Building Confidence in Vaccines

  • Jennifer C. SmithEmail author
  • Mary Appleton
  • Noni E. MacDonald
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 764)


Despite significant efforts by governments, organizations and individuals to maintain public trust in vaccines, concerns persist and threaten to undermine the effectiveness of immunization programs. Vaccine advocates have traditionally focused on education based on evidence to address vaccine concerns and hesitancy. However, being informed of the facts about immunization does not always translate into support for immunization. While many are persuaded by scientific evidence, others are more influenced by cognitive shortcuts, beliefs, societal pressure and the media, with the latter group more likely to hesitate over immunization.

Understanding evidence from the behaviour sciences opens new doors to better support individual decision-making about immunization. Drawing on heuristics, this overview explores how individuals find, process and utilize vaccine information and the role health care professionals and society can play in vaccine decision-making.

Traditional, evidence-based approaches aimed at staunching the erosion of public confidence in vaccines are proving inadequate and expensive. Enhancing public confidence in vaccines will be complex, necessitating a much wider range of strategies than currently used. Success will require a shift in how the public, health care professionals and media are informed and educated about vaccine benefits, risks and safety; considerable introspection and change in current academic and vaccine decision-making practices; development of proactive strategies to broadly address current and potential future concerns, as well as targeted interventions such as programs to address pain with immunization. This overview outlines ten such opportunities for change to improve vaccine confidence.


