The State of Vaccine Confidence

The State of Vaccine Confidence

Download the full report, including details of confidence challenges, strategies, research methods, and the Vaccine Confidence Index.

Confidence Commentary: The VCP Blog Blog archive

World Immunization Week 2015:  “Close the immunization (confidence) gap”

Heidi Larson | April 17, 2015

The theme of this year’s World Immunization Week – celebrated the 24th-30th April 2015 – is “Close the Immunization Gap.”  But, if there is one thing we have learned about closing the immunisation gap, it is that we cannot close that gap without addressing other underlying gaps that successful vaccination depends on.

The World Health Organization’s briefing on this year’s Immunization Week theme points to the gap of 21.8 million infants who did not receive the basic vaccines (according to 2013 data). They highlight the more traditionally acknowledged underlying gaps of “inadequate supply of vaccines, lack of access to health services, a shortage of accurate information about immunization and insufficient political and financial support”.  But, while all of these issues are key to closing the immunisation coverage gap, they miss another important, and increasingly documented, driver of under-vaccination— the vaccine confidence gap.

In 2011, we published a paper in The Lancet called “Addressing the Vaccine Confidence Gap” which mapped out a number of vaccine confidence issues around the world and a few lessons learned, recognising the need for local assessment, measurement and monitoring of vaccine confidence. Also in 2011, a “Global Vaccine Action Plan 2011-2020” was launched and endorsed by the 194 Member States of the World Health Assembly. They too, acknowledged vaccine confidence as one of the indicators which needs monitoring to support the achievement of globally endorsed immunisation goals.  The Global Action Plan specifically called for measuring the “percentage of countries that have assessed (or measured) confidence in vaccination at subnational level” and the “percentage of un- and under-vaccinated in whom lack of confidence was a factor that influenced their decision”.

Confidence in vaccination is a newly acknowledged metric, and has no current baseline. It cannot be measured by immunisation awareness or knowledge surveys, nor by behaviour surveys, as it sits in the divide between awareness and action (or inaction).

Our recently launched report on “The State of Vaccine Confidence: 2015” includes a chapter on “Measuring Vaccine Confidence.” The chapter presents the initial findings of our “Vaccine Confidence Index” which aims to establish a globally relevant metric to monitor public confidence in vaccines and the systems that deliver them. (For a full description of the methods, see:  “Measuring Vaccine Confidence: Introducing a Global Vaccine Confidence Index,”  Larson et al. PLOS Currents Outbreaks, 25 Feb 2015). This metric will not close the vaccine confidence gap on its own, but it can help identify areas of weak or waning confidence where an intervention is needed. 

Where vaccine confidence gaps are evident, local conversations are needed to understand why.  Once understood, addressing these confidence gaps can bring us closer to overcoming the immunisation gaps they influence.