Vaccine hesitancy: Definition, scope and determinants — TEI-tagged view

Noni E. MacDonald · 2015 · social-sciences · doi:10.1016/j.vaccine.2015.04.036 · TEI xml · tagged edition · index · concepts · authors
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This record’s own method is expert-consensus, and the tags below follow from that. A review’s findings, quantities and statistics are things stated IN this paper, and some of them report results obtained elsewhere. No tag on this page names a different author. Measured across every review in this corpus, 81% of a review’s tags carry no citation at all — most of them are the review speaking. The corpus does not adjudicate the rest: read an unmarked tag as a claim this paper makes, not necessarily one it made first.
Other fields define these differently the same word, defined another way in another discipline
confidence 5 fields · trust 4 fields · communication 3 fields · vaccine hesitancy 2 fields · education 2 fields
Tags on this paper every tag the record carries, whether or not the words occur in the text below — a number is how many papers in the corpus carry that tag; a tag with no number is unique to this paper
vaccine hesitancy10 vaccination hesitancy vaccine demand confidence8 complacency2 convenience3 trust13 communication9 determinant vaccine hesitancy determinants social determinants of health5 Vaccine Hesitancy Determinants Matrix expert-consensus69
Method, as described: a working group deliberating: review of the literature and of existing conceptual models, a commissioned systematic review of determinants, field reports, and a commissioned survey of immunization managers - then a decision

Our tag layer for this paper

Cross-disciplinary analysis
content-tags & facets: phenomenon · claim-type · cross-domain-transfer · mechanism · claim-relation · replication-status · limitation — grounded in the full text
phenomenondelay or refusal of vaccination where services are available - a behaviour lying on a continuum between full acceptance and outright refusal, and heterogeneous everywhere between— “Hesitancy is thus set on a continuum between those that accept all vaccines with no doubts, to complete refusal with no doubts, with vaccine hesitant individuals the heterogeneous group between these two extremes”
claim-typemethod— “The Working Group concluded that this practical definition of vaccine hesitancy was needed in order to ensure that Immunization Programme Managers, policy makers, clinicians and researchers would consistently use a standard term to cover the broad range of factors causing low vaccination uptake while excluding those not related to…
method — evidence— “After review of models and much discussion about factors that can influence hesitancy, the WG developed the Vaccine Hesitancy Determinants Matrix with factors grouped in three categories: contextual, individual and group and vaccine/vaccination-specific influences ( Table 1). The Matrix includes determinants identified from research studies…
object of study — evidence— “As review of the literature did not reveal an established definition, the WG, in its early meetings, discussed at some length whether ‘hesitancy’ was the most appropriate word to describe the problem. Concerns were raised that hesitancy has a negative connotation.”
research question — evidence— “The Working Group concluded that this practical definition of vaccine hesitancy was needed in order to ensure that Immunization Programme Managers, policy makers, clinicians and researchers would consistently use a standard term to cover the broad range of factors causing low vaccination uptake while excluding those not related to…
contribution — evidence— “Following its deliberations, the WG decided upon the following definition: _Vaccine hesitancy refers to delay in acceptance or refusal of vaccination despite availability of vaccination services. Vaccine hesitancy is complex and context specific, varying across time, place and vaccines. It is influenced by factors such as complacency…
mechanismthe paradox the definition has to accommodate: `Immunization programme success may, paradoxically, result in complacency and ultimately, hesitancy`, because the risk of the disease falls out of view as the vaccine works. The determinant is generated by the intervention's own successmechanisms[0]
mechanismand the asymmetry that the term must not hide: `When rates of hesitancy are high, levels of demand are low, but low rates of hesitancy do not necessarily mean that demand will be high`. Removing hesitancy does not produce demand, so the two cannot be used as each other's proxy
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mechanisms[1]
extends the '3 Cs' model proposed to the WHO EURO Vaccine Communications Working Group in 2011 - adopted into the definition BECAUSE it was the most readily understandable
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claim_relations[0]
supports the Global Vaccine Action Plan's Strategic Objective 2, which asks that communities 'demand immunization as both their right and responsibility' - the definition is written to serve a programme goal, not only to settle a term
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claim_relations[1]
contradicts the treatment of vaccine hesitancy determinants as social determinants of health, whose variables have a fixed direction
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claim_relations[2]
