From hesitancy to confidence: Shaping the future of vaccine messaging

Introduction

Vaccine hesitancy is a major challenge in global public health, influencing both the success of immunization programs and the control of preventable diseases. In recent years, the COVID-19 pandemic has shown how quickly public trust can shift and how political, cultural, and social factors influence vaccine attitudes.^1,2

To build confidence in vaccines, it is important to understand the root causes of hesitancy, engage communities in meaningful ways, equip healthcare professionals with effective communication tools, and develop innovative messaging strategies. This collection of 15 original articles provides new insights and evidence-based approaches to guide vaccine communication and strengthen public trust.

Understanding vaccine hesitancy: context and determinants

Vaccine hesitancy arises from a complex interplay of factors, including individual beliefs, cultural norms, and political influences.^3–5 Several studies in this collection highlight the importance of understanding these factors to create effective and context-sensitive vaccine messages.

Ward et al.⁶ provided an overview of social sciences research on vaccination and emphasized the importance of considering national and local contexts when studying vaccine attitudes. The COVID-19 pandemic made this particularly evident, as strategies that proved effective in some countries or communities failed in others, underscoring that tailoring strategies to context is essential for relevance and impact. Paschoalotto et al.⁷ illustrated this point in their study conducted in Brazil, which showed how confidence in COVID-19 vaccines was shaped by local political dynamics. Ittefaq et al.⁸ offered a broad perspective on the factors shaping COVID-19 vaccine attitudes in the United States by analyzing over 1,400 survey questions from 19 national polls. Their study shows how public concerns about vaccine safety, efficacy, and trust in authorities shifted over the course of the pandemic. Together, these findings underscore the importance of tailoring vaccination and communication strategies to the political and cultural realities of specific contexts, rather than relying on uniform, “one-size-fits-all” approaches.

Complementing these insights, Vigezzi et al.⁹ proposed integrating health management principles with Immunization Information Systems to identify under-vaccinated populations and guide targeted intervention in Italy. In Australia, Kaufman et al.¹⁰ developed the Vaccine Barriers Assessment Tool (VBAT) to capture acceptance and access barriers among parents of young children, thereby helping to identify groups at risk of under-vaccination. Together, these studies offer practical approaches for designing effective, context-sensitive vaccination strategies and communication efforts.

Engaging communities: trust, equity, and co-design

Building trust in vaccines requires genuine engagement with communities and recognition of their unique perspectives. Sommers et al.¹¹ demonstrated that equity-focused, community-driven programs can increase trust and participation in vaccine efforts. Karras et al.¹² examining Sydney’s ethnic minority communities, showed that incorporating local voices makes public health messages more relevant and impactful. In Ghana, Cook et al.¹³ adapted the “Cranky Uncle Vaccine” digital game through a co-design process to address common vaccine misconceptions, showing how participatory approaches can both educate and empower communities to fight misinformation. Together, these studies underscore that when communities are actively involved in designing and delivering vaccine messages, both trust and vaccine uptake can significantly improve.

Healthcare professionals and communication strategies

Healthcare professionals play a pivotal role in influencing vaccine decisions and their success depends on clear, empathetic communication.

Marhánková et al.¹⁴ identified strategies that help clinicians to build and maintain trustful dialogs with vaccine-hesitant parents. Gagneur et al.¹⁵ developed a practical four-step guide that enables healthcare providers to turn hesitancy into motivation through personalized, patient-centered conversations. White et al.’s¹⁶ systematic review showed that medical education programs teaching these communication skills increase students’ confidence in addressing vaccine hesitancy in clinical settings. Together, these studies demonstrate that structured training and evidence-based communication strategies can empower healthcare professionals to be stronger advocates for vaccination.

Innovative messaging approaches: narratives, media, and digital tools

Innovative communication approaches can complement traditional messaging by engaging emotions, values, and social norms. Dubé et al.¹⁷ showed that using stories can effectively change parents’ attitudes toward childhood vaccines by creating emotional connections and trust. Sun et al.¹⁸ analyzed Canadian media coverage of HPV vaccination and religion, highlighting how media framing affects public perception and the importance of understanding theses narratives in shaping vaccine discourse. Fritz and Smith¹⁹ studied anti-vaccine content on the social media platform Gab, revealing widespread misinformation and distrust that make public health efforts harder. Finally, Parsons Leigh et al.²⁰ found that inconsistent messages during the COVID-19 pandemic undermined people’s trust in booster and bivalent vaccines. Together, these studies highlight the importance of using stories, media analysis, and digital tools to fight misinformation and help people make informed decisions about vaccines.

Conclusion

Enhancing vaccine confidence requires a shift from fragmented, reactive approaches toward tailored strategies that build trust and engagement. As the studies in this collection show, effective vaccine communication emerges when public health efforts are tailored to national and local contexts, when healthcare professionals are supported with evidence-based tools and approaches, when innovative strategies are used strategically, and when communities are directly engaged in shaping messages. Taken together, these insights chart a path toward vaccine messaging systems that build lasting confidence, increase vaccine uptake, and protect against preventable diseases.