Vaccine hesitancy: clarifying a theoretical framework for an ambiguous notion

Area of Science:

• Public Health
• Sociology
• Behavioral Science

Background:

• Public confidence in vaccines is decreasing, with "vaccine hesitancy" (VH) widely used to describe this trend.
• Existing definitions of VH are ambiguous, encompassing beliefs, attitudes, and behaviors, making it a broad and uncertain concept.
• Current understanding of VH as a linear spectrum from anti-vaccine to pro-vaccine attitudes is questioned.

Purpose of the Study:

• To review and analyze current definitions and characteristics of vaccine hesitancy (VH).
• To identify ambiguities and limitations in the conceptualization of VH.
• To propose a new theoretical framework for understanding VH as a decision-making process.

Main Methods:

• Literature review of existing definitions and characteristics of vaccine hesitancy.
• Critical analysis of the conceptual ambiguities and limitations of VH.
• Development of a theoretical framework integrating societal factors and trust in health systems.

Main Results:

• Vaccine hesitancy (VH) is defined inconsistently across public health literature, often as a catch-all category.
• VH is characterized by a heterogeneous population exhibiting reluctant conformism, vaccine-specific behaviors, or a combination thereof.
• A proposed framework views VH as a decision-making process influenced by "healthism/risk culture" and confidence in health authorities and medicine.

Conclusions:

• Vaccine hesitancy (VH) is an ambiguous concept lacking a clear theoretical foundation.
• The prevailing understanding of VH as a simple continuum is insufficient.
• A novel framework positions VH as a complex decision-making process influenced by societal values and trust in healthcare.