Send to

Choose Destination
Soc Sci Med. 2014 Jul;112:1-11. doi: 10.1016/j.socscimed.2014.04.018. Epub 2014 Apr 16.

Attitudes to vaccination: a critical review.

Author information

SPRU, Jubilee Building, University of Sussex, Brighton BN1 9SL, UK. Electronic address:
RAND Europe, Cambridge CB4 1YG, UK.
Imperial Centre for Patient Safety and Service Quality, St Mary's Hospital, Wright Fleming Wing, Norfolk Place, London W2 1PG, UK.
Development Policy and Practice, Open University, Chambers Building, Milton Keynes MK7 6AA, UK.


This paper provides a consolidated overview of public and healthcare professionals' attitudes towards vaccination in Europe by bringing together for the first time evidence across various vaccines, countries and populations. The paper relies on an extensive review of empirical literature published in English after 2009, as well as an analysis of unpublished market research data from member companies of Vaccines Europe. Our synthesis suggests that hesitant attitudes to vaccination are prevalent and may be increasing since the influenza pandemic of 2009. We define hesitancy as an expression of concern or doubt about the value or safety of vaccination. This means that hesitant attitudes are not confined only to those who refuse vaccination or those who encourage others to refuse vaccination. For many people, vaccination attitudes are shaped not just by healthcare professionals but also by an array of other information sources, including online and social media sources. We find that healthcare professionals report increasing challenges to building a trustful relationship with patients, through which they might otherwise allay concerns and reassure hesitant patients. We also find a range of reasons for vaccination attitudes, only some of which can be characterised as being related to lack of awareness or misinformation. Reasons that relate to issues of mistrust are cited more commonly in the literature than reasons that relate to information deficit. The importance of trust in the institutions involved with vaccination is discussed in terms of implications for researchers and policy-makers; we suggest that rebuilding this trust is a multi-stakeholder problem requiring a co-ordinated strategy.


Attitude; Choice; Europe; Hesitancy; Immunisation; Perception; Public health; Vaccination

[Indexed for MEDLINE]
Free full text

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center