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Public Health›Condition·Updated Jul 11, 2026·v1

Vaccine Hesitancy

Vaccine hesitancy is a multidimensional behavioral phenomenon on a continuum from acceptance to refusal, driven by confidence, complacency, and convenience factors. Evaluation using validated tools like the VHS or PACV identifies the specific driver. Management centers on a strong provider recommendation, motivational interviewing, and tailored communication addressing the 3Cs. Policy interventions (reminder/recall, financial incentives, mandates) are adjuncts. The strongest predictor of uptake is trust in the healthcare system; digital interventions risk backfire in high-information-avoidance groups. Most hesitant patients can be counseled effectively with empathy and evidence.

High Evidence69 references·1,248 words·5 min read·v1
vaccine hesitancypublic healthvaccinationimmunizationbehavioral phenomenon3Csmotivational interviewingherd immunitymisinformationhealth literacy

Quick Reference

RxDrug of choiceNot applicable; behavioral intervention, motivational interviewing is the most evidence-based direct counseling technique.
AltAlternativesPresumptive approach, autonomy-confirming messages, reminder/recall systems, financial incentives ($50 for influenza).
⊘AvoidAuthoritarian tone, shaming, dismissal from practice without ethical consultation, one-size-fits-all digital messaging for high-information-avoidance groups.
DxTest of choiceVaccine Hesitancy Scale (VHS) for rapid screening; Parent Attitudes about Childhood Vaccines (PACV) for detailed pediatric assessment.
ScKey scoreVHS score: < 25 suggests low hesitancy, 25-50 moderate, > 50 high. In a case-control study, mean VHS was 22.2 for refusers vs. 39.8 for acceptors (p<0.001).
→When to referWhen a child is at imminent risk of serious harm from vaccine-preventable disease due to parental refusal, or when a patient's antivaccination beliefs are deeply entrenched and unresponsive to counseling.
Vaccine hesitancy is common, modifiable, and best addressed by identifying the specific driver (confidence, complacency, or convenience) and using empathy, evidence, and a strong provider recommendation.
Vaccine hesitancy is a complex, context-specific phenomenon defined by WHO SAGE as delay in acceptance or refusal of vaccination despite availability [1][2]. This concise reference distills key clinical facts, validated tools, and evidence-based interventions for bedside use, prioritizing actionable content and critical thresholds.

Overview and Recommendations

Background

  • •Vaccine hesitancy, as defined by the WHO SAGE working group, is a delay in acceptance or refusal of vaccination despite availability of vaccination services. It exists on a continuum from full acceptance through selective acceptance to outright refusal, and is distinct from organized antivaccination movements, which reject vaccination as a principle.
  • •The 3Cs model, Confidence (trust in vaccine safety, efficacy, and the system), Complacency (low perceived risk of disease), and Convenience (access, affordability, health literacy), provides a structured framework for understanding drivers. An expanded 5Cs model adds Calculation (risk-benefit deliberation) and Collective responsibility (duty to protect others).
  • •Prevalence varies widely: up to 40% of caregivers report childhood vaccine hesitancy in high-income settings, and global COVID-19 vaccine hesitancy rose from 18.8% in 2020 to 30.8% in 2022, with highest rates in Africa (42%). The strongest predictor across all populations is low trust in the healthcare system.
  • •Historical drivers, safety concerns, institutional distrust, and personal liberty objections, have persisted since the smallpox era. The 1998 Wakefield MMR-autism fraud caused a lasting trust deficit, and the COVID-19 pandemic amplified politicization and misinformation, with negative sentiment toward childhood vaccination surging from 6.7% to 43.3% by April 2021.
  • •Consequences of hesitancy include erosion of herd immunity (requiring 90-95% coverage for measles), resurgence of vaccine-preventable diseases, and deepening health disparities. Even a 3-5% decline in MMR uptake can drop coverage below the elimination threshold, creating pockets of susceptibility.