sensevaccine hesitancy - THE DEFINITION, VERBATIM: `delay in acceptance or refusal of vaccination despite availability of vaccination services ... complex and context specific, varying across time, place and vaccines ... influenced by factors such as complacency, convenience and confidence`. THREE OF THE FOUR CLAUSES ARE HEDGES, and the operative one is `despite availability`
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senses[0]
sense`vaccine` versus `vaccination` hesitancy - THE PAPER'S OWN GLOSS SAYS THE CHOSEN NAME IS THE WRONG ONE: the former `implies that the core issue is vaccine related`, the latter `covers a much wider range of factors`, and the group took the former while meaning the latter. THE DEFINING PROPERTY IS A COMMITTEE DECISION, RECORDED
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senses[1]
senseconfidence - REJECTED AS THE NAME AND KEPT AS A COMPONENT. `The most commonly offered alternative in the literature`, `a more positive word`, refused because it is `still narrow in scope covering only one category of factors` - and then installed as one of the three Cs inside the definition it lost to
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senses[2]
senseconfidence, the component - `defined as trust in (i) the effectiveness and safety of vaccines; (ii) the system that delivers them ...; and (iii) the motivations of policy-makers`. Two of the three objects of that trust are institutions, not vaccines
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senses[3]
sensevaccine acceptance / uptake - EXCLUDED AS NAMES because `neither captured the concept breadth`, with the worked reason given: `one might accept a vaccine but delay in accepting it`. A term rejected for being satisfiable by the wrong case
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senses[4]
sensehesitancy determinants - EXPLICITLY NOT SOCIAL DETERMINANTS OF HEALTH: `education and socio-economic status do not influence hesitancy in only one direction`, whereas as a social determinant `education drives in one direction`. A variable whose sign is not fixed cannot be used the way the neighbouring literature uses it
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senses[5]
controlwhether the Matrix had missed any determinant - the paper checks it against a commissioned systematic review and a commissioned managers' survey — partial
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— rules out little, and the reason is visible in the Matrix's own construction: it was built from research studies, WG field experience and expert discussion, which overlaps the sources it is then checked against. The paper reports the check and claims no independence for it
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controls[0]
controlwhether low uptake caused by system failure is being counted as hesitancy — failed
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— rules out the confound in principle - 'in these situations hesitancy is not the main explanation' - but no procedure is given for telling them apart in a real population, and the conclusions repeat the warning rather than resolving it
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controls[1]
controlwhether hesitancy and demand can be treated as one quantity — held
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— rules out the identification, by a stated asymmetry: high hesitancy implies low demand, and low hesitancy DOES NOT imply high demand
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controls[2]
controlwhether 'confidence' would have served as the name, tested against scope rather than against sentiment — held
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— rules out the alternative term - it covers 'only one category of factors' - though the objection raised against 'hesitancy' itself, its negative connotation, is recorded and never answered
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controls[3]
weightthe '3 Cs' model proposed to the WHO EURO Vaccine Communications Working Group in 2011 - adopted into the definition BECAUSE it was the most readily understandable — 0.85
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claim_relations[0]
weightthe Global Vaccine Action Plan's Strategic Objective 2, which asks that communities 'demand immunization as both their right and responsibility' - the definition is written to serve a programme goal, not only to settle a term — 0.7
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claim_relations[1]
weightthe treatment of vaccine hesitancy determinants as social determinants of health, whose variables have a fixed direction — 0.75
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claim_relations[2]
edgeconfidence —operationalised-as→ trust
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concept_edges[0]
edgevaccine hesitancy —distinct-from→ vaccine demand
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concept_edges[1]
edgecommunication —distinct-from→ determinant
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concept_edges[2]
edgevaccine hesitancy determinants —distinct-from→ social determinants of health
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concept_edges[3]
edgevaccine hesitancy —contrasted-with→ vaccination hesitancy
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concept_edges[4]
outcomecontrol — partial
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controls[0]
outcomecontrol — failed
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controls[1]
outcomecontrol — held
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controls[2]
outcomecontrol — held
Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher.
