Vaccination hesitancy – Understanding it better to address it better


AMONGST all public health interventions, vaccination still tops the list, because of its effectiveness in preventing diseases and saving millions of lives each year. As such, it has been called the greatest public health achievement of the 20th century.
In addition to direct protection for vaccinated individuals, high vaccination coverage induces indirect protection for the community through herd immunity. As a result, transmission of diseases is slowed down, with the risk of infections among those who remain unvaccinated, markedly reduced. This is one of the most important roles vaccination plays that significantly contributes to elimination, and the eventual eradication of vaccine-preventable diseases.
With the success story of vaccination programmes, there has been significant decrease in permanent lifelong disabilities and death from life-threatening infectious diseases, especially in the developed world, and in some cases, in the developing countries as well. In general, vaccine-preventable diseases including smallpox, poliomyelitis, diphtheria, pertussis, tetanus, measles, mumps, rubella, and influenza have been successfully reduced to negligible levels. It has been estimated that 2-3 million deaths from these life-threatening diseases are prevented every year.
The high rate of childhood vaccination coverage in most developed countries indicates that vaccination remains a widely accepted public health measure. But the national estimates can be misleading and may not show the true picture of under-vaccinated or non-vaccinated communities, which is indeed, a burden in many developing countries. Various outbreaks of vaccine-preventable diseases including, measles, poliomyelitis, diphtheria and pertussis in several parts of the world have been linked mainly to such communities.
One would anticipate that this life saving medical advance would be universally embraced by all and at all cost. It is a pity that, certainly, that is not the case. Globally, a growing number of individuals, including parents, are refusing vaccines. They belief vaccination is unnecessary, ineffective, or unsafe. And so, the reappearance of vaccine-preventable diseases in various parts of the world have been linked to areas of under-vaccinated or non-vaccinated populations. This is surely a reflection of growing negative attitudes to vaccination. The World Health Organization has since listed vaccination hesitancy as one of the top ten threats to global health. Numerous studies done in many different parts of the world all indicate an increasing trend in vaccination hesitancy in its various capacities.
Vaccine or vaccination hesitancy refers to delaying or the refusal of vaccines despite the availability of vaccination services. It recognizes that there is a range between full acceptance and outright refusal of some or all vaccines, and challenges established understanding of individuals or groups on the life-saving benefits of vaccination. The reasons for vaccine hesitancy fit into three categories: lack of confidence (in effectiveness, safety, the system, or policy makers), complacency (perceived low risk of acquiring vaccine-preventable diseases), and lack of convenience (in the availability, accessibility, and appeal of immunization services, including time, place, language, and cultural contexts). The two other additional reasons are, risk calculation and collective responsibility of individuals, parents, and communities to vaccines and vaccine-preventable diseases. These are again strongly connected to environmental, vaccine-specific, and host or parental-specific factors.
All over the world, many negative opinions and sentiments against vaccines and vaccination are being circulated. Apart from playing a significantly positive role in vaccine uptake, social media also plays an outright negative role in its influences on the communities worldwide. Studies have shown that negative reports from media demotivates communities regarding vaccine uptake. The classic example of whooping cough (pertussis) immunisation shows that media controversies regarding immunisation led to decrease in vaccine uptake and as a result, a 10 to 100 times increase in the number of cases in countries where there was very low or no immunization cover compared to immunized countries.
Nowadays, the very effective platform of Internet is being utilized to dispense negative publicity by anti-vaccination activists. Such negative opinions are causing a growing number of people and communities around the world to lose confidence in vaccines, see vaccination as an inconvenience to their other daily activities, become complacent, miscalculate associated risks of diseases and benefits of vaccination, and contribute to lose to that sense of collective social responsibilities on the safety and protection of others as well.
