PapersFlow Research Brief
Vaccine Coverage and Hesitancy
Research Guide
What is Vaccine Coverage and Hesitancy?
Vaccine coverage refers to the proportion of a population that has received recommended vaccinations, while vaccine hesitancy is a delay in acceptance or refusal of vaccination despite availability of services, as defined by the SAGE Working Group.
The field encompasses 110,838 works on vaccine coverage and hesitancy. "Vaccine hesitancy: Definition, scope and determinants" by Noni E. MacDonald (2015) established that vaccine hesitancy is complex, context-specific, and varies across time, place, and vaccines. Studies like "A global survey of potential acceptance of a COVID-19 vaccine" by Jeffrey V. Lazarus et al. (2020) highlight global variations in willingness to vaccinate.
Research Sub-Topics
Determinants of Vaccine Hesitancy
Researchers identify psychological, social, and cultural factors influencing hesitancy through surveys and qualitative studies across populations. Studies develop measurement scales and explore interactions with misinformation exposure.
COVID-19 Vaccine Acceptance Surveys
This area conducts global and national polls on willingness to vaccinate against COVID-19, analyzing demographic disparities and temporal trends. Research models predictors like trust in science and efficacy perceptions.
mRNA Vaccine Safety and Immunogenicity
Studies evaluate clinical trial data and post-marketing surveillance for mRNA vaccines like BNT162b2, focusing on adverse events, antibody responses, and durability. Emphasis is on rare side effects and booster efficacy.
Vaccine Decision-Making Processes
Researchers apply decisional conflict scales and behavioral models to understand parental and individual choices in vaccination. Interventions test nudges, communication strategies, and shared decision-making tools.
Trained Immunity and Vaccine Responses
This sub-topic examines epigenetic reprogramming of innate immune cells by vaccines or adjuvants for enhanced heterologous protection. Studies link trained immunity to antibody persistence and breakthrough infection resistance.
Why It Matters
Vaccine coverage directly impacts public health outcomes, as shown in "BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Mass Vaccination Setting" by Noa Dagan et al. (2021), which demonstrated the vaccine's effectiveness across a wide range of COVID-19 outcomes in Israel's mass vaccination program. Hesitancy undermines these gains, with "Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak" by Bao-Liang Zhong et al. (2020) revealing how KAP influenced adherence to control measures during the outbreak. Recent NIH actions terminated 33 grants studying hesitancy and uptake strategies, potentially affecting research into improving access.
Reading Guide
Where to Start
"Vaccine hesitancy: Definition, scope and determinants" by Noni E. MacDonald (2015) provides the foundational definition and determinants, essential for understanding the core concept before exploring applications.
Key Papers Explained
MacDonald (2015) defines hesitancy in "Vaccine hesitancy: Definition, scope and determinants", setting the stage for COVID-specific studies. Zhong et al. (2020) in "Knowledge, attitudes, and practices towards COVID-19 among Chinese residents" applies this to outbreak KAP. Lazarus et al. (2020) in "A global survey of potential acceptance of a COVID-19 vaccine" extends to global acceptance, while Dagan et al. (2021) in "BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Mass Vaccination Setting" demonstrates coverage outcomes.
Paper Timeline
Most-cited paper highlighted in red. Papers ordered chronologically.
Advanced Directions
Recent preprints like "Understanding Vaccine Hesitancy: Insights and Improvement Strategies Drawn from a Multi-Study Review" (2025) synthesize drivers and interventions. NIH grant terminations for 33 hesitancy projects signal shifting priorities. WHO emphasizes countering misinformation, as in "Message by the Director of the Department of Immunization" (2025).
Papers at a Glance
| # | Paper | Year | Venue | Citations | Open Access |
|---|---|---|---|---|---|
| 1 | Vaccine hesitancy: Definition, scope and determinants | 2015 | Vaccine | 5.3K | ✓ |
| 2 | Knowledge, attitudes, and practices towards COVID-19 among Chi... | 2020 | International Journal ... | 3.2K | ✓ |
| 3 | A global survey of potential acceptance of a COVID-19 vaccine | 2020 | Nature Medicine | 3.0K | ✓ |
| 4 | BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Mass Vaccinatio... | 2021 | New England Journal of... | 2.8K | ✓ |
| 5 | Safety and Immunogenicity of Two RNA-Based Covid-19 Vaccine Ca... | 2020 | New England Journal of... | 2.7K | ✓ |
| 6 | Bulletin of the World Health Organization | 2003 | Bulletin of the World ... | 2.6K | ✓ |
| 7 | Tackling drug-resistant infections globally: final report and ... | 2016 | — | 2.6K | ✕ |
| 8 | Mandell, Douglas, and Bennett's Principles and Practice of Inf... | 2015 | Elsevier eBooks | 2.6K | ✕ |
| 9 | Trained immunity: A program of innate immune memory in health ... | 2016 | Science | 2.5K | ✕ |
| 10 | Validation of a Decisional Conflict Scale | 1995 | Medical Decision Making | 2.3K | ✕ |
In the News
NIH to ax grants on vaccine hesitancy
The National Institutes of Health (NIH) is abruptly terminating at least 33 research grants for projects studying why some people are hesitant to receive vaccines or evaluating strategies that coul...
The effect of NIH funding cuts on vaccine access and ...
The National Institutes of Health has terminated dozens of grants for scientific research projects related to vaccine use and hesitancy, informing researchers that their studies no longer aligned w...
Vaccination and Immunization Registries
2. **Support Vaccine Equity:**Increase federal funding for vaccination programs in underserved communities to ensure equitable access to vaccines for all Canadians.
Understanding Vaccine Hesitancy
Vaccines are among the most effective public health interventions, significantly reducing morbidity and mortality from infectious diseases. Despite their proven efficacy, vaccine hesitancy has emer...