Health Care Provider Human Papilloma Virus Influenza Vaccine Immunization Program Vaccine Uptake 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Callereus T (2010) Perceptions of vaccine safety in a global context. Acta Paediatrica 99:166–171Google Scholar
  2. 2.
    MacDonald NE, Smith J, Appleton M (2012) Risk perception, risk management and safety assessment: what can governments do to increase public confidence in their vaccine system? Biologicals 40(5):384–388CrossRefGoogle Scholar
  3. 3.
    Leitmeyer K, Buchholz U, Kramer M, Schenkel K, Stahlhut H, Köllstadt M, Haas W, Meyer C (2006) Influenza immunization in German health care providers: effects and findings after two rounds of a nationwide awareness campaign. Vaccine 24:7003–7008CrossRefGoogle Scholar
  4. 4.
    Caban-Martinez AJ, Lee DJ, Davila EP, LeBlanc WG, Arheart KL, McCollister KE, Christ SL, Clarke T, Fleming LE (2010) Sustained low influenza immunization rates in US healthcare workers. Prev Med 50:210–212CrossRefGoogle Scholar
  5. 5.
    Centers for Disease Control and Prevention (2010) Interim Results: Influenza A (H1N1) 2009 monovalent and seasonal influenza immunization coverage among health-care personnel—United States, August 2009–January 2010. MMWR 59(12):357–362Google Scholar
  6. 6.
    Centers for Disease Control and Prevention (2011) Influenza vaccination coverage among health-care personnel. United States, 2010–11 Influenza season. MMWR 60(32):1073–1077Google Scholar
  7. 7.
    Ogilvie G, Anderson M, Marra F, McNeil S, Pielak K, Dawar M, McIvor M, Ehlen T, Dobson S, Money D, Patrick DM, Naus M (2010) A population-based evaluation of a publicly funded, school-based HPV vaccine program in British Columbia, Canada: parental factors associated with HPV vaccine receipt. PLoS Med 7(5):1000270CrossRefGoogle Scholar
  8. 8.
    Andre FE, Booy R, Bock HL, Clemens J, Datta SK, John TJ, Lee BW, Lolekha S, Peltola H, Ruff TA, Santosham M, Schmitt HJ (2008) Vaccination greatly reduces disease, disability, death and inequity worldwide. Bull World Health Organ 86:140–146CrossRefGoogle Scholar
  9. 9.
    Public Health Agency of Canada (2011) Vaccine-preventable diseases measles. Accessed 17 Aug 2011
  10. 10.
    Black S, Rappuoli R (2010) A crisis of public confidence in vaccines. Science translational medicine 2(61):61mr1. doi:10.1126/scitranslmed.3001738Google Scholar
  11. 11.
    California Department of Public Health (2011) Pertussis report January 7, 2011. Scholar
  12. 12.
    Benin AL, Wisler-Scher DJ, Colson E, Shapiro ED, Holmboe ES (2006) Qualitative analysis of mothers’ decision-making about vaccines for infants: the importance of trust. Pediatrics 117(5):1532–1541CrossRefGoogle Scholar
  13. 13.
    Freed GL, Clark SJ, Butchart AT, Singer DC, Davis MM (2010) Parental vaccine safety concerns in 2009. Pediatrics 125(4):654–659CrossRefGoogle Scholar
  14. 14.
    Ball LK, Evans G, Bostrom A (1998) Risky business: challenges in vaccine risk communication. Pediatrics 101:453–458CrossRefGoogle Scholar
  15. 15.
    Lau AY, Coiera EW (2007) Do people experience cognitive biases while searching for information? J Am Med Inform Assoc 14(5):599–608CrossRefGoogle Scholar
  16. 16.
    Galdi S, Arcuri L, Gawronski B (2008) Automatic mental associations predict future choices of undecided decision-makers. Science 321(5892):1100–1102CrossRefGoogle Scholar
  17. 17.
    Nyhan B, Reifler J (2010) When corrections fail: the persistence of political misperceptions. Polit Behav 32:303–330CrossRefGoogle Scholar
  18. 18.
    Google Privacy Center (2011) Accessed 22 Aug 2011Google Scholar
  19. 19.
    Scullard P, Peacock C, Davies P (2010) Googling children’s health: reliability of medical advice on the internet. Arch Dis Child. doi:10.1136/adc.2009.168856Google Scholar
  20. 20.
    Betsch C, Renkewitz F, Betsch T, Ulshöfer C (2010) The influence of vaccine-critical websites on perceiving immunization risks. J Health Psychol 15:446–455CrossRefGoogle Scholar
  21. 21.
    Jacobson RM, Targonski PV, Poland GA (2007) A taxonomy of reasoning flaws in the anti-vaccine movement. Vaccine 25(16):3146–3152CrossRefGoogle Scholar
  22. 22.
    Godlee F, Smith J, Marcovitch H (2011) Wakefield’s article linking MMR vaccine and autism was fraudulent. BMJ 342:7452CrossRefGoogle Scholar
  23. 23.
    Deer B (2011) How the case against the MMR vaccine was fixed. BMJ 342:5347. doi:10.1136/bmj.c5347Google Scholar
  24. 24.
    Hilton S, Petticrew M, Hunt K (2007) Parents’ champions vs. vested interests: who do parents believe about MMR? A qualitative study. BMC Public Health 7:42. doi:10.1186/1471-2458-7-42CrossRefGoogle Scholar
  25. 25.
    Chen RT, Rastogi SC, Mullen JR, Hayes SW, Cochi SL, Donlon JA, Wassilak SG (1994) The Vaccine Adverse Event Reporting System (VAERS). Vaccine 12:542–550CrossRefGoogle Scholar
  26. 26.
    Institute of Medicine (2011) Adverse effects of vaccines: evidence and causality. August 2011. correct referencing? Accessed Aug 2011Google Scholar
  27. 27.
    Zhang J, While AE, Norman IJ (2010) Knowledge and attitudes regarding influenza immunization among nurses: a research review. Vaccine 28(44):7207–7214CrossRefGoogle Scholar
  28. 28.
    British Columbia Centre for Disease Control (2011) Immunization communication tool for immunizers.–7590-48AC-8D2C-65D54ADFC77E/0/CDC_IC_Tool_OnlinePDF.pdf. Accessed 22 Aug 2011
  29. 29.
    MacDonald NE, Hebert PC (2010) Polio outbreak in Tajikistan is cause for alarm. CMAJ 182(10):1013CrossRefGoogle Scholar
  30. 30.
    MacDonald N, Hatchette T, Elkout L, Sarwal S (2011) Mumps is back: why is mumps eradication not working? Adv Exp Med Biol 697:197–220CrossRefGoogle Scholar
