title: Vaccine hesitancy: clarifying a theoretical framework for an ambiguous notion.
abstract: Today, according to many public health experts, public confidence in vaccines is waning. The term "vaccine hesitancy" (VH) is increasingly used to describe the spread of such vaccine reluctance. But VH is an ambiguous notion and its theoretical background appears uncertain. To clarify this concept, we first review the current definitions of VH in the public health literature and examine its most prominent characteristics. VH has been defined as a set of beliefs, attitudes, or behaviours, or some combination of them, shared by a large and heterogeneous portion of the population and including people who exhibit reluctant conformism (they may either decline a vaccine, delay it or accept it despite their doubts) and vaccine-specific behaviours. Secondly, we underline some of the ambiguities of this notion and argue that it is more a catchall category than a real concept. We also call into question the usefulness of understanding VH as an intermediate position along a continuum ranging from anti-vaccine to pro-vaccine attitudes, and we discuss its qualification as a belief, attitude or behaviour. Thirdly, we propose a theoretical framework, based on previous literature and taking into account some major structural features of contemporary societies, that considers VH as a kind of decision-making process that depends on people's level of commitment to healthism/risk culture and on their level of confidence in the health authorities and mainstream medicine.
authors: INSERM, UMR912 (SESSTIM), 13006, Marseille, France; Aix Marseille University, UMR_S912, IRD, 13006, Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 13006, Marseille, France.
authors: Patrick
authors: P
authors: Peretti-Watel
authors: Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
authors: Heidi J
authors: HJ
authors: Larson
authors: INSERM, UMR912 (SESSTIM), 13006, Marseille, France; Université Paris Diderot, UMR8236 (LIED), 75013 Paris.
authors: Jeremy K
authors: JK
authors: Ward
authors: Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
authors: William S
authors: WS
authors: Schulz
authors: INSERM, UMR912 (SESSTIM), 13006, Marseille, France; Aix Marseille University, UMR_S912, IRD, 13006, Marseille, France; ORS PACA, Southeastern Health Regional Observatory, 13006, Marseille, France; Inserm, F-Crin, Innovative Clinical Research Network on Vaccination (I-Reivac).
authors: Pierre
authors: P
authors: Verger
keywords: Information Seeking Behavior; risk behavior; risk culture; vaccination behavior; vaccine hesitancy