What is happening to vaccine confidence?

This article examines the trends in vaccine confidence within the UK, focussing on what has happened since Covid.

Introduction

Vaccines save millions of lives each year yet confidence in vaccines is falling. The rapid development and deployment of Covid vaccines was an undoubted success but a recent BBC article highlighted that trust in the safety of vaccines had fallen significantly since Covid. Other reports indicate that vaccine confidence has fallen since 2020 and suggest that, paradoxically, the Covid vaccine actually had the effect of reducing public confidence in vaccination.

This post looks in more detail at the data behind these reports and finds a more complex and nuanced picture. Whilst vaccine confidence has fallen in the youngest it is holding up for the older age groups resulting in an increasing age gap.

Parental attitudes to vaccinating their children are also covered, together with a look at some encouraging survey data on the impact of social media and press coverage on vaccine confidence amongst teenagers and their parents in the UK.

Finally, some thoughts on how to improve vaccine confidence are given.

What is vaccine confidence and why is it important?

Vaccine hesitancy long been an obstacle to effectively managing diseases through mass immunisation. To help overcome this issue, the World Health Organization adopted a "3 Cs" model that captures the main factors that need to be addressed to reduce vaccine hesitancy. The “3 Cs” are:

1. Confidence: This pertains to trust in the effectiveness and safety of vaccines, the reliability of the healthcare system, and the motivations of policymakers who recommend vaccines.

2. Complacency: This occurs when individuals perceive the risks of vaccine-preventable diseases as low, leading them to believe that vaccination is unnecessary.

3. Convenience: This relates to the accessibility of vaccines, including factors such as the availability, affordability, and quality of vaccination services.

Since 2015 the Vaccine Confidence Project have been working globally to provide decision-makers with vaccine confidence insights to support policy and intervention design, and reduce vaccine inequalities. An important part of their project is to survey people on their overall perceptions of the importance, safety, effectiveness and compatibility of vaccines with people’s beliefs. The surveys have been carried out since 2015 across 149 countries and are used to create a vaccine confidence index.

In later sections we will explore the data from the surveys to understand the trends in more detail. We will also see that vaccine confidence can be affected by a range of factors. These include changes in policies or recommendations, the introduction of new vaccines, disease outbreaks or pandemics, or the spread of rumours and misinformation through the media, including social media. However, the next section will look at the data from a different survey that was included in the BBC news article.

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Vaccine distrust in the UK.

The BBC recently published an article on their website with the headline Rise of vaccine distrust - why more of us are questioning jabs where they presented a chart showing survey data from a YouGov survey of adults in Great Britain. The chart, reproduced below, shows the trend in the number of people asked to respond to the question:

Do you think the following statement is true, or false? "Vaccines have harmful effects which are not being disclosed to the public."

The chart helpfully shows the date when Covid vaccination started and invites us to conclude that vaccine concerns have increased since that date, even though the chart title only ‘suggests’ that is the case.

However, the story is more nuanced as we can see in the following chart which shows the trend in the percent of those expressing vaccine concern broken down by age.

Here we see a different picture emerge with the trend in vaccine concern varying significantly by age.

Unsurprisingly, for those aged 65 years and older, who were at greatest risk, vaccine concern fell significantly when Covid vaccinations started. This fall in the level of concern was sustained during the period when the first boosters were offered and only rose slightly above the pre-Covid levels in August 2024.

For those aged 50 to 64 years old (shown in orange) there was also a reduction in vaccine concern at the start of Covid vaccinations although this soon abated. However, this was followed by a second fall in the level of concern when the last booster was offered to this age group in Autumn 2022. Following this final booster, concerns for this age group have increased and returned to the pre-Covid trend.

Interestingly, there is no discernible change as a result of the Covid vaccine in the rising trend for individuals aged 25 to 49 years (depicted in blue) to express their vaccine concern. Worryingly, those aged 18 to 24 years (shown in green) have seen a marked increase in vaccine concern since the start of the Covid vaccine campaign. This is particularly concerning, as when this group becomes parents they may not support vaccinating their children.

This illustrates that vaccine concern can be volatile and often reflects an individuals perceptions of the risk they have from catching Covid. It seems that the higher the perceived risk from a vaccine-preventable disease the greater the demand for and trust in the vaccine.

This underlines the importance of understanding the drivers of vaccine confidence and in the next section we’ll explore trends from the work of the Vaccine Confidence Project.

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Vaccine Confidence Index

The Vaccine Confidence Project uses four components to survey the confidence that individuals have in vaccines. The survey asks people how to say how safe, effective, important for children to be vaccinated, and how compatible vaccines are with their beliefs.

The following chart shows the annual trend of the percent of people in the UK that agreed vaccines were safe, effective, important for children to have, or were compatible with their beliefs.

The data confirms that vaccine confidence increased slightly in 2020 but has now fallen to its lowest level since the start of the survey in 2015. The next chart shows how the ‘safe’ and ‘effective’ components varied by gender and age in 2023.

The 2023 survey found that men are more confident in the safety and effectiveness of vaccines then women. In addition, their was a clear increase in vaccine confidence with age, confirming the findings from the YouGov survey.

It is noticeable that there has been a significant change since the start of the pandemic in the association between vaccine confidence and age, with younger adults becoming less confident since 2019, while older groups remain at high vaccine confidence levels. Although older groups tended to hold higher vaccine confidence levels than younger age cohorts before the pandemic, the divergence in confidence between old and young over time appears to be new.

Indeed the following chart shows that the gap between those aged 18-24 years and the over 65 year olds has increased every year since 2019 across all components of the vaccine confidence index.

Finally, the UK is not alone in seeing falling levels of vaccine confidence since the Covid pandemic. This is illustrated in the following chart showing the change in the percent agreeing that vaccines are safe for selected European countries.

