The Importance of Mapping Determinants, Attitudes and Beliefs of Vaccine Hesitancy in the Great Challenge of Compulsory Childhood Vaccination; Comment on “Convergence on Coercion: Functional and Political Pressures as Drivers of Global Childhood Vaccine Mandates”

Document Type : Commentary


1 IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy

2 Unit of Hygiene, Department of Biomedical and Neuromotor Sciences, Public Health and Medical Statistics, University of Bologna, Bologna, Italy


Vaccine hesitancy (VH) has risen significantly during the COVID-19 pandemic, becoming a major global health concern. VH is characterized by the delay or refusal of vaccination despite its availability. Various frameworks have been developed to understand the complex factors influencing VH, with attitudes, beliefs, and external influences being the most significant. The surge in VH has reignited the debate on the best approach to address it: persuasive/educational or coercive. Attwell and Hannah studied the political and social reasons behind the adoption of mandatory vaccination in four jurisdictions (Italy, France, Australia, and California) due to declining vaccine coverage below the safety threshold. However, these methods may foster parental disbeliefs and opposition to vaccination campaigns. To combat VH, it is crucial to systematically assess its determinants within specific contexts and population groups. Increasing awareness about vaccination benefits, engaging with social media, and employing tailored strategies can foster spontaneous adherence to vaccination programs, eliminating the need for coercive measures.


  1. World Health Organization (WHO). Immunization, Vaccines and Biologicals – Data, Statistics and Graphics. Global and Regional Immunization Profile. 2017. Accessed November 8, 2022.
  2. Zou Y, Huang D, Jiang Q, Guo Y, Chen C. The vaccine efficacy against the SARS-CoV-2 omicron: a systemic review and meta-analysis. Front Public Health. 2022;10:940956. doi:3389/fpubh.2022.940956
  3. McCosker LK, El-Heneidy A, Seale H, Ware RS, Downes MJ. Strategies to improve vaccination rates in people who are homeless: a systematic review. Vaccine. 2022;40(23):3109-3126. doi:1016/j.vaccine.2022.04.022
  4. Guaraldi F, Montalti M, Di Valerio Z, et al. Rate and predictors of hesitancy toward SARS-CoV-2 vaccine among type 2 diabetic patients: results from an Italian survey. Vaccines (Basel). 2021;9(5):460. doi:3390/vaccines9050460
  5. Montalti M, Guaraldi F, Di Valerio Z, et al. Adherence to and early adverse events of COVID-19 vaccine in a cohort of 600 Italian breastfeeding and pregnant physicians. Hum Vaccin Immunother. 2022;18(6):2106747. doi:1080/21645515.2022.2106747
  6. Attwell K, Hannah A. Convergence on coercion: functional and political pressures as drivers of global childhood vaccine mandates. Int J Health Policy Manag. 2022;11(11):2660-2671. doi:34172/ijhpm.2022.6518
  7. Gualano MR, Olivero E, Voglino G, et al. Knowledge, attitudes and beliefs towards compulsory vaccination: a systematic review. Hum Vaccin Immunother. 2019;15(4):918-931. doi:1080/21645515.2018.1564437
  8. MacDonald NE. Vaccine hesitancy: definition, scope and determinants. Vaccine. 2015;33(34):4161-4164. doi:1016/j.vaccine.2015.04.036
  9. Ten Health Issues WHO Will Tackle This Year. Accessed November 8, 2022.
  10. Dubé E, Gagnon D, Nickels E, Jeram S, Schuster M. Mapping vaccine hesitancy--country-specific characteristics of a global phenomenon. Vaccine. 2014;32(49):6649-6654. doi:1016/j.vaccine.2014.09.039
  11. Reno C, Maietti E, Di Valerio Z, Montalti M, Fantini MP, Gori D. Vaccine hesitancy towards COVID-19 vaccination: investigating the role of information sources through a mediation analysis. Infect Dis Rep. 2021;13(3):712-723. doi:3390/idr13030066
  12. Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50(2):179-211. doi:1016/0749-5978(91)90020-t
  13. Betsch C, Schmid P, Heinemeier D, Korn L, Holtmann C, Böhm R. Beyond confidence: development of a measure assessing the 5C psychological antecedents of vaccination. PLoS One. 2018;13(12):e0208601. doi:1371/journal.pone.0208601
  14. Rus M, Groselj U. Ethics of vaccination in childhood-a framework based on the four principles of biomedical ethics. Vaccines (Basel). 2021;9(2):113. doi:3390/vaccines9020113
  15. Piedrahita-Valdés H, Piedrahita-Castillo D, Bermejo-Higuera J, et al. Vaccine hesitancy on social media: sentiment analysis from June 2011 to April 2019. Vaccines (Basel). 2021;9(1):28. doi:3390/vaccines9010028