Evaluation

  • •Suspect vaccine hesitancy when a patient or caregiver expresses doubt about a vaccine, delays vaccination, or refuses a recommended dose. Do not assume opposition, most hesitant individuals are uncertain, not ideologically opposed.
  • •Assess the specific driver using the 3Cs framework: ask about confidence ('Do you worry about side effects or trust the vaccine?'), complacency ('Do you think the disease is serious enough to vaccinate?'), and convenience ('Are there barriers like cost, time, or transportation?').
  • •Use a validated screening tool for systematic assessment. The Parent Attitudes about Childhood Vaccines (PACV) scale and its Vietnamese version (PACV-Viet, Category A by COSMIN) are recommended for pediatric populations. The Vaccine Hesitancy Scale (VHS, Category B) is a practical 5-10 item tool for general adult screening.
  • •Ask about specific concerns: safety, efficacy, necessity, trust in the healthcare system, fear of side effects, and exposure to misinformation. In pregnancy, focus on fetal safety; in immunocompromised patients, address efficacy and flare risk.
  • •Examine for risk factors: low trust in the healthcare system (strongest predictor), conservative political affiliation (vs. moderate), lower health literacy, migration background, young age, rural location, and low educational attainment.
  • •Check the patient's vaccination history and records. Identify missed doses, delays, and patterns of refusal (e.g., only certain vaccines, only boosters).
  • •Distinguish vaccine hesitancy from antivaccination movements: hesitant individuals are open to information and may be influenced by trusted providers; antivaccination activists reject the scientific consensus and are less responsive to counseling.
  • •Assess the patient's stage of change: pre-contemplation (not considering vaccination), contemplation (ambivalent), preparation (intending but delayed), or action (ready to vaccinate). This guides the intensity of intervention.
  • •For pediatric patients, assess both parents' attitudes. Paternal hesitancy is often higher regarding safety and novelty, and strongly influences uptake. Use the PACV or MVHS-M (Malay version) for cultural adaptation.
  • •Consider contextual factors: historical distrust (e.g., Tuskegee, forced sterilization), religious beliefs, cultural norms (e.g., halal certification for vaccines), and the influence of social media and peer networks.

Management

  • •Deliver a strong, unambiguous provider recommendation as the first-line intervention. Use the presumptive approach: 'We need to give your child the MMR vaccine today', this frames vaccination as the default and increases uptake.
  • •Use motivational interviewing (MI) for patients with moderate hesitancy. A single MI session by a trained counselor reduced hesitancy scores by 10.1/100 points and increased intention by 0.8/10 points at 7 months (French RCT, n=733). However, clinician training in MI alone without ongoing facilitation does not reliably improve uptake.
  • •Address the specific 3C driver identified during evaluation. For confidence issues: provide clear, evidence-based information on safety and efficacy, acknowledge concerns, and share personal experiences (e.g., 'I vaccinated my own children'). For complacency: emphasize disease severity and local outbreak risk. For convenience: offer same-day vaccination, reduce wait times, provide transportation vouchers, or use mobile clinics.
  • •Tailor communication to the patient's stage of change. For pre-contemplation: build trust and explore barriers. For contemplation: discuss pros and cons using shared decision-making. For preparation: make a concrete plan and remove barriers. For action: provide clear instructions and schedule.
  • •Use autonomy-confirming messages for hesitant parents, especially those with conservative political leanings. Affirm their authority ('I respect your role as a parent') while presenting evidence, this increases vaccine confidence compared to authoritarian tones.
  • •Avoid backfire effects when using digital interventions. Social media campaigns can increase hesitancy by +8.9% in individuals with high information avoidance (Instagram trial, n=301). Instead, use bias-aware, personalized content and segment audiences by readiness.
  • •For misinformation exposure, proactively correct myths with factual refutations, but balance with emotional reassurance. Emphasize that vaccines do not cause autism, alter DNA, or contain harmful ingredients. Provide reliable sources such as the CDC or WHO.
  • •Implement reminder and recall systems in clinical practice. Automated phone calls, text messages, or mail reminders increase vaccination rates by 5-20% across settings, especially when combined with patient education.
  • •Consider financial incentives as an adjunct for patients who have resisted prior outreach. A $50 incentive plus reminder nearly doubled influenza vaccination rates at 1 week (0.343% to 0.613%) in a large RCT (n=69,972).
  • •For healthcare workers who are hesitant, address structural barriers first: vaccine availability and cost (global HBV vaccination coverage among nurses is only 44.8%, primarily due to access issues). Then address attitudinal hesitancy with education and peer role models.
  • •For special populations: in pregnancy, use clear data from pregnancy registries to address fetal safety concerns; in elderly, emphasize concrete benefits in the context of polypharmacy; in immunocompromised, discuss reduced but still protective immune responses and safety.
  • •What NOT to do: do not shame or lecture patients; do not dismiss them from the practice without a thorough ethical evaluation; do not assume that providing information alone will change behavior, emotional and trust factors are often more powerful.
  • •When to refer: if a patient has entrenched antivaccination beliefs that are harming a child (e.g., refusal of all vaccines with imminent risk of disease), consult an ethics committee or, in extreme cases, consider legal action to protect the child. The best-interests standard justifies vaccination against parental wishes in rare circumstances.
  • •Monitor vaccination rates at the practice level and track hesitancy over time. Reassess hesitant patients at each visit, as attitudes can shift with new information or personal experiences (e.g., a disease outbreak).
  • •Discharge criteria for vaccine hesitancy counseling: resolution of the specific concern, acceptance of the vaccine (or scheduled appointment), and a plan for catch-up doses. If the patient remains hesitant but not refusing, follow up at the next visit with a targeted approach.

