Towards a More Critical Public Health Understanding of Vaccine Hesitancy: Key Insights from a Decade of Research

Abstract

Vaccine hesitancy has gained renewed attention as an important public health concern worldwide. Against this backdrop, over the last decade, we have conducted various qualitative, social science studies with the broad shared aim of better understanding this complex phenomenon. This has included various Cochrane systematic reviews of qualitative research globally, systematic reviews of qualitative research in Africa, and primary research studies in South Africa. These studies have also explored vaccine hesitancy for various vaccines, including routine childhood vaccination, HPV vaccination and other routine vaccinations for adolescents, and, most recently, COVID-19 vaccination. In this reflective and critical commentary piece we reflect on seven key overarching insights we feel we have gained about this complex phenomenon from the varying studies we have conducted over the past decade. These insights comprise the following: (1) the relationship between vaccine knowledge and hesitancy is complex and may operate in multiple directions; (2) vaccine hesitancy is driven by multiple socio-political forces; (3) vaccine hesitancy may be many things, rather than a single phenomenon; (4) vaccine hesitancy may be an ongoing ‘process’, rather than a fixed ‘stance’; (5) vaccine hesitancy may sometimes be about a ‘striving’, rather than a ‘resisting’; (6) ‘distrust’ as a driver of vaccine hesitancy needs to be better contextualized and disaggregated; and (7) the ‘demand-side’ versus ‘supply/access-side’ distinction of the drivers of suboptimal vaccination may be misleading and unhelpful. In unpacking these insights, we problematize some of the common assumptions within the vaccine hesitancy literature and flag topics that we think could benefit from further scrutiny and debate. Our hope is that this can provide a platform for further engagement on these issues and ultimately contribute towards fostering a more critical public health understanding of vaccine hesitancy.

“Every Time It Comes Time for Another Shot, It’s a Re-Evaluation”: A Qualitative Study of Intent to Receive COVID-19 Boosters among Parents Who Were Hesitant Adopters of the COVID-19 Vaccine

“…These findings contrast with those of the prior literature that demonstrated a strong correlation between vaccination status (e.g., prior vaccination behavior) and subsequent vaccine uptake [ 49 , 51 , 57 , 58 , 59 , 60 , 61 ]. However, the findings are consistent with the literature which posits vaccination decisions as “dynamic, fluid, and often ambivalent processes” [ 31 ]. Our findings extend the current literature on vaccination-as-process and call into question the utility of prior vaccination as a predictor of future vaccination behavior for hesitant adopters.…”

“…Further investigation is needed to explore the correlation between prior vaccination and intent for future vaccination, especially in light of recent research demonstrating the potential spillover of COVID-19 vaccine hesitancy to other vaccines [ 55 ] and the importance of COVID-19 vaccine boosters as tools to mitigate the ongoing effects of COVID-19 [ 7 , 8 , 29 , 53 ]. Processual approaches, such as Anderson’s health-as-process [ 62 , 63 ], Becker’s early sociological work on marijuana use [ 64 , 65 ], Biehl and Locke’s anthropology of becoming [ 66 ], or Chrisman’s “health-seeking process” [ 67 ], have been underutilized in understanding the dynamic nature of vaccine hesitancy [ 10 , 31 ]. Understanding vaccine hesitancy and vaccine uptake as a dynamic process raises pragmatic issues for interventions to improve the uptake of COVID-19 boosters and other vaccines that require multiple doses, such as the human papillomavirus vaccine [ 29 ].…”

“…Understanding vaccine hesitancy and vaccine uptake as a dynamic process raises pragmatic issues for interventions to improve the uptake of COVID-19 boosters and other vaccines that require multiple doses, such as the human papillomavirus vaccine [ 29 ]. Understanding vaccination as a process could improve the operationalization of vaccine hesitancy and related constructs [ 14 ] and open new opportunities in monitoring and responding to vaccine hesitancy [ 31 , 68 , 69 ].…”

“…A recent quantitative study demonstrated that vaccine hesitancy affected the uptake of COVID-19 boosters even among those who had received prior vaccinations [ 30 ]. A small body of literature has focused on vaccination as an ongoing process, where an individual’s orientation towards vaccination may not be fixed, but instead is dynamically related to the social and health contexts for vaccine decisions [ 28 , 31 , 32 , 33 , 34 ]. Hesitant adopters are an important population for further research to understand the dynamic, ongoing effects of vaccine hesitancy on vaccine uptake.…”

Using social media to build confidence in vaccines: lessons from community engagement and social science research in Africa

“…We are not suggesting that social media are the panacea to public distrust in vaccines. No single strategy is likely to have much traction for this complex problem 54. We also recognise the apprehensions of using social media for public health purposes, such as its potential to exacerbate the digital divide and inequities in healthcare access 37 or it being yet another technical response to a complex public health problem 55.…”