Nav: Home

European region most skeptical in the world on vaccine safety

September 08, 2016

Public confidence in vaccines varies widely between countries and regions around the world, and the European region is the most sceptical about vaccine safety, according to the largest ever global survey of confidence in vaccines. [1] With recent disease outbreaks triggered by people refusing vaccination, the authors believe the findings provide valuable insights, which could help policymakers identify and address issues.

The new study, published in EBioMedicine, is led by researchers from the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine, together with co-authors at Imperial College London and the Saw Swee Hock School of Public Health, National University of Singapore.

Nearly 66,000 people were surveyed across 67 countries to discover their views on whether vaccines are important, safe, effective, and compatible with their religious beliefs. [2]

Although overall sentiment towards vaccines was positive across the countries surveyed, the researchers found significant variation in attitudes around the world.

The European region had seven of the ten countries in the global sample that were the least confident in vaccine safety (France, Bosnia & Herzegovina, Russia, Ukraine, Greece, Armenia and Slovenia). France was the country least confident in safety, with 41% of those surveyed disagreeing that vaccines are safe, more than three times the global average of 12%. France was followed by Bosnia & Herzegovina (36%), Russia (28%) and Mongolia (27%), with Greece, Japan and Ukraine not far behind (25%). [3]

The Southeast Asian region was most confident in vaccine safety across countries, including Bangladesh (fewer than 1% did not think vaccines are safe), Indonesia (3%) and Thailand (6%).

The authors say the negative attitudes in France may come as a result of a number of controversies in the country over the past two decades, including controversy over suspected side effects of the Hepatitis B and HPV vaccines, and hesitancy among a significant proportion of GPs as to the usefulness of some vaccines.

Public trust in immunisation is an increasingly important global health issue. Decreases in confidence can lead to people refusing vaccines, which in turn has triggered disease outbreaks such as measles in the US, Europe, Asia, the Pacific and Africa. It has also caused setbacks to the global polio eradication programme. The World Health Organization's Strategic Advisory Group of Experts on Immunization has called for improved monitoring of vaccine confidence and hesitancy to help prevent these damaging public health consequences.

Study lead author, Dr Heidi Larson from the London School of Hygiene & Tropical Medicine, said: "Our findings give an insight into public opinion about vaccines on an unprecedented scale. It is vital to global public health that we regularly monitor attitudes towards vaccines so that we can quickly identify countries or groups with declining confidence. We can then act swiftly to investigate what is driving the shift in attitudes. This gives us the best chance of preventing possible outbreaks of diseases like measles, polio and meningitis which can cause illness, life-long disability and death.

"It's striking that Europe stands out as the region most sceptical about vaccine safety. And, in a world where the internet means beliefs and concerns about vaccines can be shared in an instant, we should not underestimate the influence this can have on other countries around the world."

The findings show that many countries (particularly France, Bosnia & Herzegovina, Japan, Iran, Mongolia and Vietnam), display much greater confidence in the importance of vaccines than in their safety. This suggests that people do not necessarily dismiss the value of vaccination even if they have doubts about how safe vaccines are.

Dr Larson added: "Our study suggests that the public largely understands the importance of vaccines, but safety is their primary concern. This could reflect a worrying confidence gap and shows that vaccine acceptance is precarious. The findings underline that the scientific and public health community needs to do much better at building public trust in the safety of vaccination."

Bangladesh, Iran and Ecuador had the highest proportion of people who agreed that vaccines are important, while Russia, Italy and Azerbaijan reported most scepticism around their importance.

Although the researchers found that in some countries particular religious groups were more sceptical of vaccines than others were, no single religion was associated with negative attitudes worldwide. They say this indicates that the impact religion has on attitudes towards vaccines is dependent on the local context, rather than being driven by the religious doctrine itself.

Another finding suggested that older people (aged 65 and over) globally had more positive views on vaccines than other age groups.

WIN/Gallup International Association collected the data as part of their annual end-of-year survey. Survey responses were either collected through face-to-face interviews, telephone or online, based on phone and internet availability in each country.

The researchers note that the findings cannot reveal whether attitudes were related to specific vaccines, or give reasons behind the attitudes expressed. They hope future surveys will provide these insights, and that this study can be used as a baseline to monitor change in attitudes towards vaccines over time.
Additional key country and regional data available in notes to editors.

Notes to editors:

* Heidi J Larson, Alexandre de Figueiredo, Zhao Xiahong, William S Schulz, Pierre Verger, Iain G. Johnston, Alex R Cook, Nick S Jones,The State of Vaccine Confidence 2016: Global insights through a 67-country survey, EbioMedicine. DOI: 10.1016/j.ebiom.2016.08.042

[1] World regions are categorised by World Health Organization region according to definitions at

[2] The WIN/Gallup International Association has been conducting an annual survey since 1977. For this study WIN/Gallup International extended their 14 question survey in 67 countries to include four questions related to attitudes towards vaccines. A total of 65,819 people were interviewed globally, with a sample of around 500 men and 500 women interviewed either face-to-face in each country, via telephone or online. Each respondent was asked to rate - on the five-point Likert scale: strongly agree, tend to agree, do not know, tend to disagree, strongly disagree. Questions were: "vaccines are important for children to have"; "overall I think vaccines are safe"; "overall I think vaccines are effective"; and "vaccines are compatible with my religious beliefs".

[3] Figures used based on raw data which includes 'do not know/no response' survey responses (as used in paper abstract). Both raw and normalised data (with 'do not know/no response' responses removed) for each country are available in the Supplementary Materials (Table S1).

