In last week’s blog post, we looked at the history of vaccine hesitancy and at the contextual factors for vaccine hesitancy.

This week we examine the individual and group factors for vaccine hesitancy.

Quick Recap of Definition and History

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.

Vaccine hesitancy has been an issue 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 proportion 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 health-care sector did not appear to significantly influence COVID-19 vaccine hesitancy.

Individual and Group Factors for Vaccine Hesitancy for COVID-19 and Other Vaccines

• Trust

• Personal, family, and community experience with vaccination

• Knowledge and awareness

• Trust and personal experience with the health system and health-care providers

• Perceived risks, costs, and benefits of vaccination

• Social norms

• Perception of a high-risk for severe infection

• Prioritization of groups

Trust Determination

Considering the role trust plays in vaccine hesitancy and in other risk-related communications, readers will likely be interested in module three (“Trust Determination”) of Dr. Vincent Covello’s video-based course Pathway to Risk, High-Concern, and Crisis Communication.

This module focuses on the attributes of trust, first impressions, the trust ladder, and ways to overcome distrust.

Part 3

Next week we’ll look at vaccine-specific factors for vaccine hesitancy and at the characteristics of successful vaccine efforts.

Pathway Prompt: Have you heard people say they don’t trust the COVID-19 vaccines? Where do you think this lack of trust 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.