Abstract
SummaryBackgroundThere is growing evidence of vaccine delays or refusals due to a lack of trust in the importance, safety, or effectiveness of vaccines, alongside persisting access issues. Although immunisation coverage is reported administratively across the world, no similarly robust monitoring system exists for vaccine confidence. In this study, vaccine confidence was mapped across 149 countries between 2015 and 2019.MethodsIn this large-scale retrospective data-driven analysis, we examined global trends in vaccine confidence using data from 290 surveys done between September, 2015, and December, 2019, across 149 countries, and including 284 381 individuals. We used a Bayesian multinomial logit Gaussian process model to produce estimates of public perceptions towards the safety, importance, and effectiveness of vaccines. Associations between vaccine uptake and a large range of putative drivers of uptake, including vaccine confidence, socioeconomic status, and sources of trust, were determined using univariate Bayesian logistic regressions. Gibbs sampling was used for Bayesian model inference, with 95% Bayesian highest posterior density intervals used to capture uncertainty.FindingsBetween November, 2015, and December, 2019, we estimate that confidence in the importance, safety, and effectiveness of vaccines fell in Afghanistan, Indonesia, Pakistan, the Philippines, and South Korea. We found significant increases in respondents strongly disagreeing that vaccines are safe between 2015 and 2019 in six countries: Afghanistan, Azerbaijan, Indonesia, Nigeria, Pakistan, and Serbia. We find signs that confidence has improved between 2018 and 2019 in some EU member states, including Finland, France, Ireland, and Italy, with recent losses detected in Poland. Confidence in the importance of vaccines (rather than in their safety or effectiveness) had the strongest univariate association with vaccine uptake compared with other determinants considered. When a link was found between individuals' religious beliefs and uptake, findings indicated that minority religious groups tended to have lower probabilities of uptake.InterpretationTo our knowledge, this is the largest study of global vaccine confidence to date, allowing for cross-country comparisons and changes over time. Our findings highlight the importance of regular monitoring to detect emerging trends to prompt interventions to build and sustain vaccine confidence.FundingEuropean Commission, Wellcome, and Engineering and Physical Sciences Research Council.
Highlights
Alongside persisting issues of access to health services, waning vaccine confidence has taken a toll on immu nisation programmes across the globe,[1,2,3,4] contributing to stagnating or decreasing immunisation rates and consequent surges in vaccine-preventable diseases such as measles.[5,6] In this context, WHO has named vaccine hesitancy as one of the top ten threats to global health in 2019 alongside climate change.[7]Founded in 2010, the Vaccine Confidence Project (VCP) was established to develop systematic approaches to monitoring public confidence in vaccines and to inform policy makers and stakeholders of the changing trends and determinants of vaccine confidence across the globe
Argentina (89·4%, 95% highest posterior density (HPD) interval 87·7–91·3), Liberia (86·1%, 67·1–97·7), and Bangladesh (86·1%, 83·7–88·1) had the highest estimated percentage of respondents strongly agreeing that vaccines are safe in late 2015, whereas Japan (8·9%, 7·4–10·6), France (8·9%, 7·2–10·5), and Mongolia (8·1%, 6·4–9·8) had the lowest
Ethiopia (96·3%, 95% HPD interval 95·2–97·3), Argentina (95·7%, 94·5–97·0), and Bangladesh (95·1%, 93·8–96·4) had the highest estimated percentage of respondents strongly agreeing that vaccines are impor tant in 2015, whereas Turkey (22·1%, 19·5–24·7), Morocco (15·8%, 13·7–18·4), and Georgia (2·7%, 1·6–3·8) had the lowest
Summary
Founded in 2010, the Vaccine Confidence Project (VCP) was established to develop systematic approaches to monitoring public confidence in vaccines and to inform policy makers and stakeholders of the changing trends and determinants of vaccine confidence across the globe. The VCP has compre hensively explored the landscape of confidence issues and experiences in managing confidence crises around the world.[8,9,10,11] The VCP has conducted numerous surveys, focus groups, in-depth qualitative research, and largescale digital media analytics,[12,13,14] as well as convened expert roundtables and workshops to understand contextspecific attitudes to vaccines among the general public,[14,15] health-care professionals and providers,[15] and pregnant women.[16] The VCP continues to research the roots, trends, and impacts of vaccine confidence issues at national and supranational levels to inform policy and trust-building activities and mitigate the need for crisis management in immunisation programmes. Vaccine confidence was mapped across 149 countries between 2015 and 2019
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