Lancet: The state of vaccine confidence

25 November, 2018

Below are the citation and extracts from a Comment in this week's print Lancet (24 November) by Heidi Larson, Director of The Vaccine Confidence Project, and a comment from me.

Heidi Larson. Lancet: The state of vaccine confidence

Comment| volume 392, issue 10161, p2244-2246, november 24, 2018

Published: November 24, 2018



First, investment is needed at local levels to monitor public sentiments and fund the resources to respond...

Second, investment is needed for piloting and implementing strategies to find out what works best. There is a wealth of new research and proposed solutions to address vaccine hesitancy and build confidence...

Third, dialogue, including through social media, is important. Public health officials too often shy away from social media, but they and other relevant stakeholders need to go where the discussions are happening and where influence is being leveraged...

Fourth, more opportunities need to be created — eg, in clinics and schools — for parents and other stakeholders to discuss their questions and concerns. The power of listening and dialogue should never be underestimated.

Finally, more support is needed for those on the front line of questioning... anticipating questions and preparing answers in advance can support health-care workers and officials who are confronted with difficult questions.

Although there are some positive initiatives to address vaccine hesitancy, the spread of misinformation is moving quickly and boldly, appealing to emotions and heightening anxieties...


Comment (Neil): These four recommendations make sense, but the prioritisation and feasibility of implementing them will vary according to context. To reduce polio vaccine hesitancy in Afghanistan or Pakistan is a different challenge to reducing MMR vaccine hesitancy in Italy or Romania. There has been limited research, particularly in LMICs. However, a recent Cochrane review (not cited in the above paper) concluded: 'There is low- to moderate-certainty evidence suggesting that face-to-face information or education may improve or slightly improve children's vaccination status, parents' knowledge, and parents' intention to vaccinate.'

The WHO website has an excellent overview of vaccine hesitancy with practical resources in different languages. These deserve to be more widely known and applied:

Heidi Larson's recommendation on health education in schools is, I think, particularly important. A great example of this is the 10 messages for children on immunisation by Children for Health:

Best wishes, Neil

Coordinator, HIFA Project on Information for Citizens, Parents and Children:

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - ), a global community with more than 18,000 members in 177 countries, interacting on six global forums in four languages. He also currently chairs the Dgroups Foundation (, which supports 800 communities of practice on international development, health and social justice. Twitter: @hifa_org FB: /