Vaccines today prevent or significantly reduce the impact of around 30 dangerous and potentially life-threatening diseases. Consistent vaccination programs have been crucial in ensuring that most of these illnesses no longer pose a public health threat, as a large portion of the population is immunized before encountering the infections. Vaccines and vaccination programs thus represent one of the greatest success stories in infectious disease prevention.
However, few medical interventions spark as much skepticism in certain populations as vaccination. The specific effects of these doubts — ranging from hesitancy about particular vaccines to outright refusal — are hard to quantify, especially because other factors can also lead to low vaccination rates. For example, conducting vaccination campaigns in crisis or war zones remains challenging, even when sufficient vaccine supplies exist and most eligible people want to be vaccinated.
Threat to Infectious Disease Control
It is well-established that diseases such as polio and measles could be eradicated through consistent immunization of a sufficiently large segment of the population. Likewise, severe illness among especially vulnerable individuals — who cannot be vaccinated due to medical reasons — can be prevented through herd immunity, thereby reducing individual suffering. Yet, those with skeptical or anti-vaccine views often ignore or deny these facts. Instead, they argue that vaccination is a personal decision to be made solely between the individual and their healthcare provider. In this view, national vaccination plans designed to protect both individuals and the community are given lesser importance.
Not Without Consequences
In 2019, before the COVID-19 pandemic brought renewed focus to vaccination, the World Health Organization (WHO) identified vaccine skepticism as one of the top 10 global health threats. The WHO defines vaccine skepticism as the “delayed acceptance or refusal of vaccines despite the availability of vaccination services.”
Experts at WHO are particularly concerned that such skepticism threatens to reverse significant progress made in recent decades against vaccine-preventable diseases. Despite numerous efforts to educate the public objectively about vaccines and increase acceptance, vaccine-skeptical views continue to gain influence in societal discourse and among decision-makers worldwide.
Social media plays a key role in this trend. Misinformation can spread rapidly and often goes uncorrected, amplifying fears and bringing latent anxieties to the surface. These platforms act as multipliers: Individuals who have long harbored vaccine skepticism find their concerns reinforced by reports of potential dangers from supposedly insufficiently tested new vaccines, while those previously neutral or positive about vaccination become uncertain. Both groups share their fears and false beliefs, fueling further spread within networks of similarly doubtful people.
COVID-19 as a Catalyst
Vaccine skepticism and opposition are not new — they have existed since the earliest days of vaccination. Edward Jenner, the English country doctor who administered the first smallpox vaccine in 1796, faced resistance despite the widespread acclaim for his discovery. By 1866, the first organized anti-vaccination group, the British “National Anti-Vaccination League,” had formed. Opponents feared vaccination might cause more harm than good. Caricatures depicting people growing cow heads from their arms after vaccination circulated, and early anti-vaccine publications appeared.
Since then, criticism and opposition have accompanied nearly every new vaccine introduced. The COVID-19 pandemic significantly accelerated the spread of anti-vaccine content, acting as a catalyst for alarmist and conspiratorial narratives that had previously remained largely under the public radar. With COVID-19, organized anti-vaccine movements gained unprecedented visibility and influence.
The effects have been long-lasting. In vulnerable populations, vaccine myths not only influenced decisions regarding COVID-19 vaccination but also fueled broader skepticism toward vaccines in general. Experts are now exploring ways to reverse this trend. Recent research into modifiable underlying attitudes and concerns across different populations offers promising avenues for intervention.
Modifiable Risk Factors
A mixed-methods study conducted by doctors and psychologists from the universities of Oxford and Oslo, involving comparable populations from Norway and the UK, identified five key modifiable risk factors associated with COVID-19 vaccine skepticism:
- The illusion of invulnerability,
- Doubts about vaccine effectiveness,
- Distrust of (health) authorities,
- Downplaying the societal impact of COVID-19, and
- Health-related fears concerning the vaccine.
These risk factors have strong predictive value and can be strategically addressed by public health organizations to reduce vaccine hesitancy.
Both vaccine opposition and hesitancy stem largely from misconceptions about the actual risks, benefits, and potential side effects of vaccines and their adjuvants. Most people who remain undecided do not reject vaccines out of firm conviction. There are multiple opportunities to address uncertainties and counter misinformation with well-founded evidence.
Traditional educational approaches have proven to be as effective as newer motivational interventions aimed at increasing personal motivation to get vaccinated. Both strategies have helped raise vaccination rates. However, there is still a lack of high-quality studies evaluating the effectiveness of motivational methods in more detail.
Can Anti-Vaccine Movements Be Reversed?
Anti-vaccine activism is not confined to the general public; even some healthcare professionals are susceptible to vaccine skepticism and may inadvertently contribute to the spread of misinformation — often via the same channels as nonexperts. When such views come from medical professionals, the impact is especially damaging. The high credibility generally afforded to doctors lends greater weight to their vaccine-related statements than those from former classmates or alternative medicine practitioners.
The spread of false or biased information about vaccines amounts to an attack on science itself — a reality that many fail to recognize. Medical assessments of vaccines, adjuvants, or new vaccine technologies are sometimes deliberately downplayed or misrepresented to bolster anti-vaccine narratives. These groups use such claims to suggest contradictory scientific opinions on vaccines exist, despite a clear consensus among experts supporting vaccination.
Recent developments in the US highlight the dangers of coordinated misinformation. In June, all 17 permanent members of the Advisory Committee on Immunization Practices were dismissed and partially replaced with known vaccine critics and underqualified individuals. Experts have warned that this move severely undermines trust in the committee’s future recommendations.
It is concerning that even health authorities can fall under the influence of anti-vaccine groups, with real consequences for official vaccine policies. While such scenarios remain unthinkable in Germany and other European countries, it is crucial to proactively resist attempts at influence, counter misinformation, and communicate the scientific basis of vaccine decisions clearly and accessibly.
Doctors and healthcare professionals often lack the time to provide detailed information and persuasion to vaccine-skeptical individuals or those unsettled by misinformation. However, in many cases, extensive information isn’t necessary — simply highlighting the health benefits of vaccination and directing patients to reliable online resources can be sufficient. For example, the Robert Koch Institute, Berlin, Germany, offers alphabetically organized, easy-to-understand information from the German Standing Committee on Vaccination on each available vaccine, along with answers to frequently asked questions, under the title “ Vaccinations AZ.”
Making Vaccines More Accessible
Another often overlooked factor in vaccine hesitancy is that missed vaccinations can result from a lack of information, misunderstandings, or simply forgetting appointments. Limited language skills may hinder understanding of vaccine information, while patients might hesitate to ask questions. Multilingual brochures can help by enabling patients to review information at their own pace and raise queries at follow-up visits. In Germany, for example, the current vaccination schedule is available in 10 languages.
Physicians can also help reduce missed appointments by setting up automatic reminders via apps, email, or short message service. Since 2025, vaccination records for all insured individuals have been accessible through the digital vaccination pass, unless the individual opts out. Patients can also enroll in personalized vaccination reminder services to stay on schedule.
This story was translated from Univadis Germany.