Board Review — High Yield

  • •3Cs model, Framework for vaccine hesitancy: Confidence (trust in safety/system), Complacency (low perceived disease risk), Convenience (access barriers).
  • •Motivational interviewing, Reduces hesitancy by ~10 points on a 100-point scale when delivered by trained counselors (French RCT, n=733).
  • •Presumptive approach, Clinician states 'We need to vaccinate today' as default; increases uptake compared to participatory style.
  • •PACV-Viet, Category A COSMIN-rated instrument for parental hesitancy; assesses behavior, safety concerns, and general attitudes.
  • •Herd immunity threshold, Measles requires 90-95% coverage; even a 3-5% decline in MMR uptake can trigger outbreaks.
  • •COVID-19 hesitancy, Perceived benefit (r=0.40) strongest predictor of acceptance; perceived barriers (r=-0.25) strongest deterrent (Health Belief Model meta-analysis, n=83,995).
  • •Backfire effect, Social media campaigns can increase hesitancy by +8.9% in high-information-avoidance individuals (Instagram trial, n=301).
  • •Trust, The strongest predictor of vaccine uptake across all populations is trust in the healthcare system (machine learning analysis, Alaska survey).
  • •Autonomy-confirming messages, Affirming parental decision-making authority increases vaccine confidence among conservative parents, a group often resistant to mandates.
  • •$50 incentive, Nearly doubled influenza vaccination rates in a 3-arm RCT (n=69,972) when combined with a reminder message.

Deep Dive — Evidence Details

References

  1. [1]

    Kennard A, Kılıç A, Alsugeir D et al.. “A systematic review of the determinants of vaccine hesitancy in the UK: Implications for future TB vaccine adoption.” BMC public health (2026). PMID: 42374300 ↗

    L5SR_OBSCited in: Definition and Conceptual Framework, Epidemiology and Prevalence, Determinants and Causes, Future Directions and Research Gaps
  2. [2]

    Calella P, Pelullo CP, Di Giuseppe G et al.. “Adoption of Focus Groups in Designing Interventions to Address Vaccine Hesitancy Among Adolescents and Their Parents: A Systematic Review.” Vaccines (2025). PMID: 41295482 ↗

    L4SR_OBSCited in: Definition and Conceptual Framework
  3. [3]

    Stuetzle SCW, Willis M, Barnowska EJ et al.. “Factors influencing vaccine hesitancy toward non-covid vaccines in South Asia: a systematic review.” BMC public health (2025). PMID: 40175957 ↗

    L4SR_OBSCited in: Definition and Conceptual Framework
  4. [4]

    Costello LM, Kerns EK, McCulloh RJ et al.. “Hesitancy and confidence in pediatric COVID-19 vaccination among diverse caregivers of unvaccinated children.” Vaccine (2025). PMID: 40472668 ↗

    L1RCTCited in: Definition and Conceptual Framework
  5. [5]

    Ku CP, Christian A, Delacroix E et al.. “Increasing COVID-19 vaccine uptake through motivational interviewing-informed tailored digital intervention: Study protocol.” Contemporary clinical trials (2026). PMID: 41554332 ↗

    L5TRIAL_NONRANDOMCited in: Definition and Conceptual Framework, Communication and Counseling Strategies, Future Directions and Research Gaps
  6. [6]

