Vaccine Hesitancy

The Vaccine Confidence Project™ is a WHO Centre of Excellence on addressing Vaccine Hesitancy, and is engaged in many strands of research pertaining to vaccine hesitancy, including (but not limited to) the projects described below.


ADVANCE (Accelerated development of vaccine benefit-risk collaboration in Europe) is a five-year IMI-funded project which started in October 2013. It is a unique project which aims to review, develop and test methods, data sources and procedures which should feed into a blueprint of an efficient and sustainable pan-European framework that can rapidly deliver robust quantitative data for the assessment of the benefits and risks of vaccines that are on the market. Such a framework would allow regulators and public health authorities to make fast, informed decisions regarding vaccination strategies, and help to maintain public confidence in vaccines, particularly when questions are raised in the media about the safety of specific vaccines.

The Vaccine Confidence Project™ is responsible for analysing public concerns and perceptions related to benefits and risks of vaccines, analyse key issues and gaps about perception and knowledge on benefits and risks of vaccines, and develop a strategy for public communication in the context of vaccine benefit-risk monitoring.

More information about the project can be found here: 

Vaccine Hesitancy in Europe

 The Vaccine Confidence Project™ has been involved in various projects with the European Centre for Disease Prevention and Control on understanding vaccine hesitancy in Europe, particularly among healthcare workers. The technical reports reporting the findings from these studies are available here.

The latest project, started in September 2016, aims to better understand HPV vaccine hesitancy in Europe.

The Fifth Child Project

The ‘Fifth Child Project’, implemented by IRC, aims to increase vaccination coverage by working with local communities in a way that promotes the principle of shared responsibility for immunisation. Community leaders are encouraged to co-manage vaccination activities with health extension workers and members of the health development army, and parents and caregivers are given more opportunity to discuss, learn about and access immunisation services. New tools like a colour-coded health calendar (Mama Matawesha) and a defaulter tracing tool have been developed and introduced in order to support communication and the timely uptake of vaccinations. 

LSHTM is in charge of the evaluation of the ‘Fifth Child Project’. The purpose of this study is to evaluate the implementation and acceptability of the ‘Fifth Child Project’ and consider how it contributes to supporting the timely uptake of vaccines and increased coverage. The study findings will be used to improve the project and will be shared with health policy makers to inform national strategies for improving immunisation rates.

Vaccine Acceptance in Pregnancy

The Vaccine Confidence Project™ is engaged in research into vaccine uptake during pregnancy, including an anthropological study of facilitators and barriers to vaccine uptake amongst pregnant women, as well as research into the psychological factors involved when pregnant women search for information about vaccines.

Maternal vaccination programmes have been evaluated and found to be extremely effective at preventing illness in pregnant women and new-borns. Vaccine uptake in pregnancy is much higher in the UK than many other countries. Studies have found that in some areas of the USA, uptake is 14.3% for tetanus, diptheria, and acellular pertussis (Tdap), in Australia, 23% for influenza and in China, 1.7% for influenza. These low uptake rates may be due to challenges such as issues around maternal acceptance of vaccines, complex delivery arrangements involving different health care workers (HCW), challenges in data collection and reporting and because the vaccines were relatively newly introduced. Pregnant women and HCW also often feel confused about mixed messages regarding vaccination and medication in pregnancy: usually it is advised that pregnant women do not take many types of medication or live vaccines during pregnancy.  Therefore, introducing these two programmes has involved developing a communication strategy targeted at pregnant women and HCW around the acceptability, safety and effectiveness of the inactivated influenza and acellular pertussis vaccines in pregnancy.

For pregnant women the decision to take the pertussis vaccination during their pregnancy is the culmination of many cognitive, attitudinal and social factors. At the centre of the decision making process a risk assessment is said to occur on two dimensions; perception of risk associated with the disease that a given vaccine is intended to prevent and perception of risk associated with the administration of the vaccine itself. This risk assessment is influenced by past experience and individual differences, while being moderated by attitude towards the vaccination (or vaccination in general) and perceived social norms.

Vaccine Delivery and Confidence in England

 As part of the Health Protection Research Unit (HPRU) in Immunisation, in partnership with Public Health England, we are conducting research to understand factors that contribute to challenges in programme delivery and performances, lack of public confidence in immunisation and poor vaccine uptake. Our research strategy focuses both on the organisation of health systems involved in the immunisation programme and populations with poor vaccination coverage (e.g. elderly, risk groups aged <65 years, pregnant women, health care workers, urban migrants) in order to improve coverage and programme efficiency. We aim to deliver results that feed directly into policy recommendations to ensure that the immunisation programme and related health systems can respond intelligently, rapidly and effectively. Examples of specific research studies include a qualitative study on parental concerns about the influenza vaccine and the 2014/15 school flu pilots in West Yorkshire and Greater Manchester, a qualitative study on parental views of the childhood immunisation programme in the London Charedi orthodox Jewish Community and a PhD study exploring factors influencing vaccination uptake in pregnancy. This grant is funded by the National Institute for Health Research.

In collaboration with UCL, we have carried out a qualitative study exploring how parents and guardians view the seasonal influenza vaccination programme for young children in England, and their preferences as to where and how the vaccine is given, with the aim of informing the implementation of this programme.


Literature Literature archive

Baalen, S. van. 2018 Research Ethics 14(4), 1–17.
Lutz CS, Carr W, Cohn A, Rodriguez L. 2018 Vaccine Volume 36: 7445–7455

Videos Video archive

Key figures share their perspectives on a controversy that led to the suspension of Ebola vaccine clinical trials in Ghana.

Drs. Heidi Larson and Pauline Paterson of the Vaccine Confidence Project join episode 50 of the Public Health United podcast with Nina Martin, November 2017.

Drs. Larson and Paterson join a discussion on vaccine confidence at Hong Kong University.  September, 2015.

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