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NVAC Vaccine Hesitancy Working Group Charge


Vaccines are among the most effective public health interventions available, saving between 2 and 3 million lives per year.1 However, the success of any vaccine in protecting a population requires high coverage rates. In the US coverage remains low for several of the vaccines recommended for adolescents and adults. Even in children, where coverage rates are high (above 90% for most), evidence suggests that nearly 12% of parents refuse at least one recommended childhood vaccine, 30% delay one or more vaccines, and exemptions obtained for personal reasons from school immunization requirements have been increasing.2-4 Together this data suggests a growing loss of vaccination confidence in the United States.

Vaccination confidence is one of a number of factors that affect individual and population-level willingness to accept a vaccine. It means having confidence in the safety and efficacy of a vaccine, having confidence in the competence of the health professionals who administer the vaccine, and having trust in the motivations of the policy-makers who decide which vaccines are needed and when. Vaccine confidence has been shown to influence vaccine decision making, but to what extent remains unclear.2,3,5,6 This is partly due to a lack of consensus on how best to quantify the confidence of an individual and a population. Gaining this understanding along with identifying factors which drive public confidence is critical for assessing the magnitude of the problem in the US, as well as designing and evaluating potential intervention strategies. 


Recognizing that immunizations are given across the lifespan and there are likely to be important differences in vaccine acceptance at different stages of life, the Assistant Secretary for Health (ASH) is initially charging the National Vaccine Advisory Committee (NVAC) to report on how confidence in vaccines impacts the optimal use of recommended childhood vaccines in the United States, including reaching HP2020 immunization coverage targets. Focus of such a report may include understanding the determinants of vaccination acceptance among parents, what HHS should be doing to improve parental confidence in vaccine recommendations and how to best measure confidence in vaccine and vaccination to inform and evaluate interventions in the future.

  1. Bunker JP, Frazier HS, Mosteller F. Improving health: measuring effects of medical care. Milbank Q. 1994;72(2):225–258
  2. Freed GL, Clark SJ, Butchart AT, Singer DC, Davis MM. Parental vaccine safety concerns in 2009. Pediatrics.2010;125(4):654-9.
  3. Smith PJ, Humiston SG, Marcuse EK, Zhao Z, Dorell CG, Howes C, Hibbs B. Parental Delay or Refusal of Vaccine Doses, childhood vaccination coverage at 24 months of age and the health belief model. Public Health Rep. 2011;126(Suppl 2):135–146.
  4. Omer SB, Salmon DA, Orenstein WA, DeHart MP, Halsey N. Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. N Engl J Med. 2009;360(19):542-50.
  5. Cooper LZ Larson HJ, Katz LS. Protecting public trust in immunization. Pediatrics. 2008;122(1):149-53.
  6. Gellin BG, Maibach EW, Marcuse EK. Do parents understand immunizations? A national telephone survey. Pediatracs.