The importance of broader societal context in addressing vaccine hesitancy

This is a news item written by the Ghent Universtiy (UGent) team based mainly on the findings from the VAX-TRUST Work Package 2 ”A situation analysis of vaccine hesitancy in the Target Regions and Europe”. UGent is the leader of Work Package 2.

The complexity of vaccine hesitancy

The variety of individual barriers to the acceptance of vaccination is well-documented. “Much previous research has devoted attention to the individual-level determinants of vaccine hesitancy”, says Katrijn Delaruelle, a researcher in the VAX-TRUST project from the Ghent University. Vaccine hesitancy is often affected by people’s risk perception of vaccination. These concerns can be rooted in past experiences with vaccination services and the healthcare system, orientation towards mainstream medicine and use of Complementary and Alternative Medicine. Other factors, such as religious and philosophical beliefs, ethnicity, household composition, age, educational attainment, socio-economic status and income level also play a role in shaping people’s opinions about vaccination.

Moving beyond the individual

There is a large degree of cross-national variation in attitudes towards vaccination: “While the pattern for the Czech Republic is less clear-cut, the other countries of the VAX-TRUST consortium reveal disparities. Citizens in Finland, the UK, and Portugal generally report more positive vaccine attitudes, other countries, such as Poland, Belgium and Italy tend to show more negative vaccine attitudes”, explains Katrijn Delaruelle.

This highlights the need to go beyond the individual. “After reviewing the academic literature, we concluded that past research has largely ignored that people’s attitudes towards vaccines may additionally be shaped by the societal conditions in which they are living and working: citizens with a specific socio-demographic profile in certain countries have more positive attitudes towards vaccines than citizens with a similar profile from other countries”, states professor Piet Bracke, a leading scholar of the VAX-TRUST consortium from the Ghent University. To address the impact of the contextual factors which can influence vaccine hesitancy, the VAX-TRUST project takes a macro-sociological approach.

The significance of contextual factors

Our analysis from the Special Eurobarometer 488 and other public data sources pointed towards two contextual factors: healthcare corruption and societal trust. This means that people are more likely to attach great importance to vaccines and to assess vaccines as (highly) effective in countries where the practice of giving and taking bribes in the healthcare system is virtually absent, as well as in countries where people have greater trust in one another.

“In some cases, contextual factors affect attitudes towards vaccination in particular social groups”, adds Melissa Ceuterick, researcher in the VAX-TRUST project from the Ghent University. For instance, the institutionalization of a preventive lifestyle affects differences in the perceived effectiveness and importance of vaccines by age, educational attainment, and number of children. Additionally, while the effectiveness of vaccines is more regularly questioned in countries characterized by large degrees of institutional trust in the social media, this is more pronounced among men and the shorter educated. Lastly, the characteristics of the primary healthcare system’s structure are crucial to acknowledge when analyzing age differences in vaccine importance.


The results underscore the importance of devoting attention to the contextual conditions when studying vaccine hesitancy and its determinants. “Context sensitivity and flexibility are crucial when studying people’s attitudes towards vaccines”, concludes Piet Bracke. These results will be taken into account as VAX-TRUST proceeds.