    Zhao T, Xu Q, Cai X et al.. “Global spatio-temporal distribution of coronavirus disease 2019 vaccine hesitancy between 2020 and 2022: A meta-analysis.” Vaccine (2025). PMID: 40037126 ↗

    L2SR_OBSCited in: Definition and Conceptual Framework
  7. [7]

    Bazar M, Baliga KN, Nayak Panakaje A et al.. “Assessment of effectiveness of health education bundle to overcome vaccine hesitancy in mothers: single blinded randomized study.” BMC research notes (2025). PMID: 40410821 ↗

    L1RCTCited in: Definition and Conceptual Framework
  8. [8]

    Etowa J, Beauchamp S, Fseifes M et al.. “Understanding Low Vaccine Uptake in the Context of Public Health in High-Income Countries: A Scoping Review.” Vaccines (2024). PMID: 38543903 ↗

    L5REVIEW_NARRATIVECited in: Definition and Conceptual Framework
  9. [9]

    White P, Alberti H, Tang E et al.. “Frustrated, hopeless and hesitant: Understanding doctors' learned attitudes and emotions toward vaccine hesitancy through socialisation theory.” Social science & medicine (1982) (2026). PMID: 42431000 ↗

    L4OTHERCited in: Epidemiology and Prevalence, Communication and Counseling Strategies
  10. [10]

    Hassan M, Mitchell A, Inghammar M et al.. “Differences in COVID-19 vaccine acceptance and uptake according to region of birth: findings from a cross-sectional survey in Sweden.” Frontiers in public health (2026). PMID: 42422674 ↗

    L4OTHERCited in: Epidemiology and Prevalence, Determinants and Causes, Consequences and Public Health Impact, Vaccine Hesitancy in the COVID-19 Pandemic
  11. [11]

    Baldiotti ALP, Chi DL. “Caregiver political affiliation is associated with childhood vaccine hesitancy but not fluoride opposition.” Vaccine (2026). PMID: 42418961 ↗

    L4OTHERCited in: Epidemiology and Prevalence
  12. [12]

    Saha PK, Guo J, Khan L et al.. “AI Meets Attitudes: Cross-Sectional Quantitative Study of COVID-19 Vaccine Hesitancy in Alaska's Diverse Communities.” Journal of medical Internet research (2026). PMID: 42413028 ↗

    L4OTHERCited in: Epidemiology and Prevalence, Interventions and Policy Approaches
  13. [13]

    Balcioğlu YS, Karatana Çaliş Ö, Altindağ E. “Popular Attitudes Toward Vaccination During the Initial COVID-19 Vaccination Rollout (December 2020-May 2021): A Social Media Analysis.” Journal of health communication (2026). PMID: 42402954 ↗

    L4OTHERCited in: Epidemiology and Prevalence, Determinants and Causes
  14. [14]

    Seo S, Jo S, Kim H et al.. “Behavioral and psychosocial factors associated with coadministration of COVID-19 and influenza vaccines among the elderly.” BMC public health (2026). PMID: 42399847 ↗

    L4OTHERCited in: Epidemiology and Prevalence
  15. [15]

    Hermann KC, Peralta Chiriboga AA, Fuji KT et al.. “Perceptions, knowledge, and access to the HPV vaccine among parents and healthcare providers in South Quito, Ecuador in 2025: A qualitative study.” Global public health (2026). PMID: 42396795 ↗

    L5OTHERCited in: Epidemiology and Prevalence, Consequences and Public Health Impact
  16. [16]

    Fawaz Y. “Does education shield against vaccine hesitancy? Evidence from the East-West divide.” Social science & medicine (1982) (2026). PMID: 42392028 ↗

    L4OTHERCited in: Epidemiology and Prevalence
  17. [17]

    Donaghy FA, Schlaudecker EP. “Clinical progress note: Influenza.” Journal of hospital medicine (2026). PMID: 42381591 ↗

    L5REVIEW_NARRATIVECited in: Epidemiology and Prevalence
  18. [18]

    Janssen T, Degraeve J, De Coster I et al.. “A systematic review on parental vaccine hesitancy for childhood immunizations in the European region: Can findings be generalized?” Human vaccines & immunotherapeutics (2026). PMID: 42246489 ↗

