Vaccine hesitancy

Vaccine hesitancy describes people who delay accepting a vaccine, or refuse it, even though services are available. The important phrase is despite availability: these people could be vaccinated.

Hesitancy sits between full acceptance and outright refusal, and many people delay rather than refuse. The WHO expert advisory group describes it as influenced by factors such as complacency, convenience and confidence. Roughly, complacency means not seeing the disease as a real threat, convenience is how easy vaccination is to obtain, and confidence is how far people trust the vaccine and the system. Hesitancy still means that services are available: being unable to reach them is an access barrier.

Key clues are free, accessible clinics and repeated postponing; hesitancy is often driven by safety concerns or misinformation.

Access problems, medical contraindications and vaccine failure are different from hesitancy. Extreme needle phobia (a specific fear of needles) and allergy to vaccines or medicines do exist, but they explain only a fraction of the people who will not accept a vaccine, and reassurance, counselling and appropriate safety precautions can address them. After a significant allergic reaction, further doses may be contraindicated, and specialist advice is then needed. A contraindication (a medical reason not to give a vaccine) is a legitimate safety exclusion. It is not a decision to delay or refuse, so it is not hesitancy.

With a hesitant patient, ask about their concerns, give personalised information on the risks and benefits of vaccination, and respect their decision. Vaccines are best given on time, but most vaccines can still be caught up if missed.