Skip to main content

Vaccine Hesitancy: A Growing Concern


Vaccines are one of the great achievements of medical science. They have eradicated or drastically reduced the incidence of once common diseases. It is estimated that vaccines save between 2 and 6 million lives each year, but 1.5 million more lives could be saved if coverage was increased. Vaccine hesitancy, defined by the World Health Organization as “the reluctance or refusal to vaccinate despite the availability of vaccines”, is a barrier to increasing coverage that has received a great deal of attention from the media and public health academics in recent years. It is argued that many parents are reluctant to vaccinate their children because of concerns about vaccine safety, despite reassurances from doctors and public health authorities. Vaccine hesitancy is a particularly big problem in high-income countries. Observers have noted that the internet and social media play an important role in spreading fears about vaccine safety. It is, however, important to understand how the wider social and political context has influenced concerns about vaccine safety. Vaccine hesitancy appears to be one aspect of a broader breakdown in trust between some sections of the population on the one hand, and elites and experts on the other.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. Fallows J. The 50 greatest breakthroughs since the wheel (2013).

  2. Stone D. The 10 inventions that changed the world (2017).

  3. World Health Organization, Strategic Advisory Group of Experts on Immunization. Report of the SAGE working group on vaccine hesitancy (2014).

  4. Andre FE, Booy R, Bock HL, Clemens J, Datta SK, John TJ, Santosham M. Vaccination greatly reduces disease, disability, death and inequity worldwide. Bull World Health Organ. 2008;86:140–6.

    CAS  Article  Google Scholar 

  5. Winegard T. The mosquito: a human history of our deadliest predator. Allen Lane (2019).

  6. Wellcome Trust. Chapter 5: Attitudes to vaccines in Wellcome Global Monitor 2018 (2019).

  7. World Health Organization. Smallpox. Eradicating an ancient scourge. In WHO. Bugs, drugs and smoke: stories from public health (2012).

  8. World Health Organization. Measles (2019).

  9. UNICEF. The story of the end of polio (undated).

  10. World Health Organization. Polio case count (2016).

  11. World Health Organization. 10 facts on immunization (2018).

  12. World Health Organization, UNICEF, World Bank. State of the world’s vaccines and immunization. World Health Organization (2009).

  13. Bloom DE, Black S, Salisbury D, Rappuoli R. Antimicrobial resistance and the role of vaccines. Proc Natl Acad Sci. 2018;115(51):12868–71.

    CAS  Article  Google Scholar 

  14. Royal Society for Public Health. Moving the needle. Promoting vaccination uptake across the life course (2019).

  15. Largeron N, Lévy P, Wasem J, Bresse X. Role of vaccination in the sustainability of healthcare systems. J Mark Access Health Policy. 2015;3(1):27043.

    Article  Google Scholar 

  16. Bloom DE, Fan VY, Sevilla JP. The broad socioeconomic benefits of vaccination. Sci Transl Med. 2018;10(441):eaaj2345.

    Article  Google Scholar 

  17. Gessner BD, Kaslow D, Louis J, Neuzil K, O’Brien KL, Picot V, Pang T, Parashar UD, Saadatian-Elahi M, Nelson CB. Estimating the full public health value of vaccination. Vaccine. 2017;35(46):6255–63.

    Article  Google Scholar 

  18. Ehreth J. The value of vaccination: a global perspective. Vaccine. 2003;21(27–30):4105–17.

    Article  Google Scholar 

  19. Ozawa S, Clark S, Portnoy A, Grewal S, Brenzel L, Walker DG. Return on investment from childhood immunization in low-and middle-income countries, 2011–20. Health Aff. 2016;35(2):199–207.

    Article  Google Scholar 

  20. National Health Service. Why vaccination is safe and important (undated).

  21. Centers for Disease Control and Prevention. Common vaccine safety concerns (undated).

  22. World Health Organization. Table 1: Summary of WHO position papers—recommendations for routine immunization (2019).

  23. World Health Organization. Immunization (2019).

  24. GAVI. Mission (undated).

  25. World Health Organization, Strategic Advisory Group of Experts on Immunization. The Global Vaccine Action Plan 2011–2020. Review and lessons learned (2019).

  26. Rossen I, Hurlstone MJ, Dunlop PD, Lawrence C. Accepters, fence sitters, or rejecters: moral profiles of vaccination attitudes. Soc Sci Med. 2019;224:23–7.