    L4SR_OBSCited in: Determinants and Causes, Special Populations
  19. [19]

    Hensley AA, Jiles KA, Edwards S et al.. “Characteristics of successful and unsuccessful strategies to increase vaccine intention and improve vaccine uptake for U.S. adult populations in the Affordable Care Act era (2010-2025): a systematic review and meta-regression.” Vaccine (2026). PMID: 42430872 ↗

    L2SR_OBSCited in: Determinants and Causes
  20. [20]

    Kebe AT, Diarra B, Kalossi I et al.. “[Associated factors with vaccine hesitancy in sub-Saharan Africa: a literature review].” The Pan African medical journal (2026). PMID: 42221597 ↗

    L4SR_OBSCited in: Determinants and Causes, Consequences and Public Health Impact, Interventions and Policy Approaches, Vaccine Hesitancy in the COVID-19 Pandemic
  21. [21]

    Medeleanu MV, Gill EE, Winsor GL et al.. “Vaccination attitudes and intentions reported by Canadian children and their parents in the CHILD Cohort Study during the COVID-19 pandemic.” BMC public health (2026). PMID: 42192359 ↗

    L2COHORTCited in: Determinants and Causes
  22. [22]

    Malik ZI, Ahmad AMR, Iqbal S. “Determinants of HPV vaccine hesitancy in South Asia: a systematic review.” Clinical and experimental vaccine research (2026). PMID: 42099699 ↗

    L4SR_OBSCited in: Determinants and Causes, Interventions and Policy Approaches, Special Populations
  23. [23]

    Aung TN, Muyindike W, Hoeppner SS et al.. “COVID-19 vaccination among people with HIV in Uganda: lessons from a high-risk group with high vaccine uptake for the next pandemic.” Vaccine (2026). PMID: 42430873 ↗

    L4OTHERCited in: Determinants and Causes
  24. [24]

    Brown J, Brennan H, Levine CB et al.. “A historical overview of the anti-vaccine movement and its public health implications.” Vaccine (2026). PMID: 42391692 ↗

    L5OTHERCited in: Determinants and Causes, Measurement and Assessment Tools
  25. [25]

    Putri ND, Fuady A, Soeharno N et al.. “How can new TB vaccines be effectively introduced in Indonesia? Insights from diverse stakeholders.” PLOS global public health (2026). PMID: 42391251 ↗

    L5OTHERCited in: Determinants and Causes
  26. [26]

    Derakhshani L, Feddern S, Grüne B et al.. “Factors influencing vaccination willingness in the context of the COVID-19 pandemic: data from the CoCo-Fakt study.” BMC public health (2026). PMID: 42351071 ↗

    L4OTHERCited in: Determinants and Causes
  27. [27]

    Özmen Sever S, Aksu SB, Zeren Öztürk G. “Changes in childhood vaccine hesitancy during the COVID-19 pandemic: a retrospective study based on data from Turkey.” Italian journal of pediatrics (2026). PMID: 41857752 ↗

    L2COHORTCited in: Consequences and Public Health Impact
  28. [28]

    Cao T, Chen B, Chen S et al.. “Instruments for measuring parents' vaccine hesitancy towards their children based on the COSMIN guidelines: A systematic review.” Vaccine (2026). PMID: 42140092 ↗

    L4SR_OBSCited in: Consequences and Public Health Impact, Measurement and Assessment Tools, Special Populations
  29. [29]

    Lihemo G, Blunt M, Dadari I et al.. “The impact of COVID-19 on general vaccine acceptance in low- and middle-income countries: a systematic review.” Frontiers in public health (2026). PMID: 41810312 ↗

    L2SR_OBSCited in: Consequences and Public Health Impact, Vaccine Hesitancy in the COVID-19 Pandemic
  30. [30]

    Sithole MN, Khan MR, Mohammed HA et al.. “A systematic review on vaccine developmental approaches: Evaluating efficacy, and addressing challenges of infectious diseases in the post-COVID-19 era.” Virus research (2026). PMID: 41932444 ↗

    L5SR_OBSCited in: Consequences and Public Health Impact, Vaccine Hesitancy in the COVID-19 Pandemic, Future Directions and Research Gaps
  31. [31]

