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Understanding vaccine hesitancy: the evidence

02 June 2021
Volume 26 · Issue 6


Vaccination is an important public health intervention, but its effectiveness depends upon the uptake of vaccination reaching sufficient levels to yield ‘herd’ immunity. While the majority of the UK hold positive attitudes about vaccination, some people, including health professionals, decline vaccinations. This article reviews the evidence relating to vaccine hesitancy, its underlying factors and the sociodemographic variations. A second article will review the evidence relating to strategies to address vaccine hesitancy and promote vaccination acceptance.

Vaccination is one of the most effective public health measures to control and manage infectious diseases (Hickler et al, 2015), as has been demonstrated by the eradication of smallpox and the control of poliomyelitis (polio). Vaccination is again forming a key aspect of the control of SARS-CoV-2, both within the UK and globally, alongside other public health measures, which include identification of those infected and isolation of these individuals and their contacts. Phillis (2020) described how two vaccines (Oxford AstraZeneca's adenovirus-vectored vaccine and Novavax's protein adjuvant vaccine) were developed and tested.

The frequent mutation (antigenic drift) of the influenza virus requires an annual vaccination programme of the vulnerable population, which was previously restricted to older people, but was extended to all adults with long-term conditions (Joint Committee on Vaccination and Immunisation (JCVI), 2020). In 2020, the programme was extended further to everyone over 50 years of age where there was vaccine availability (NHS England, 2020). A phased extension of the seasonal influenza vaccination programme to children began in 2013 (JCVI, 2020) to minimise vector transmission to the vulnerable older adult population. The autumn of 2020 (September–November) was the first time that the seasonal influenza vaccination rates in England for people aged 65 years and older exceeded the World Health Organization (WHO) target of 75% uptake at 77%, with uptake levels in previous years fluctuating between 71% and 75%) (Nuffield Trust, 2021). Yet, despite the annual seasonal influenza vaccination programme, the influenza mortality rate remains notable and has varied over the past 5 years (2015/16–2019/20) between 7371 (2015/16) and 22 087 (2017/18) (Public Health England (PHE), 2020a).

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