Key country and regional data

Regions ranked by confidence in the safety of vaccines
  • Southeast Asian Region (4.4% of people disagree that vaccines are safe) - most confident
  • African Region (7.4%)
  • American Region (8.3%)
  • Eastern Mediterranean Region (9.4%)
  • Western Pacific Region (15.0%)
  • European Region (15.8%) - least confident

Countries most confident in the safety of vaccines
  • Bangladesh (Fewer than 1% of people surveyed disagreed that vaccines are safe) - most confident
  • Saudi Arabia (1%)
  • Argentina (1%)
  • Philippines (2%)
  • Ecuador (3%)

Countries least confident in the safety of vaccines
  • France (41% of people surveyed disagreed that vaccines are safe) - least confident
  • Bosnia & Herzegovina (36%)
  • Russia (28%)
  • Mongolia (27%)
  • Greece (25%) [tied with Japan and Ukraine, also 25%]

Regions ranked by confidence in the importance of vaccines
  • Southeast Asian Region (2.3% of people disagree that vaccines are important) - most confident
  • Eastern Mediterranean Region (3.4%)
  • African Region (3.5%)
  • American Region (4.0%)
  • Western Pacific Region (6.2%)
  • European Region (7.7% of people disagree that vaccines are important) - least confident

Countries most confident in the importance of vaccines
  • Bangladesh (Fewer than 1% of people surveyed disagreed that vaccines are important) - most confident
  • Iran (Fewer than 1%)
  • Ecuador (Fewer than 1%)
  • Philippines (Fewer than 1%)
  • Argentina (Fewer than 1%)

Countries least confident in the importance of vaccines
  • Russia (16% of people surveyed disagreed that vaccines are important) - least confident
  • Italy (15%)
  • Azerbaijan (14%)
  • China (14%)
  • Slovenia (13%)

About the London School of Hygiene & Tropical Medicine

The London School of Hygiene & Tropical Medicine is a world-leading centre for research and postgraduate education in public and global health, with more than 4,000 students and 1,000 staff working in over 100 countries. The School is one of the highest-rated research institutions in the UK, and among the world's leading schools in public and global health. Our mission is to improve health and health equity in the UK and worldwide; working in partnership to achieve excellence in public and global health research, education and translation of knowledge into policy and practice.

London School of Hygiene & Tropical Medicine

Related Public Health Articles:

Public health guidelines aim to lower health risks of cannabis use
Canada's Lower-Risk Cannabis Use Guidelines, released today with the endorsement of key medical and public health organizations, provide 10 science-based recommendations to enable cannabis users to reduce their health risks.
Study clusters health behavior groups to broaden public health interventions
A new study led by a University of Kansas researcher has used national health statistics and identified how to cluster seven health behavior groups based on smoking status, alcohol use, physical activity, physician visits and flu vaccination are associated with mortality.
Public health experts celebrate 30 years of CDC's prevention research solutions for communities with health disparities
It has been 30 years since CDC created the Prevention Research Centers (PRC) Program, currently a network of 26 academic institutions across the US dedicated to moving new discoveries into the communities that need them.
Public health experts support federally mandated smoke-free public housing
In response to a new federal rule mandating smoke-free policies in federally funded public housing authorities, three public health experts applaud the efforts of the US Department of Housing and Urban Development to protect nonsmoking residents from the harmful effects of tobacco exposure.
The Lancet Public Health: UK soft drinks industry levy estimated to have significant health benefits, especially among children
The UK soft drinks industry levy, due to be introduced in April 2018, is estimated to have significant health benefits, especially among children, according to the first study to estimate its health impact, published in The Lancet Public Health.
Social sciences & health innovations: Making health public
The international conference 'Social Sciences & Health Innovations: Making Health Public' is the third event organized as a collaborative endeavor between Maastricht University, the Netherlands, and Tomsk State University, the Russian Federation, with participation from Siberian State Medical University (the Russian Federation).
Columbia Mailman School Awards Public Health Prize to NYC Health Commissioner Dr. Mary T.
Dr. Mary T. Bassett, Commissioner of the New York City Department of Health and Mental Hygiene, was awarded the Frank A.
Poor health literacy a public health issue
America's poor record on health literacy is a public health issue, but one that can be fixed -- not by logging onto the internet but by increased interaction with your fellow human beings, a Michigan State University researcher argues.
Despite health law's bow to prevention, US public health funding is dropping: AJPH study
Although the language of the Affordable Care Act emphasizes disease prevention -- for example, mandating insurance coverage of clinical preventive services such as mammograms -- funding for public health programs to prevent disease have actually been declining in recent years.
'Chemsex' needs to become a public health priority
Chemsex -- sex under the influence of illegal drugs -- needs to become a public health priority, argue experts in The BMJ this week.

Related Public Health Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Do animals grieve? Do they have language or consciousness? For a long time, scientists resisted the urge to look for human qualities in animals. This hour, TED speakers explore how that is changing. Guests include biological anthropologist Barbara King, dolphin researcher Denise Herzing, primatologist Frans de Waal, and ecologist Carl Safina.
Now Playing: Science for the People

#SB2 2019 Science Birthday Minisode: Mary Golda Ross
Our second annual Science Birthday is here, and this year we celebrate the wonderful Mary Golda Ross, born 9 August 1908. She died in 2008 at age 99, but left a lasting mark on the science of rocketry and space exploration as an early woman in engineering, and one of the first Native Americans in engineering. Join Rachelle and Bethany for this very special birthday minisode celebrating Mary and her achievements. Thanks to our Patreons who make this show possible! Read more about Mary G. Ross: Interview with Mary Ross on Lash Publications International, by Laurel Sheppard Meet Mary Golda...