A 2023 report also showed that the vaccine confidence age gap has also increased across almost every EU member state between 2018 and 2022.

Declining confidence among younger age groups is a significant cause for concern as they are the next group of parents making decisions around childhood vaccination. It should be a public health priority to address the vaccination concerns of this age group.

The next section examines this in more detail by examining data from the UK on parental attitudes to vaccination.

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Parental attitudes to vaccines.

Each year the UK government carries out surveys to explore parental attitudes to vaccines given to babies, children and young people, and the attitudes of young people themselves to vaccination, to inform planning of vaccination programmes.

The following table shows that parents of young children are more positive about vaccinating their children than would be indicated by the vaccine confidence index described in the previous section.

Although parental attitudes fell in 2023, they remain considerably higher than the vaccine confidence index would suggest, where just 62% of those aged 18-34 years agreed that it was important for children to get vaccinated. It would seem that having young children focuses the mind in a positive way.

However, it is important not to be complacent as the following chart shows.

The chart confirms that 2023 experienced the lowest level of MMR coverage at age five in the past decade across all Home Nations. These levels fall significantly below the 95% target, unfortunately resulting in several recent outbreaks of measles.

Finally, the 2023 survey report of teenagers and their parents provided some reassuring insights in to the impact of press and social media coverage following the Covid vaccine.

The report found that there was no evidence that the press and social media interest in the Covid vaccine had a negative impact on attitudes to the routine vaccination programme:

1. 27% of teenager’s parents said they felt more positive about vaccines following the press and media interest in the COVID-19 vaccine programme while 12% felt less positive;

2. 29% of teenagers stated that they felt more positive about vaccines following the press and media interest in the COVID-19 vaccine programme while 9% felt less positive – similar results were seen for trust in vaccines and vaccine safety; and

3. of the 9% of teenagers who refused or delayed at least one vaccine, over 70% specified the COVID-19 vaccine; however, numbers refusing or delaying the other teenage vaccines were similar to previous surveys.

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What can be done to improve vaccine confidence?

Vaccine confidence issues are not a recent phenomenon, although the scope and scale have changed. In Victorian Britain, anti-vaccination movements formed in opposition to the Compulsory Vaccination Act of 1853. More recently, vaccine confidence fell in the UK following discredited claims that the MMR vaccine was linked to autism. As the widespread use of vaccines has grown, so have anxieties about vaccine safety and their regulation. Unfortunately, these anxieties are often spread and amplified through social media.

As we saw earlier, vaccine hesitancy is a complex combination of many factors. Whilst vaccine Confidence is important, Compliance and and Convenience of access also play a vital role. Indeed some have argued that Collective responsibility and Conspiracy should be added to the “3Cs” of vaccine hesitancy.

Due to the different situations in which vaccine hesitancy can arise, interventions have to be contact specific (depending on the public involved) and problem specific (depending on the type of concern). For this reason an important first step is the continuous monitoring of confidence in vaccination to identify changes and develop tailored responses and policy actions.

Depending on the nature of the concern identified interventions can made be at the individual, community level, or both to tackle the problem. In general, it has been found that interventions work best when they focus on:

• Parents at the individual level;

• Improving healthcare workers’ confidence and communication skills to respond to hesitant patients; and

• Responding to hesitancy at a community level.

For those interested on more detail, a report outlining 42 best practices to address vaccine hesitancy can be found here.

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In Conclusion

In this article, we have seen that vaccine confidence, a crucial factor influencing vaccine hesitancy, has declined since 2020, with the decline accelerating fastest among the younger age groups. While vaccine concerns among the older age group decreased at the beginning of the Covid vaccination campaign and when boosters were administered, they have now begun to rise.

Parental attitudes to vaccinating there children fell in 2023 but remain higher than would be suggested by the results for their age group from the vaccine confidence index. However, MMR vaccination rates are now at their lowest levels in 10 years.

Finally, there were some hopeful reports that social media and press coverage are not eroding vaccine confidence amongst teenagers and their parents.

As always if you have any questions or comments then please make them below.

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Sources.

The following are the main sources used to prepare this article.

WHO Report on lives saved from immunisation

https://www.who.int/news/item/24-04-2024-global-immunization-efforts-have-saved-at-least-154-million-lives-over-the-past-50-years

Estimated number of lives directly saved by COVID-19 vaccination programmes in the WHO European Region from December, 2020, to March, 2023: a retrospective surveillance study

https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(24)00179-6/fulltext

Rise of vaccine distrust - why more of us are questioning jabs

https://www.bbc.co.uk/news/articles/c1jgrlxx37do#:~:text=In%202023%20around%2070%25%20of,and%20Tropical%20Medicine%20(LSHTM).

Recent trends in vaccine coverage and confidence: A cause for concern

https://www.tandfonline.com/doi/full/10.1080/21645515.2023.2237374#abstract

Attitudes to vaccination: national surveys

https://www.gov.uk/government/collections/parental-attitudes-to-vaccination-in-young-children

Confirmed cases of measles in England by month, age, region and upper-tier local authority: 2024 and 2025

https://www.gov.uk/government/publications/measles-epidemiology-2023/confirmed-cases-of-measles-in-england-by-month-age-region-and-upper-tier-local-authority-2024#:~:text=There%20was%20a%20rapid%20increase,stabilised%20at%20a%20low%20level.

The Mission Board on Vaccination in Europe

https://missionvaccination.eu/

Measuring the 7Cs of Vaccination Readiness | European Journal of Psychological Assessment

https://econtent.hogrefe.com/doi/10.1027/1015-5759/a000663

Catalogue of interventions addressing vaccine hesitancy

https://www.ecdc.europa.eu/sites/default/files/documents/Catalogue-interventions-vaccine-hesitancy.pdf