Here in Papua New Guinea, it is quite obvious that now misleading information and misconceptions about vaccines and vaccination have become commonplace on social media and out on the streets of our townships, especially, during the current Covid-19 pandemic. And some of these are completely outrageous. It is becoming even more complicated when those trusted to be technically well-informed, feed us all the anti-vaccine sentiments that we the people willingly buy and bite deeply into. This information gets disseminated into communities and the outskirts of our country especially, through social media, making delivery of vaccination services somewhat challenging in many areas.
A growing number of people do not have confidence in vaccination. They do not trust vaccines or in the systems that deliver them, and not even in policy makers who decide which vaccines are needed and when. Some people also think that the process to vaccination is a total inconvenience to their daily lives.
Issues relating to lack of availability and affordability to go access the services, geographical inaccessibility, the inability to understand language and health literature, and that lack of appeal of immunisation programmes to draw people in for vaccination, all contribute to affect vaccination service delivery.
Furthermore, the anti-vaccine campaigns have caused some people to believe that they would just be fine even without being vaccinated. When the perceived risk of vaccine-preventable diseases gets low, vaccination is not anymore considered a necessary preventative action. Other life and health responsibilities are seen as more important, and therefore, overshadow the risk of infectious disease, and of not being vaccinated.
To all these, we may also consider our common responsibility for the prevention of infectious disease. All these anti-vaccine advocacies just do not add up to giving us the realization that vaccination not only saves one’s life but also protects others around us. We have a collective responsibility to take to heart the wellbeing of every other person in that drive to prevent infectious diseases and to save lives. Apart from improved sanitation, hygiene, and antibiotics, there is no other better way to achieve that than through vaccination.
The Covid-19 pandemic has added its own share of issues to the already growing concerns of vaccine hesitancy. Incorrect information are being circulated relating to the speed of production, the location and origin of vaccine development, and the worry of unforeseen future negative effects. These misleading information on Covid-19 vaccines have caused a growing number of people all over the world to refuse being vaccinated. The fact of the matter is that, just like all the other vaccines that came before Covid-19 vaccines, stringent measures of laboratory testing, clinical trial, and quality screening have been strictly adhered to, in order to ensure their safety, effectiveness, and stability before being supplied for use in immunisation programmes.
As we now see, vaccination hesitancy is a complex and dynamic issue. It is as such that individual and parental decisions are influenced by emotional, cultural, social, spiritual, political, as well as intellectual factors. These factors weigh heavily against the importance of vaccines to reach high vaccination coverage, so to provide significant protection to the individuals as well as the communities. It is therefore, of paramount importance that issues and concerns relating to vaccination hesitancy are not simply ignored, but be given some serious attention, so to be addressed in the most appropriate manner. To address it better, the factors and issues surrounding vaccine hesitancy have to be better understood.
Many experts are of the view that it is best to counter vaccine hesitancy at the population level. They believe that it can be done by introducing more transparency into policy decision-making before immunization programs, providing up-to-date information to the public and health providers about the rigorous procedures undertaken before introduction of new vaccines, and through diversified post-marketing surveillance of vaccine-related events. In addition, a special focus should be placed on listening to concerns of the public. Such an undertaking will create avenues to understand their perceptions and therefore, an opportunity to incorporate public perspectives in planning immunisation policies and programmes.
As a people and a nation, we all are accountable to one and another. Let us take serious recollections of our moral responsibilities, challenge anti-vaccine campaigns and misconceptions – get vaccinated, save ourselves, build a strong level of community protection, protect our loved ones, and save Papua New Guinea, for our children and their children’s children.

Source of information:

  • Dubé, E, et al. 2013, Vaccine hesitancy, Human Vacc Immunother, 9(8), 1763-1773, viewed 22 November 2021,
  • Kumar, D, et al. 2016, Vaccine hesitancy: understanding better to address better, Israel Journal of Health Policy Research, 5(2), viewed 24 November 2021,
  • Murdan, S, Ali, N, Ashiru-Oredope, D 2021, How to address vaccine hesitancy, Pharm Journal, 306(7946), viewed 22 November 2021,
  • Orenstein, WA and Ahmed, R 2017, Simply put: Vaccination saves lives, PNAS, 114(16), 4031-4033, viewed 11 November 2021,

Gelinde Narekine is a technical officer at the School of Medicine and Health Sciences of the University of Papua New Guinea