Understanding pneumococcal vaccine perceptions in seven countries: Findings from a cross-sectional survey

Pneumococcal disease remains a major global cause of morbidity and mortality, yet vaccine uptake varies. Understanding how demographic, socioeconomic, and regional factors shape pneumococcal vaccine perceptions is essential for developing effective public health strategies. We conducted a stratified, cross-sectional survey of 7,000 adults across seven countries (Canada, Brazil, France, India, Nigeria, the United Kingdom, and the United States), with sampling structured by age, sex, income, and education. Perceptions of pneumococcal vaccine safety, efficacy, importance, and disease concern were assessed using Likert scales. χ² tests, Kruskal-Wallis tests, and ordinal regression models examined demographic and country-level differences, with trust in information sources included as a predictor. Confidence in pneumococcal vaccine safety and efficacy was highest among adults aged 35-44 and 65+, whereas younger adults expressed the greatest concern about pneumococcal disease (p < .001). Women showed the strongest support across all measures, including awareness and importance of vaccination at different life stages (p < .001). Higher income and education were associated with greater confidence and awareness (p < .001). Country-level variation was substantial: Brazil and India reported the highest agreement with pneumococcal vaccine safety and efficacy, while France and the UK reported the lowest, despite established health systems. Trust in healthcare providers and public health institutions was the strongest predictor of positive perceptions, while informal sources had little influence. Demographic, socioeconomic, and country-level differences significantly shape pneumococcal vaccine perceptions. Efforts to strengthen trust in healthcare providers, address misinformation among younger adults, and tailor outreach to local contexts are needed to improve uptake globally.