Combatting vaccination mistrust requires hearing from different voices [INTERVIEW]


Building vaccine confidence [INTERVIEW] [Photo via Canva]

The key issue in the debate on vaccine hesitancy is understanding that it is not a new phenomenon. It can have various origins, like mistrust to pharma companies and medical authorities or the feeling that doubts are not being addressed, says Pia Vuolanto, the project coordinator of the VAX-TRUST innitiative.


The interview with Pia Vuolanto is also available as a podcast on our Spotify, Soundcloud, Apple Podcasts and Google Podcasts


Pia Vuolanto is Senior Research Fellow at the Tampere University Institute for Advanced Social Research and the project coordinator of the EU-funded research project VAX-TRUST. 


Kinga Wysocka: What is the main aim of the VAX-TRUST project? 

Pia Vuolanto: VAX-TRUST was created to address the vaccine hesitancy in Europe and to help health care professionals prepare to meet the vaccine-hesitant individuals. The project is funded by the Horizon 2020 Research and Innovation Programme and coordinated by Tampere University in Finland. It was started in March this year and now is carried out in seven countries which are Finland, Belgium, Poland, Czech Republic, Italy, Portugal and the UK. We have already gained 10 partners in all these countries We have ten partners in seven countries. I’m the principal investigator, which means I lead this research consortium.

Of course, the question of vaccine hesitancy in Europe is of profound importance right now. It appears that Europe stands out as a region where vaccine services are widely available and many vaccine preventable diseases have disappeared, but despite the good access and well-functioning healthcare systems, some people still hesitate to get vaccinated.

People come to consultancy rooms with negative or critical attitude towards vaccinations, medications or any other medical treatments. Consequently, health care professionals meet more and more challenges in building trust relations with their patients. VAX-TRUST project was set up to look into vaccine hesitancy as a broad societal phenomenon. Our principal aim is to support and provide tools to health care professionals to encounter vaccine-hesitant individuals. 

VAX-TRUST explores media coverage of vaccines. Do media contribute to vaccine confidence or, on the contrary, strenghthen vaccine hesitancy?

Media have a strong role when it comes to boosting the discussion on vaccines. They have to ensure that all voices are heard and that different opinions about vaccines come out. Currently, the discussion on vaccine hesitancy is quite polarized. There are two opposite camps of the followers and opposers of vaccines. Media needs to be careful about not labelling the individuals who choose not to vaccinate themselves or their children and that they are not left out of the debate.

I think it would be counterproductive to leave vaccine-hesitant people out of the debate. It would be bad for the discussion, but also for the media. If people don’t feel like their voices are heard, they might turn away from respected media sources to get information from less reliable sources, like social media, for example.

But of course the media also has a responsibility to give voice to experts, authorities and researchers, who promote vaccinations. I think the role of the media is a lot about balancing between different actors and opinions. The media should always give voice to individuals who have different ways of thinking. That’s the balance of media, what they have to do. 

What in your opinion contributes the most to the public’s distrust of vaccines? 

I think the lack of trust is central here. Experts and health care professionals still enjoy high level of trust, but some individuals have lost this trust for some reason. Many people who criticise vaccines don’t trust the information provided by health care authorities or pharmaceutical companies.

For instance, critical people call for better transparency of research. They might suspect that global pharmaceutical companies share with the public opinion only favourable research results. Vaccine hesitant people might also be concerned about the impartiality of authorities that give recommendations about vaccines. They may suspect that the role of pharmaceutical companies is too strong in making the recommendations.

The lack of trust also concerns health care professionals. The vaccine-hesitant individuals may have experienced situations in which their concerns regarding vaccines have been bypassed or their questions about vaccines have been silenced or nullified. They may also be afraid that their rights to their bodies will be restricted, and they no longer have the right to choose what they want to do for their health. I think it is this lack of trust that is most important here that we need to address. 

You also conduct research on vaccine hesitancy among healthcare professionals. Is it common and what is the cause of this phenomenon? 

Vaccine hesitancy can be observed among healthcare professionals as well. Even if it is not very common, the phenomenon does exist. Healthcare professionals also live in a world where this contestation of expertise is common, which means that they are faced with doubts and uncertainties about the evidence, knowledge and recommendations. They might become doubtful or vaccine-hesitant themselves.

There are many reasons behind that. Some of them might fear the side effects, some do not trust pharmaceutical companies or healthcare authorities. The reasons are similar to those concerning the general public. Yet another factor that may have contributed to vaccine hesitancy among healthcare workers was that in many countries, including in Finland, vaccinations among this group were obligatory.

Do you think it is easier to combat vaccine hesitancy in the medical community or among patients? 

It is never easy. As I mentioned earlier, the main issue here is the lack of trust and recovering this trust is difficult. There is a need to correct untrue information and correct views that are based on misinformation. Social trust requires open dialogue between different social actors, including medical community, healthcare authorities, but also vaccine-hesitant people.

We need to develop an open dialogue between science, decision making authorities and the general public. Overall, we need to take vaccine hesitancy seriously on many levels and figure out where does this lack of trust come from, which societal actors are not trusted, and also how we could prevent further deepening of distrust. It is never easy, though.

Do you think that vaccine hesitancy was as strong before the pandemic as it is now? Or was it intensified by the COVID-19 pandemic?

Overall, the key issue about vaccine hesitancy is understanding that it is not a new phenomenon. Ever since vaccines have been developed, some individuals or groups have questioned their value and importance. Some people have expressed distrust towards the proponents of vaccines.

Since the first vaccines were developed 100 years ago, resistance was observed and I think it is a part of a much larger phenomenon. I believe COVID-19 has brought it up and exposed the fact that many people think differently from the mainstream when it comes to health and their immunisation needs. Some refuse to get vaccinated and take no medications, or do not listen to any recommendations from medical bodies.

The COVID-19 pandemic has been a turning point in the sense that Europe has rapidly become aware that there are different ways of taking care of health. Vaccine hesitancy is an issue that highlights this diversity. We are not a unified part of the world, and the pandemic has also made people express their choices in visible ways. Some do it in public and loudly demand their right to choose, so it has become an open issue. 

Is vaccine hesitancy a problem of the same degree in all European countries or some societies are more vaccine-hesitant than others? 

There might be several reasons for regional differences, and some might be related to macro-level factors rather than individual issues. One issue is that vaccine services are organised in different ways in different regions of Europe. In some countries, availability of vaccines is an issue. Some countries don’t have easy access to healthcare systems for several groups.

One other aspect is that vaccinations are administered by different experts in different countries, which means different groups are faced with vaccine hesitancy. For example, in Finland, public health nurses administer most of the children’s vaccinations, and their role is central in building parents’ trust in vaccinations. And then in Italy it is paediatricians that administer vaccines. These two groups have obviously different competencies to respond to parents’ questions, different knowledge about family situations and different amounts of time to listen to parents. So this also might be a reason.

Yet another key issue is whether vaccinations are obligatory. When vaccines are voluntary the uptake tends to be higher. This points out that obligatory vaccinations may not be a solution to increase low vaccine uptake. But the situation is more complex than just the question of whether vaccines should be obligatory or not. These examples are just issues that might be behind the regional differences. It shows that it is not easy to state the reasons why vaccine hesitancy is more predominant in some regions rather than in others.


The interview was conducted as part of IMMUNION project / Wywiad jest częścią projektu IMMUNION.


Ten projekt jest współfinansowany przez program Unii Europejskiej w dziedzinie zdrowia (2014-2020) /  This project is co-funded by the European Union’s Health Programme 2014-2020.