    Article  Google Scholar 

  27. WHO. Ten threats to global health in 2019 (undated).

  28. Vaccine Confidence Project. The state of vaccine confidence 2015 (2015).

  29. Larson HJ, de Figueiredo A, Xiahong Z, Schulz WS, Verger P, Johnston IG, Cook AR, Jones NS. The state of vaccine confidence 2016: global insights through a 67-country survey. EBioMedicine. 2016;12:295–301.

    Article  Google Scholar 

  30. Larson H, de Figueiredo A, Karafillakis E, Rawal M. State of vaccine confidence in the EU 2018. Luxembourg: Publications Office of the European Union (2018).

  31. LSTHM. Vaccine Confidence improving in some EU countries but decreasing in others (2018).

  32. Curtale F, Perrelli F, Mantovani J, degli Atti MC, Filia A, Nicoletti L, Magurano F, Borgia P, Di Lallo D. Description of two measles outbreaks in the Lazio Region, Italy (2006–2007). Importance of pockets of low vaccine coverage in sustaining the infection. BMC Infect Dis. 2010;10(1):62.

    Article  Google Scholar 

  33. D’Ancona F, D’Amario C, Maraglino F, Rezza G, Iannazzo S. The law on compulsory vaccination in Italy: an update 2 years after the introduction. Eurosurveillance. 2019;24(26):1900371.

    Article  Google Scholar 

  34. Lévy-Bruhl D, Fonteneau L, Vaux S, Barret AS, Antona D, Bonmarin I, Che D, Quelet S, Coignard B. Assessment of the impact of the extension of vaccination mandates on vaccine coverage after 1 year, France, 2019. Eurosurveillance. 2019;24(26):1900301.

    Article  Google Scholar 

  35. Trentini F, Poletti P, Melegaro A, Merler S. The introduction of “No jab, no school” policy and the refinement of measles immunisation strategies in high-income countries. BMC Med. 2019;17(1):86.

    Article  Google Scholar 

  36. WHO. Measles cases hit record high in the European Region (2018).

  37. Davis N Lives at risk from surge in measles across Europe, experts warn (2019).

  38. Stack L. Highest level in more than 25 years, C.D.C. says (2019).

  39. Drew L. The case for mandatory vaccination. Nature. 2019;575:S58–60.

    CAS  Article  Google Scholar 

  40. Niederhuber M. The fight over inoculation during the 1721 Boston smallpox epidemic. Science in the News (2014).

  41. Williamson S. Anti-vaccination leagues. Arch Dis Child. 1984;59(12):1195–6.

    CAS  Article  Google Scholar 

  42. Porter R, Porter R. The politics of prevention: anti-vaccinationism and public health in nineteenth-century England. Med Hist. 1988;32(3):231–52.

    CAS  Article  Google Scholar 

  43. Kennedy J. Why have the majority of recent polio cases occurred in countries affected by Islamist militancy? A historical comparative analysis of the political determinants of polio in Nigeria, Somalia, Pakistan, Afghanistan and Syria. Med Confl Surviv. 2016;32(4):295–316.

    Article  Google Scholar 

  44. Kennedy J. How drone strikes and a fake vaccination program have inhibited polio eradication in Pakistan: an analysis of national level data. Int J Health Serv. 2017;47(4):807–25.

    Article  Google Scholar 

  45. Ali K, Celentano L. Addressing vaccine hesitancy in the “Post-Truth” era. Eurohealth. 2017;23(4):16–20.

    Google Scholar 

  46. Parker SK, Schwartz B, Todd J, Pickering LK. Thimerosal-containing vaccines and autistic spectrum disorder: a critical review of published original data. Pediatrics. 2004;114(3):793–804.

    Article  Google Scholar 

  47. Prue G, Baker P, Graham D, Nutting C, Greenhouse P, Lawler M. It is time for universal HPV vaccination. Lancet. 2018;392(10151):913–4.

    Article  Google Scholar 

  48. McKie R. Fears for women’s health as parents reject HPV vaccine (2017).

  49. Elliman D, Bedford H. MMR: where are we now? Arch Dis Child. 2007;92(12):1055–7.

    Article  Google Scholar 

  50. Public Health England. Confirmed cases of measles, mumps and rubella in England and Wales: 1996 to 2016 (2017). Accessed 14 Sep 2018.

