Trends in classifying vaccine hesitancy reasons reported in the WHO/UNICEF Joint Reporting Form, 2014–2017: Use and comparability of the Vaccine Hesitancy Matrix

Figures & data

Table 1. Distribution of the vaccine hesitancy reasons reported in the WHO/UNICEF Joint Reporting Form, coded based on the Vaccine Hesitancy Matrix, 2014–2017

	2014	2015	2016	2017	2014–2017
	n (%)	n (%)	n (%)	n (%)	n (%)
Member state response rate*	154 (79)	158 (81)	160 (82)	163 (83)	-
Category as per Vaccine Hesitancy Matrix (VHM)
Individual and group	177 (60)	187 (58)	198 (60)	192 (56)	754 (59)
Contextual	67 (23)	76 (24)	83 (25)	98 (29)	324 (25)
Vaccine- or vaccination-specific	52 (18)	57 (18)	49 (15)	53 (15)	211 (16)
Total valid responses	296 (100)**	320 (100)	330 (100)	343 (100)	1,289 (100)
Excluded responses
Not aligned with VHM	43	42	46	55	186
Not applicable	33	23	34	32	122
No hesitancy	45	43	45	21	154
Total excluded responses	121	108	125	108	462
All responses	417	428	455	451	1,751

*Number of member states out of the 194 member states that reported at least one or more hesitancy reason. ** Does not add to exact 100 due to rounding.

WHO = World Health Organization

UNICEF = United Nations Children’s Fund

Table 2. Examples of the responses coded based on the Vaccine Hesitancy Matrix, using the data reported in the WHO/UNICEF Joint Reporting Form, 2014–2017

Categories and sub-categories of vaccine hesitancy influences based on the VHM*	Examples of the reasons for vaccine hesitancy given to the open-ended questions as reported by WHO member states in the JRF*
1. Individual and group influences
1.1. Experience with past vaccination 1.2. Beliefs, attitudes about health and prevention 1.3. Knowledge/awareness 1.4. Health systems and providers-trust and personal experience 1.5. Risk/benefit (perceived, heuristic) 1.6. Immunization as a social norm vs. not needed/harmful	Afraid of side effects; doubts of vaccine safety Personal beliefs/philosophical reasons, practice of homeopathic medication, natural lifestyle Low knowledge about vaccine preventable diseases, myths and misconceptions, rumors about side effects Past bad experience at health care facility, mistrust of health staff for fear of catching Ebola Virus Disease, low level of trust between parents and health care workers Lack of parental motivation/neglect, belief that there is no threat-no need, low perceived risk of vaccine preventable diseases Complacency, impact of anti-vaccine movements, the influence of peers
2. Contextual influences
2.1 Communication and media environment 2.2. Influential leaders, gatekeepers, and anti-vaccination lobbies 2.3. Historical influences 2.4. Religion/culture/gender/ socioeconomic 2.5. Politics/policies 2.6. Geographic barriers 2.7. Pharmaceutical industry	Disclosure of potential adverse events in the wrong way in the media; negative information on social networks; negative information about vaccines in the media, the Internet, and other publications Anti-vaccine movement, anti-vaccine campaign, impact of anti-vaccine campaign None reported Religious beliefs, pockets of religious groups, traditional cultural beliefs None reported Inaccessibility/security problem; geographic accessibility of services Vaccine manufacturers, vaccines are designed for pharmacists to profit, pressure from the pharma companies
3. Vaccine and vaccination-specific issues
3.1. Risk/benefit (scientific evidence) 3.2. Introduction of a new vaccine or new formulation 3.3. Mode of administration 3.4. Design of vaccination program/mode of delivery 3.5. Reliability and/or source of vaccine supply 3.6. Vaccination schedule 3.7. Costs 3.8. Role of health care professionals	The situation presented in 2014 with the girls of the Carmen de Bolívar [school-based HPV vaccination program in Colombia] (HPV) [vaccine], still exists in the group of parents and relatives of the country’s adolescents, remembering the risk of getting sick that was before the publicity made around the event, the fear of adverse effect following vaccination (esp. HPV). The fear of new vaccination from epidemic of Ebola virus disease, consent form needed for HPV vaccine The fear of needles, bad application techniques, afraid of injection Discouragement of parents linked to the long waiting line in vaccination posts, parents working and unable to attend, parents do not have enough time to take their children to receive vaccination Temporary dose shortages, the shortage of vaccine, doubts about the quality of vaccines Multiple injections in one session, being scared of three injections at one time, the vaccine schedule Illegal payment of vaccines, costs, vaccinators do not come to their homes for immunization False contradiction by specialist pediatrician, recommendation from HCWs, low awareness of health workers
4. Codes that did not align with the VHM categories	Obstacles, lack of ownership, missing vaccination card, poor demand, lack of interest, vaccine safety, safety

*VHM = Vaccine Hesitancy Matrix; JRF = Joint Reporting Form; HCW: Health care workers; Note: Verbatim responses noted above

Figure 1. Vaccine hesitancy trends using the WHO/UNICEF Joint Reporting Form data on open-ended responses for 2017

WHO: World Health Organization; UNICEF: United Nations Children’s Fund

Figure 2. Percentage of responses for the two quantitative content analyses, using the WHO/UNICEF Joint Reporting Form data on open-ended responses coded as the individual and group influences for vaccine hesitancy, 2014–2016

Lane et analysis: Lane S, MacDonald NE, Marti M, Dumolard L. Vaccine hesitancy around the globe: Analysis of 3 years of WHO/UNICEF Joint Reporting Form data-2015–2017WHO: World Health Organization; UNICEF: United Nations Children’s Fund

Figure 3. Percentage of responses for the two quantitative content analyses, using the WHO/UNICEF Joint Reporting Form data on open-ended responses coded as the contextual influences for vaccine hesitancy, 2014–2016

Lane et analysis: Lane S, MacDonald NE, Marti M, Dumolard L. Vaccine hesitancy around the globe: Analysis of 3 years of WHO/UNICEF Joint Reporting Form data-2015–2017WHO: World Health Organization; UNICEF: United Nations Children’s Fund

Figure 4. Percentage of responses for the two quantitative content analyses, using the WHO/UNICEF Joint Reporting Form data on open-ended responses coded as vaccine- or vaccination-specific influences for vaccine hesitancy, 2014–2016

Lane et analysis: Lane S, MacDonald NE, Marti M, Dumolard L. Vaccine hesitancy around the globe: Analysis of 3 years of WHO/UNICEF Joint Reporting Form data-2015–2017WHO: World Health Organization; UNICEF: United Nations Children’s Fund