  31. 31.
    National Advisory Committee on Immunization (2006) Haemophilus Vaccine. 7th Edition Canadian Immunization Guide. Pub Health Agency Canada 172–178Google Scholar
  32. 32.
    Scheifele DW, Bettinger JA, Halperin SA, Law B, Bortolussi R (2008) Ongoing control of Haemophilus influenzae Type B infections in Canadian children, 2004–2007. Pediatr Infect Dis J 27:755–757CrossRefGoogle Scholar
  33. 33.
    Centers for Disease Control and Prevention (2009) Invasive Haemophilus influenzae Type B disease in five young children—Minnesota, 2008. MMWR 58:58–60Google Scholar
  34. 34.
    Black S, Eskola J, Siegrist C, Halsey N, MacDonald NE, Law B, Miller E, Andrews N, Stowe J, Salmon D, Vannice K, Izurieta HS, Akhtar A, Gold M, Oselka G, Zuber P, Pfeifer D, Vellozzi C (2009) Importance of background rates of disease in assessment of vaccine safety during mass immunization with pandemic H1N1 influenza vaccines. Lancet 374(9707):2115–2122CrossRefGoogle Scholar
  35. 35.
    Collet JP, MacDonald N, Cashman N, Pless R (2000) Monitoring signals for vaccine safety: the assessment of individual adverse event reports by an expert advisory committee. Advisory Committee on Causality Assessment. Bull World Health Organ 78(2):178–185PubMedPubMedCentralGoogle Scholar
  36. 36.
    MacDonald NE, Pickering L (2009) Canadian paediatric society, infectious diseases and immunization committee. Canada’s eight-step vaccine safety program: vaccine literacy. Paediatr Child Health 14(9):605–608CrossRefGoogle Scholar
  37. 37.
    Salmon D, Pavia A, Gellin B (2011) Vaccine safety thoughout the product life cycle. Pediatrics 127(Suppl 1):1–137CrossRefGoogle Scholar
  38. 38.
    Baggs J, Gee J, Lewis E, Fowler G, Benson P, Lieu T, Naleway A, Klein NP, Baxter R, Belongia E, Glanz J, Hambidge SJ, Jacobsen SJ, Jackson L, Nordin J, Weintraub E (2011) The Vaccine Safety Datalink: a model for monitoring immunization safety. Pediatrics 127(Suppl 1):45–53CrossRefGoogle Scholar
  39. 39.
    MacDonald NE, Picard A (2009) A plea for clear language on vaccine safety. CMAJ 180(7):697–698CrossRefGoogle Scholar
  40. 40.
    Smith JC (2010) The structure, role and procedures of the U.S. Advisory Committee on Immunization Practices (ACIP). Vaccine 28S:68–75CrossRefGoogle Scholar
  41. 41.
    Jacobson RM, Targonski PV, Poland GA (2007) Meta-analyses in vaccinology. Vaccine 25(16):3153–3159CrossRefGoogle Scholar
  42. 42.
    Jacobson RM, Targonski PV, Poland GA (2007) Why is evidence-based medicine so harsh on vaccines? An exploration of the method and its natural biases. Vaccine 20/25(16):3165–3169CrossRefGoogle Scholar
  43. 43.
    Faunce T, Townsend R, McEwan A (2010) The Vioxx pharmaceutical scandal: Peterson v Merke Sharpe & Dohme (Aust) Pty Ltd (2010) 184 FCR 1. Law Med 18(1):38–49Google Scholar
  44. 44.
    Kennedy A et al (2011) Vaccine attitudes, concerns, and information sources reported by parents of young children: results from the 2009 HealthStyles survey. Pediatrics 127(Suppl):92–99CrossRefGoogle Scholar
  45. 45.
    Taddio A, Appleton M, Bortolussi R, Chambers C, Dubey V, Halperin S, Hanrahan A, Ipp M, Lockett D, MacDonald N, Midmer D, Mousmanis P, Palda V, Pielak K, Riddell RP, Rieder M, Scott J, Shah V (2010) Reducing the pain of childhood immunization: an evidence-based clinical practice guideline (summary). CMAJ 182(18):1989–1995CrossRefGoogle Scholar
  46. 46.
    Pelly L, Pierrynowski MacDougall D, Halperin B, Strang R, Bowles S, Baxendale M, McNeil S (2010) The VaxEd project: an assessment of immunization education in canadian health professional programs. BMC Med Educ 2010, 10, 86. Published online 2010 November 26. 10.1186/1472-6920-10-86 Copyright ©2010 Pelly et al; licensee BioMed Central LtdGoogle Scholar
  47. 47.
    Immunization Competencies for Health Professionals (2011) Prepared by the Professional Education Working Group of the Canadian Immunization Committee. Approved by the Communicable Disease Control Expert Group and the Pan-Canadian Public Health Network. Published by the Public Health Agency of Canada Centre for Immunization and Respiratory Infectious Diseases November 2008. Accessed 23 Aug 2011
  48. 48.
    Teachers Kit, National Immunization Poster Contest (2011) Canadian Coalition for Immunization Awareness & Promotion and the Public Health Agency of Canada. Accessed 19 Jul 2011Google Scholar
  49. 49.
    Hussain H, Omer SB, Manganello JA, Kromm EE, Carter TC, Kan L, Stokley S, Halsey NA, Salmon DA (2011) Immunization safety in US print media, 1995–2005. Pediatrics 127(Suppl 1):100–106CrossRefGoogle Scholar
  50. 50.
    Fondation Mérieux (2011) European Media Workshop on Vaccine Safety: Unjustified scare or reasonable scepticism. 20–21 April 2009, Les Pensières, Annecy (France),2321.html. Accessed 31 Aug 2011
  51. 51.
    Picard A (2011) The return of measles: where did we go wrong? Globe & Mail. June 8 2011 Accessed 31 Aug 2011
  52. 52.
    World Health Organization (2011) Mobilizing for Action. Communication-for-Behavioural-Impact (COMBI) Accessed 31 Aug 2011Google Scholar
  53. 53.
    Lasker RD, Guidy JA (2009) Engaging the community in decision making. Case studies tracking participation, voice and influence. McFarland and Company 2009, Jefferson, North Carolina USA, 2009Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Jennifer C. Smith
    • 1
    Email author
  • Mary Appleton
    • 1
  • Noni E. MacDonald
    • 1
  1. 1.Pediatric Infectious DiseasesDalhousie University, Canadian Center for Vaccinology, IWK Health CenterHalifaxCanada

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