    AlRadini FA, Alibrahim JM, Almasoud RS et al.. “Predicting Human Papillomavirus Vaccination Uptake in Saudi Arabia: Analyzing Health Belief Model Constructs, Vaccine Hesitancy, and Pap Smear Uptake.” Vaccines (2026). PMID: 42347642 ↗

    L4OTHERCited in: Consequences and Public Health Impact
  32. [32]

    Leonforte F, Nicosia V, Comite P et al.. “Media Exposure and Its Association With Vaccine Attitudes, Intentions, and Hesitancy: Systematic Review.” Journal of medical Internet research (2026). PMID: 42061834 ↗

    L2SR_OBSCited in: Measurement and Assessment Tools, Special Populations, Vaccine Hesitancy in the COVID-19 Pandemic
  33. [33]

    Taseen S, Ayub R, Noman GEL et al.. “Leveling up immunization: a systematic review of gamification interventions to improve Human Papillomavirus (HPV) vaccine uptake.” BMC public health (2026). PMID: 41673627 ↗

    L2SR_OBSCited in: Measurement and Assessment Tools
  34. [34]

    Menin IBF, Dias ADC, da Rosa MI et al.. “COVID-19 vaccine hesitancy among people with epilepsy: an updated systematic review and meta-analysis.” Seizure (2026). PMID: 42068729 ↗

    L2SR_OBSCited in: Measurement and Assessment Tools, Vaccine Hesitancy in the COVID-19 Pandemic
  35. [35]

    Maltezou PG, Papakonstantinou ME, Kourkouni E et al.. “Influenza and Pertussis Vaccination During Pregnancy: A Systematic Review of Vaccination Rates and Vaccination Determinants.” Vaccines (2026). PMID: 42042801 ↗

    L2SR_OBSCited in: Measurement and Assessment Tools
  36. [36]

    Deger VB, Butun A. “Health literacy and vaccination attitudes among parents from different ethnic groups: a health belief model approach.” BMC public health (2026). PMID: 42380835 ↗

    L4OTHERCited in: Measurement and Assessment Tools
  37. [37]

    Aydemir Ö, Yıldırım-Öztürk EN, Koç M. “Childhood Vaccine Refusal: Sociodemographic, Behavioral, and Vaccine Confidence Factors in Konya, Türkiye.” Vaccines (2026). PMID: 42347659 ↗

    L3OTHERCited in: Measurement and Assessment Tools
  38. [38]

    Menicagli D, Casigliani V, Panizza F et al.. “HPVoice: a single-blind three-arm RCT on social media communication strategies among adolescents in Tuscany, Italy.” Vaccine (2026). PMID: 41855647 ↗

    L1RCTCited in: Communication and Counseling Strategies, Interventions and Policy Approaches
  39. [39]

    Seal KH, Kaplan A, Manuel JK et al.. “A Cluster Randomized Trial of a Vaccination Communication Educational Intervention: Impact on COVID-19 Vaccine Uptake in Veterans.” Journal of general internal medicine (2026). PMID: 41680545 ↗

    L1RCTCited in: Communication and Counseling Strategies, Vaccine Hesitancy in the COVID-19 Pandemic
  40. [40]

    Chang TY, Jacobson M, Shah M et al.. “Impact of reminder messages, with and without financial incentives, on influenza vaccination: A randomized trial in a California health system.” Vaccine (2026). PMID: 41604808 ↗

    L1RCTCited in: Communication and Counseling Strategies
  41. [41]

    Ramalli L, Cogordan C, Fressard L et al.. “Sustained impact of motivational interviewing on reducing vaccine hesitancy among postpartum mothers: A randomized control trial, Southeastern France, 2021 to 2022.” Human vaccines & immunotherapeutics (2026). PMID: 41628064 ↗

    L1RCTCited in: Communication and Counseling Strategies
  42. [42]

    Çeleğen İ, Sarıöz A. “Exposure to health misinformation on social media across key health domains: a systematic review and meta-analysis of survey-based studies.” BMC public health (2026). PMID: 41918096 ↗

    L2SR_OBSCited in: Communication and Counseling Strategies, Special Populations
  43. [43]

    Nazari A, Ataei R, Heydarifard Z et al.. “Social media-based interventions for improving vaccine uptake, reducing hesitancy, and combating misinformation: a comprehensive systematic review and meta-analysis of RCT.” BMC public health (2026). PMID: 41904410 ↗

