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Vaccine. 2017 Sep 5;35(37):4840-4850. doi: 10.1016/j.vaccine.2017.07.061. Epub 2017 Jul 29.

The benefit of the doubt or doubts over benefits? A systematic literature review of perceived risks of vaccines in European populations.

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Vaccine Confidence Project, London School of Hygiene & Tropical medicine, London, United Kingdom.
Vaccine Confidence Project, London School of Hygiene & Tropical medicine, London, United Kingdom; Department of Global Health, University of Washington, Seattle, USA. Electronic address:



The success of vaccination strategies depends in part on population perceptions of benefits and risks of vaccines and related confidence in vaccination. Better knowledge of public concerns about vaccines and what is driving them is needed to inform vaccination strategies and communications. This literature reviewer examined studies on vaccine and vaccination risk perceptions and concerns across European populations.


A systematic literature review was conducted to identify studies published between 2004 and 2014 in Europe. A descriptive analysis was performed.


A total of 145 articles were selected, most of which were conducted in the UK, the Netherlands and France and studied seasonal influenza, HPV and pandemic influenza vaccination. Across all countries and vaccines, the primary area of concern was vaccine safety, followed by perceptions of low likelihood of contracting vaccine-preventable diseases (VPDs), perceived low severity of VPDs, beliefs that vaccines do not work, and overall lack of information. Concerns were found to be vaccine-, country- and population-specific.


In addition to identifying concerns about vaccination in Europe, this study confirmed the notion that individuals have many safety concerns about vaccination and often believe that the risks of vaccination outweigh their benefits. More research needs to be conducted to explore the impact of different types of communication strategies, which would frame the benefits of vaccination as well as risks of not vaccinating. Strategies to better inform public perceptions of vaccines should include the provision of unbiased, comprehensive information tailored to population information needs, and delivered using multiple and new communication technologies such as social media.


Confidence; Hesitancy; Immunisation; Risk perception; Risk-benefit; Vaccine

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