moral reasoning. The findings provide important insights into vaccination avoidance and potential for reconsideration, as well as dealing with related risks. Furthermore, we offer a general framework as well as practical guidelines that may help the development of strategies aimed at increasing vaccination rates.