2025-2030 Interim National Immunization Strategy
* National Immunization Strategy pillars * Vaccine confidence and uptake * Coordinated immunization schedules and programs * Program evaluation and research
Code & Tools
### Analyse SARS-CoV-2 vaccines coverage This project aims to compare vaccine coverage between countries and the correlation between coverage and...
This comprehensive data analysis project examines global vaccination trends, disease control effectiveness, and public health outcomes using WHO va...
This guide is for government teams who are responsible for providing COVID-19 vaccines to their communities. The guide provides frameworks for vacc...
*epidemics*is an R package that provides modular representations of populations and public health response measures, allowing them to be combined w...
This site serves as a repository for tools associated with the globally validated behavioural and social drivers of vaccination surveys and intervi...
Recent Preprints
Understanding Vaccine Hesitancy: Insights and Improvement Strategies Drawn from a Multi-Study Review
Vaccines are among the most effective public health interventions, significantly reducing morbidity and mortality from infectious diseases. Despite their proven efficacy, vaccine hesitancy has emer...
Parental Vaccine Hesitancy, Awareness, and Attitudes Toward ...
PMC Copyright notice PMCID: PMC12587841 PMID: 41199796 ## Abstract ### Objective This study aims to measure vaccine hesitancy, awareness and attitude towards vaccination among parents in Sau...
Addressing HPV vaccine hesitancy: unveiling concerns ...
**Introduction:**Human papillomavirus (HPV) causes cervical cancer, and HPV vaccination is highly effective in preventing vaccine-targeted HPV infection. However, low HPV vaccination coverage in Ki...
Message by the Director of the Department of Immunization ...
We are at a critical juncture. While best estimates conclude that vaccines have saved more than 150 million lives in the past 50 years, the potential for their impact for future decades is increasi...
Immunization Coverage and Its Determinants Among ...
# Immunization Coverage and Its Determinants Among Children Aged 12–23 Months in East Africa: A Bayesian Hierarchical Modeling Approach Based on DHS 2019–2022 Simachew Getaneh Endalamew ### Sim...
Latest Developments
Recent research indicates that vaccine exemption rates in the US are increasing, with exemptions for nonmedical reasons surging among children since the COVID-19 pandemic, leading to larger vulnerable populations (CNN). Additionally, vaccine hesitancy, which initially was high during the COVID-19 vaccine rollout, has significantly decreased for the majority, though a small minority remain mistrustful (Health Policy Watch, as of January 14, 2026; The Lancet01912-9/fulltext)). Strategies addressing vaccine hesitancy focus on factors like confidence, complacency, and convenience, with recent studies emphasizing the importance of tailored, evidence-based communication (PubMed, MDPI, as of September 2025).
Sources
Frequently Asked Questions
What is vaccine hesitancy?
The SAGE Working Group on Vaccine Hesitancy concluded that vaccine hesitancy refers to delay in acceptance or refusal of vaccination despite availability of vaccination services. It is complex and context specific, varying across time, place, and vaccines. "Vaccine hesitancy: Definition, scope and determinants" by Noni E. MacDonald (2015) identified influencing factors.
How does vaccine hesitancy affect COVID-19 vaccination?
"A global survey of potential acceptance of a COVID-19 vaccine" by Jeffrey V. Lazarus et al. (2020) assessed global potential acceptance rates. Lower acceptance correlates with hesitancy influenced by knowledge, attitudes, and practices, as in "Knowledge, attitudes, and practices towards COVID-19 among Chinese residents" by Bao-Liang Zhong et al. (2020). This impacts mass vaccination effectiveness.
What are determinants of vaccine coverage?
Coverage depends on hesitancy factors outlined in "Vaccine hesitancy: Definition, scope and determinants" by Noni E. MacDonald (2015). Studies like "BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Mass Vaccination Setting" by Noa Dagan et al. (2021) show high coverage enables broad protection. Recent preprints examine determinants in regions like East Africa.
How is vaccine hesitancy measured?
"Validation of a Decisional Conflict Scale" by Annette M. O’Connor (1995) provides a scale for uncertainty in health decisions, applicable to vaccination. Surveys assess KAP, as in Bao-Liang Zhong et al. (2020). Global tools from WHO's BeSD repository support behavioral drivers measurement.
What role do attitudes play in hesitancy?
"Knowledge, attitudes, and practices towards COVID-19 among Chinese residents" by Bao-Liang Zhong et al. (2020) showed attitudes affect adherence to measures. "A global survey of potential acceptance of a COVID-19 vaccine" by Jeffrey V. Lazarus et al. (2020) surveyed attitudes toward COVID-19 vaccines worldwide. Misinformation exacerbates negative attitudes, per recent WHO messages.
Open Research Questions
- ? What interventions most effectively reduce vaccine hesitancy across diverse contexts?
- ? How do regional differences in knowledge, attitudes, and practices influence COVID-19 vaccine uptake?
- ? What are the long-term impacts of funding cuts on vaccine hesitancy research and coverage strategies?
- ? How can decisional conflict scales be adapted to predict hesitancy in low-coverage areas like East Africa?
- ? What drivers of parental hesitancy persist post-COVID in regions like Saudi Arabia and Kenya?
Recent Trends
NIH terminated at least 33 grants on vaccine hesitancy research in 2025, impacting studies on uptake strategies.
Preprints like "Understanding Vaccine Hesitancy: Insights and Improvement Strategies Drawn from a Multi-Study Review" review drivers and interventions.
2025-09-25Coverage analyses in East Africa via Bayesian modeling (recent) and low HPV coverage at 10% in Kenya highlight persistent gaps.
WHO notes vaccines saved over 150 million lives in 50 years, threatened by misinformation.
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