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controls[3]
limitationTHE NAME WAS CHOSEN AGAINST ITS OWN SEMANTICS AND THE PAPER SAYS SO. `vaccine hesitancy` implies `the core issue is vaccine related`, while `vaccination hesitancy` covers `a much wider range of factors` - and the WG `nevertheless chose to adopt the term vaccine hesitancy but defining it in the broader sense`. The two reasons given are both institutional: SAGE'S OWN TERMS OF REFERENCE, and EXISTING USAGE
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limitations[0]
limitationthe word was kept over a stated objection to its connotation - `Concerns were raised that hesitancy has a negative connotation` - and the more positive alternative was rejected on scope rather than on accuracy
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limitations[1]
limitationthe definition is RELATIVE TO A TARGET, which makes it a moving quantity: hesitancy is `measured against an expectation of reaching a specific vaccination coverage goal, given the immunization services available`. The same behaviour is more or less hesitant depending on the goal set for the population
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limitations[2]
limitationthe boundary against system failure is asserted rather than operationalised: where uptake is low because of stock-outs or conflict, `hesitancy is not the main explanation` - but the paper gives no procedure for deciding, in a given population, which it is. It only says the decision is `ESSENTIAL for the selection of interventions`
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limitations[3]
limitationthe model was chosen for COMPREHENSIBILITY, not for fit: the 3 Cs were adopted `As this model was viewed as being the most readily understandable`, and those three words then entered the definition itself. A selection criterion about readers became a property of the concept
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limitations[4]
limitationTHE MATRIX WAS BUILT FROM THE SOURCES IT IS LATER CHECKED AGAINST: `determinants identified from research studies, experiences of WG members in the field, and discussions with experts`. The paper does report a completeness check against the commissioned systematic review and the managers' survey, and it comes back empty - but those are two of the same three inputs, so the check is agreement with itself. (The sentence reporting it carries a URL inside each subject and cannot be quoted; see the harness note.)
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limitations[5]
limitationand the Matrix is disclaimed as an instrument: `while not primarily intended as a practical tool, may be helpful` - offered to survey-question developers while declining responsibility for being a measure
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limitations[6]
limitationthe funding disclosure sits directly on the concept: the group monitoring `public confidence in Immunization Programs` took research funding from Novartis and meeting funding from GSK, and one author consulted for GSK ON VACCINE CONFIDENCE. Declared, and worth recording because `confidence` is one of the three words in the definition
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limitations[7]
Content tags
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finding
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quantitythe number of Cs - complacency, convenience, confidence - carried from a communications working group's model into a WHO definition
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content_tags.quantities[0]
variableeducation
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content_tags.variables[0]
variablesocio-economic status
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content_tags.variables[1]
definitionvaccine hesitancy
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content_tags.definitions[0]
definitionconfidence
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content_tags.definitions[1]
definitioncomplacency
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content_tags.definitions[2]
definitionconvenience
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content_tags.definitions[3]
Concepts
terms this paper carries, each with the sentence it was cut from — the layer that joins one paper to another. Terms with no quote yet are on CONCEPTS.html.
conceptvaccine hesitancy — not defined in this paper's own words; delay in acceptance or refusal of vaccination DESPITE AVAILABILITY of vaccination services; complex, context specific, and influenced by complacency, convenience and confidence
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concepts[0]
conceptvaccination hesitancy — not defined in this paper's own words; the term the group did NOT adopt, which by its own account covers the wider range of factors the definition actually intends
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concepts[1]
conceptvaccine demand — not defined in this paper's own words; a distinct quantity on the same continuum - not the complement of hesitancy, because low hesitancy does not imply high demand
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concepts[2]
conceptconfidence — not defined in this paper's own words; trust in the effectiveness and safety of vaccines, in the system that delivers them, and in the motivations of policy-makers
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concepts[3]
conceptcomplacency — not defined in this paper's own words; the state where perceived risks of vaccine-preventable disease are low and vaccination is not deemed necessary
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concepts[4]
conceptconvenience — not defined in this paper's own words; physical availability, affordability, geographical accessibility, comprehensibility and appeal of immunization services
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concepts[5]
concepttrust — not defined in this paper's own words; what confidence is defined as - and its objects include the delivery system and policy-makers, not only the vaccine
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concepts[6]
conceptcommunication — not defined in this paper's own words; ruled A TOOL AND NOT A DETERMINANT, though poor communication is allowed to contribute to hesitancy
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concepts[7]
conceptdeterminant — not defined in this paper's own words; the category communication was refused entry to; the Matrix's unit
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concepts[8]
conceptvaccine hesitancy determinants — not defined in this paper's own words; factors that influence hesitancy in EITHER direction - the property that separates them from social determinants of health
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concepts[9]
conceptsocial determinants of health — not defined in this paper's own words; the neighbouring family the paper distinguishes itself from, on the grounds that its variables have a fixed sign
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concepts[10]
conceptVaccine Hesitancy Determinants Matrix — not defined in this paper's own words; three categories - contextual, individual and group, and vaccine/vaccination-specific - built from studies, WG field experience and expert discussion
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concepts[11]

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