title: Measuring vaccine confidence: introducing a global vaccine confidence index.
abstract: BACKGROUND
  Public confidence in vaccination is vital to the success of immunisation programmes worldwide. Understanding the dynamics of vaccine confidence is therefore of great importance for global public health. Few published studies permit global comparisons of vaccination sentiments and behaviours against a common metric. This article presents the findings of a multi-country survey of confidence in vaccines and immunisation programmes in Georgia, India, Nigeria, Pakistan, and the United Kingdom (UK) - these being the first results of a larger project to map vaccine confidence globally.
  
  
  METHODS
  Data were collected from a sample of the general population and from those with children under 5 years old against a core set of confidence questions. All surveys were conducted in the relevant local-language in Georgia, India, Nigeria, Pakistan, and the UK. We examine confidence in immunisation programmes as compared to confidence in other government health services, the relationships between confidence in the system and levels of vaccine hesitancy, reasons for vaccine hesitancy, ultimate vaccination decisions, and their variation based on country contexts and demographic factors.
  
  
  RESULTS
  The numbers of respondents by country were: Georgia (n=1000); India (n=1259); Pakistan (n=2609); UK (n=2055); Nigerian households (n=12554); and Nigerian health providers (n=1272). The UK respondents with children under five years of age were more likely to hesitate to vaccinate, compared to other countries. Confidence in immunisation programmes was more closely associated with confidence in the broader health system in the UK (Spearman's ρ=0.5990), compared to Nigeria (ρ=0.5477), Pakistan (ρ=0.4491), and India (ρ=0.4240), all of which ranked confidence in immunisation programmes higher than confidence in the broader health system. Georgia had the highest rate of vaccine refusals (6 %) among those who reported initial hesitation. In all other countries surveyed most respondents who reported hesitating to vaccinate went on to receive the vaccine except in Kano state, Nigeria, where the percentage of those who ultimately refused vaccination after initially hesitating was as high as 76%) Reported reasons for hesitancy in all countries were classified under the domains of "confidence," "convenience," or "complacency," and confidence issues were found to be the primary driver of hesitancy in all countries surveyed.
authors: Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
authors: Heidi J
authors: HJ
authors: Larson
authors: Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
authors: William S
authors: WS
authors: Schulz
authors: University of North Carolina at Chapel Hill (UNC) Medical School and UNC Project-China, University of North Carolina, Chapel Hill, North Carolina, USA.
authors: Joseph D
authors: JD
authors: Tucker
authors: Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
authors: David M D
authors: DM
authors: Smith
keywords: vaccine hesitancy