  51. Kmietowicz Z. Wakefield is struck off for the “serious and wide-ranging findings against him. Br Med J. 2010;340:c2803.

    Article  Google Scholar 

  52. Hviid A, Hansen JV, Frisch M, Melbye M. Measles, mumps, rubella vaccination and autism: a nationwide cohort study. Ann Intern Med. 2019;170(8):513–20.

    Article  Google Scholar 

  53. Public Health England and NHS Digital. Childhood Vaccination Coverage Statistics: England 2018–19 (2019).

  54. Boseley S. Drop in vaccination rates in England alarming, experts warn (2019).

  55. Giuffrida A. Italy’s Five Star Movement blamed for surge in measles cases (2017).

  56. Sun L. Trump’s vaccine views are at odds with those of most Americans, study says (2017). Accessed 14 Sep 2018.

  57. Russo A. Trump shifts on measles vaccine: “they have to get the shots” (2019).

  58. Larson HJ. The biggest pandemic risk? Viral misinformation. Nature. 2018;562(7726):309–10.

    CAS  Article  Google Scholar 

  59. Broniatowski DA, Jamison AM, Qi S, AlKulaib L, Chen T, Benton A, Quinn SC, Dredze M. Weaponized health communication: Twitter bots and Russian trolls amplify the vaccine debate. Am J Public Health. 2018;108(10):1378–84.

    Article  Google Scholar 

  60. Collins H, Evans R. Rethinking expertise. University of Chicago Press (2008).

  61. Latour B. Why has critique run out of steam? From matters of fact to matters of concern. Crit Inq. 2004;30(2):225–48.

    Article  Google Scholar 

  62. Lockett H, Noble J. Oxford Dictionaries word of the year: “post-truth” (2016).

  63. Kavanagh J, Rich M. Truth decay: an initial exploration of the diminishing role of facts and analysis in American public life. Rand Corporation (2018).

  64. Kennedy J. Populist politics and vaccine hesitancy in Western Europe: an analysis of national-level data. Eur J Public Health. 2019;29(3):512–6.

    Article  Google Scholar 

  65. Lewis P, Boseley S, Duncan P. Revealed: populists far more likely to believe in conspiracy theories (2019).

  66. Kennedy J, Michailidou D. Divergent policy responses to increasing vaccine scepticism in southern Europe. Lancet Infect Dis. 2017;17(9):900.

    Article  Google Scholar 

  67. Kennedy J. Should childhood vaccinations be mandatory? Perspect Public Health. 2020;140(1):23–4.

    CAS  Article  Google Scholar 

  68. Kaler A. Health interventions and the persistence of rumour: the circulation of sterility stories in African public health campaigns. Soc Sci Med. 2009;68(9):1711–9.

    Article  Google Scholar 

  69. Piketty T. Capital in the twenty-first century. Belknap Press (2014).

  70. Piketty T. Brahmin left vs merchant right: rising inequality and the changing structure of political conflict (evidence from France, Britain and the US, 1948–2017). World Inequality Database Working Paper 2018/7 (2018).

  71. Case A, Deaton A. Mortality and morbidity in the 21st century. Brookings Papers on Economic Activity. 2017;2017(1):397–476.

    Article  Google Scholar 

  72. Hiam H, McKee M, Dorling D. Why is life expectancy in England and Wales “stalling”? J Epidemiol Community Health. 2018;72:404–8.

    Article  Google Scholar 

  73. Kahan DM. A risky science communication environment for vaccines. Science. 2013;342(6154):53–4.

    CAS  Article  Google Scholar 

  74. Drochon H. Britons are swallowing conspiracy theories. Here’s how to stop the rot 2018 (2018).

  75. Public Health England. Vaccination is a lifelong benefit—make every contact count (2016).

Download references


I am grateful to three anonymous reviewers, the editor, and Farrah Jarral for helpful comments on this paper.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Jonathan Kennedy.

Ethics declarations

Conflict of interest

JK has received no funding relevant to this article. JK has no conflicts of interest to declare.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kennedy, J. Vaccine Hesitancy: A Growing Concern. Pediatr Drugs 22, 105–111 (2020).

Download citation

  • Published:

  • Issue Date:

  • DOI: