Abstract
Today, according to many public health experts, public confidence in vaccines is waning. The term “vaccine hesitancy” (VH) is increasingly used to describe the spread of such vaccine reluctance. But VH is an ambiguous notion and its theoretical background appears uncertain. To clarify this concept, we first review the current definitions of VH in the public health literature and examine its most prominent characteristics. VH has been defined as a set of beliefs, attitudes, or behaviours, or some combination of them, shared by a large and heterogeneous portion of the population and including people who exhibit reluctant conformism (they may either decline a vaccine, delay it or accept it despite their doubts) and vaccine-specific behaviours. Secondly, we underline some of the ambiguities of this notion and argue that it is more a catchall category than a real concept. We also call into question the usefulness of understanding VH as an intermediate position along a continuum ranging from anti-vaccine to pro-vaccine attitudes, and we discuss its qualification as a belief, attitude or behaviour. Thirdly, we propose a theoretical framework, based on previous literature and taking into account some major structural features of contemporary societies, that considers VH as a kind of decision-making process that depends on people’s level of commitment to healthism/risk culture and on their level of confidence in the health authorities and mainstream medicine.
Highlights
Today, according to many public health experts, public confidence in vaccines is waning1,2,3
While some empirical studies report that vaccine hesitancy” (VH) is more frequent among people with a high socioeconomic status (SES), others report the opposite or observe no relation, especially regarding educational level 6,7,8,12,17,27. Such inconsistent results are disturbing for social scientists, as SES is supposed to strongly shape our beliefs, attitudes and behaviours, in meaningful ways. These different attitudes tend to assort into specific profiles; for example, those who consider VH an old phenomenon that encompasses anti-vaccination attitudes often attribute it to ignorance, misinformation or irrationality, while those who describe it as a new attitude, distinct from strong opposition to vaccination, argue that it is positively correlated with vaccine-related knowledge
This feature of contemporary societies is closely related to healthism, and some authors have even combined these concepts: in such cases, healthism refers to individuals who seek to control their health, who want to become its informed and rational entrepreneur, but who express strong doubts about medical authorities and mainstream medicine and are more prone to turn to alternative experts, including on vaccination issues 36
Summary
Today, according to many public health experts, public confidence in vaccines is waning1 ,2 ,3. Such inconsistent results are disturbing for social scientists, as SES is supposed to strongly shape our beliefs, attitudes and behaviours, in meaningful ways These different attitudes tend to assort into specific profiles; for example, those who consider VH an old phenomenon that encompasses anti-vaccination attitudes often attribute it to ignorance, misinformation or irrationality, while those who describe it as a new attitude, distinct from strong opposition to vaccination, argue that it is positively correlated with vaccine-related knowledge. VH may be associated with other kinds of behaviours, such as information seeking, and the notion of attitude can be defined in many different ways (including a positive or negative evaluation, or a disposition to act) This ambiguity regarding the nature of VH may create problems in dealing with it: when researchers design an intervention aimed at promoting vaccination or a specific vaccine, for example, should they target an attitudinal or a behavioural outcome?. Positioning them along a continuum corresponding to attitudes toward vaccination in general appears quite inappropriate
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