    L1SR_OBSCited in: Communication and Counseling Strategies, Interventions and Policy Approaches
  44. [44]

    Gabellone V, Nuccetelli F, Gabrielli E et al.. “Exploring determinants of vaccine hesitancy among healthcare professionals: a systematic literature review.” Expert review of vaccines (2025). PMID: 41431219 ↗

    L2SR_OBSCited in: Communication and Counseling Strategies
  45. [45]

    Takemura T, Nishikawa Y, Inoue K et al.. “Association of Health Literacy and Information Sources With COVID-19 Booster Vaccine Hesitancy in Japan: A Cohort Study.” Asia-Pacific journal of public health (2026). PMID: 41721650 ↗

    L2COHORTCited in: Communication and Counseling Strategies
  46. [46]

    Huth D, Hennemann S, Witthöft M et al.. “Effectiveness of a video-based intervention for COVID-19 vaccine acceptance among individuals with mental disorders: a randomized online experiment.” Frontiers in public health (2026). PMID: 42415765 ↗

    L1RCTCited in: Interventions and Policy Approaches, Vaccine Hesitancy in the COVID-19 Pandemic
  47. [47]

    Rahman S, Zhang C, Khan A et al.. “Institutional factors influencing vaccine access in Canada: a scoping review.” BMC public health (2026). PMID: 42056955 ↗

    L5SR_OBSCited in: Interventions and Policy Approaches
  48. [48]

    Pennisi F, Lunetti C, Barbati C et al.. “Interventions Addressing Vaccine Hesitancy in the WHO European Region and in North America (United States and Canada): A Systematic Review.” Public health reviews (2026). PMID: 42051244 ↗

    L2SR_OBSCited in: Interventions and Policy Approaches
  49. [49]

    Zappullo I, Catalano L, De Biase R et al.. “Tailoring educational interventions targeting parental vaccine hesitancy: a systematic review of quantitative studies.” Frontiers in public health (2026). PMID: 42022818 ↗

    L2SR_OBSCited in: Interventions and Policy Approaches, Special Populations
  50. [50]

    Gulati RR, Yaqub F, Goodman AL. “Enhancing uptake of respiratory vaccinations in asthma and chronic obstructive pulmonary disease (COPD) patients: a systematic review.” Vaccine (2026). PMID: 42000586 ↗

    L2SR_OBSCited in: Interventions and Policy Approaches
  51. [51]

    Rosso A, Riccio M, Renzi E et al.. “The role of school-based health education in promoting childhood and adolescent vaccination: A systematic review and Meta-analysis.” Vaccine (2026). PMID: 41887023 ↗

    L1SR_OBSCited in: Interventions and Policy Approaches
  52. [52]

    Ekezie W, Connor A, Gibson E et al.. “Intervention Strategies for Healthcare Workers to Promote Vaccine Uptake in Ethnic Minority Populations: A Systematic Review of Behaviour Change Techniques.” Healthcare (Basel, Switzerland) (2026). PMID: 41897203 ↗

    L2SR_OBSCited in: Interventions and Policy Approaches, Special Populations
  53. [53]

    Amanat N, Hosseini SH, Habibisaravi R et al.. “COVID-19 vaccination hesitancy in pediatrics: a systematic review.” Systematic reviews (2026). PMID: 41998754 ↗

    L4SR_OBSCited in: Special Populations, Vaccine Hesitancy in the COVID-19 Pandemic
  54. [54]

    Cheng D, Duan D. “Global uptake of complete hepatitis B vaccination among nurses: a systematic review and meta-analysis.” The Journal of hospital infection (2026). PMID: 41935745 ↗

    L4SR_OBSCited in: Special Populations
  55. [55]

    Alanazi YA, Albilasi B, Almaa Z et al.. “Paternal vaccine hesitancy and its impact on childhood immunization coverage in Saudi Arabia: A systematic review.” Journal of infection and public health (2026). PMID: 41935439 ↗

    L4SR_OBSCited in: Special Populations
  56. [56]

    Akazili J, Anaseba D, Chatio S et al.. “Factors affecting equitable access and uptake of COVID-19 vaccines in Ghana: a scoping review.” Frontiers in public health (2026). PMID: 41777372 ↗

    L5SR_OBSCited in: Vaccine Hesitancy in the COVID-19 Pandemic
  57. [57]

