The rollout of vaccines for COVID-19 has resulted in a division between those eager to get the vaccine and those experiencing some level of vaccine hesitancy.

But what accounts for this vaccine hesitancy?

Vaccine hesitancy is the refusal of or delay in accepting vaccines. This hesitancy ranges from those who fully accept vaccination to those who delay vaccination to those who completely reject it.

The History

Vaccine hesitancy has been an issue ever since vaccines were invented.

In the United States, approximately one in five children have a parent who is hesitant to have their child vaccinated for childhood diseases such as measles.

For seasonal influenza vaccination, in 2020, less than half (48.4%) of adults received the flu vaccine.

For the COVID-19 pandemic that began in 2020, a sizable portion of the population in the US reported they either did not plan to, or were unsure about, getting vaccinated with vaccines approved by the US Food and Drug Administration.

Moreover, being employed in the healthcare sector did not appear to significantly influence COVID-19 vaccine hesitancy.

What Drives Vaccine Hesitancy?

Evaluation research indicates vaccine hesitancy for COVID-19 and other diseases is complex and varies across time, place, and populations.

But a universal truth is that risk perceptions and levels of concern about vaccination are seldom consistent with the actual risks of vaccination.

Vaccine hesitancy is driven primarily by complacency, convenience, trust, and confidence, which are in turn driven by individual, organizational, and socioeconomic factors.

These factors are themselves driven by diverse contextual factors, individual and group factors, and vaccine-specific factors.

Contextual Factors for Vaccine Hesitancy for COVID-19 and Other Vaccines

The following are the contextual factors associated with vaccine hesitancy:

• Trust

• Mainstream and social media environment

• Influential leaders

• Vaccination program gatekeepers

• Anti- and pro-vaccination lobbies

• Historical factors

• Religion/culture/gender/socioeconomic factors

• Political factors

• Geographical factors

• Perceptions of the pharmaceutical industry

Next week we’ll look at individual and group factors for vaccine hesitancy.

Pathway Prompt: What are reasons you’ve heard for vaccine hesitancy? Where do you think this hesitancy comes from?

Communicating Effectively When Feelings, Fears, and Facts Collide

More information about risk, high-concern, and crisis communication can be found in Dr. Covello’s video-based course Pathway to Risk, High-Concern, and Crisis Communication. This master class introduces communicators to the tools and techniques for communicating effectively—while providing greater insight into why audiences react the way they do during times of stress.

The course comprises nine video lectures and accompanying text modules, plus supplemental materials for putting valuable lessons into practice. More information about the course, including group rates and partnering opportunities, can be found by emailing

Dr. Vincent Covello

Dr. Vincent Covello, director of the Center for Risk Communication, is one of the world’s leading experts and practitioners on risk, high-concern, and crisis communication. He is the author of more than 150 articles in scientific journals and the author/editor of more than 20 books. Dr. Covello is a consultant, writer, and teacher. He is a frequent keynote speaker and has conducted communication skills training for thousands.


Santibanez, T.A., Nguyen, K.H., Greby, S.M. (2020). “Parental Vaccine Hesitancy and Childhood Influenza Vaccination.” Pediatrics, 146(6):1-10. Accessed at:

Centers for Disease Control and Prevention (2020). Flu Vaccination Coverage, United States, 2019–20 Influenza Season. Accessed at:

See., e.g., Dror, A.A., Eisenbach, N., Taiber, S. (2020). “Vaccine hesitancy: the next challenge in the fight against COVID-19.” European Journal of Epidemiology 35: 775–779 (2020). Accessed at:; Wen-Ying Sylvia Chou, W.S., Budenz, A. (2020). “Considering Emotion in COVID-19 Vaccine Communication: Addressing Vaccine Hesitancy and Fostering Vaccine Confidence.” Health Communication, 35:14, 1718-1722.

Nowak, G.,  Karafillakis, E., Larson H. (2020. “Pandemic Influenza Vaccines: Communication of Benefits, Risk, and Uncertainties.” Pp. 162-178 In P. Bahri, ed., Communicating about Risks and Safe Use of Medicines. Singapore: Springer Nature. P. 166.

MacDonald, N.E. and the SAGE Working Group on Vaccine Hesitancy. (2015). “Vaccine hesitancy: Definition, scope and determinants.” Vaccine. 33 (34):4161-4164. See also Olson, O., Berry, C., Kumar, N. (2020). “Addressing Parental Vaccine Hesitancy towards Childhood Vaccines in the United States: A Systematic Literature Review of Communication Interventions and Strategies.” Vaccines 8(4): 590.