    Li R, Vafeiadis M, Shen F et al.. “The role of health beliefs in COVID-19 vaccination acceptance: A Meta-analysis.” Vaccine (2026). PMID: 41723921 ↗

    L4SR_OBSCited in: Vaccine Hesitancy in the COVID-19 Pandemic
  58. [58]

    Güzel S, Baysal HY, Türkoğlu N et al.. “Factors ınfluencing vaccine refusal in children: an umbrella review on COVID-19 and childhood vaccinations.” BMC public health (2026). PMID: 41593575 ↗

    L5SR_OBSCited in: Vaccine Hesitancy in the COVID-19 Pandemic
  59. [59]

    Ilboudo DP, Simpore A, Sawadogo J et al.. “Acceptance, hesitancy, and ethical challenges of the COVID-19 vaccine in sub-Saharan Africa: a systematic review and meta-analysis.” Vaccine (2025). PMID: 41253021 ↗

    L4SR_OBSCited in: Ethical and Legal Considerations
  60. [60]

    Khuu E, Moussaoui S, Vignier N et al.. “Vaccine hesitancy among migrant populations in Europe: A mixed-methods systematic review.” Vaccine (2025). PMID: 41202609 ↗

    L4SR_OBSCited in: Ethical and Legal Considerations
  61. [61]

    Wiley K, Christou-Ergos M, Degeling C et al.. “Childhood vaccine refusal and what to do about it: a systematic review of the ethical literature.” BMC medical ethics (2023). PMID: 37940949 ↗

    L5SR_OBSCited in: Ethical and Legal Considerations
  62. [62]

    Bianchi FP, Stefanizzi P, Martinelli A et al.. “COVID-19 vaccination hesitancy in people affected by diabetes and strategies to increase vaccine compliance: A systematic narrative review and meta-analysis.” Vaccine (2023). PMID: 36690559 ↗

    L4SR_OBSCited in: Ethical and Legal Considerations
  63. [63]

    Cotter LM, Hopkins-Sheets M, Yang S et al.. “Increasing confidence for pediatric COVID-19 and influenza vaccines using messages affirming parental autonomy: A randomized online experiment.” Vaccine (2025). PMID: 40031087 ↗

    L1RCTCited in: Ethical and Legal Considerations
  64. [64]

    Pereira da Silva A, Castaneda LR, Cavalcante de Oliveira AP et al.. “COVID-19 Vaccination Acceptance and Hesitancy in Healthcare Workers and the General Population: A Systematic Review and Policy Recommendations.” International journal of environmental research and public health (2024). PMID: 39338017 ↗

    L4SR_OBSCited in: Ethical and Legal Considerations
  65. [65]

    Bianchi FP, Stefanizzi P, Cuscianna E et al.. “COVID-19 vaccination hesitancy among Italian parents: A systematic review and meta-analysis.” Human vaccines & immunotherapeutics (2023). PMID: 36698309 ↗

    L4SR_OBSCited in: Ethical and Legal Considerations
  66. [66]

    Moini A, Rabiei M, Pirjani R et al.. “COVID‑19 vaccine hesitancy among pregnant women and their reported reasons for vaccine refusal - A prospective study in Tehran, Iran.” Vaccine (2023). PMID: 36707338 ↗

    L4COHORTCited in: Ethical and Legal Considerations
  67. [67]

    Piltch-Loeb R, Shen Y, Fleary S et al.. “Testing Theory-Enhanced Messaging to Promote COVID-19 Vaccination Among Adults: Randomized Controlled Trial.” Journal of medical Internet research (2025). PMID: 41057045 ↗

    L1RCTCited in: Future Directions and Research Gaps
  68. [68]

    Lo Moro G, Ferrara M, Langiano E et al.. “Determinants of vaccine hesitancy and interventions aimed at contrasting this issue in Europe: an overview of systematic reviews.” Annali dell'Istituto superiore di sanita (2026). PMID: 41867157 ↗

    L5SR_OBSCited in: Future Directions and Research Gaps
  69. [69]

    Opaleye OO, Esan DT. “Mobile health strategies to improve HPV vaccination uptake among parents of adolescent girls: a scoping review.” Vaccine (2026). PMID: 42134133 ↗

    L5REVIEW_NARRATIVECited in: Future Directions and Research Gaps

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