Vaccine Hesitancy: Redefining Indecision to Decision – An Evolving Challenge

February 9, 2026 Dr. Michael Lee – Health Editor Health

Vaccine hesitancy,a complex issue impacting global public health,is increasingly understood as more than a simple rejection of vaccines. Initially defined by the World Health Institution (WHO) in 2015 as a “delay in acceptance or refusal of vaccines despite availability of vaccination services,”1 the concept is evolving. Recent perspectives argue for a redefinition,characterizing hesitancy as a “psychological state of indecisiveness that peopel may experience when making a decision regarding vaccination.”2

This shift in understanding is crucial because it distinguishes between the internal process of weighing options – the hesitancy itself – and the ultimate behavioral outcome: the decision to accept or refuse vaccination. While hesitancy represents an internal state of indecision before a vaccination decision is made, the actual choice constitutes the observable behavior.

Understanding this distinction is vital for crafting effective public health strategies. Interventions aimed at addressing vaccine hesitancy must acknowledge the psychological factors at play and recognize that hesitancy doesn’t automatically equate to outright refusal. Instead, it represents a period of uncertainty where individuals may be receptive to accurate information and supportive dialog.3

The factors contributing to vaccine hesitancy are multifaceted, ranging from concerns about vaccine safety and side effects to distrust of healthcare systems and the influence of misinformation.4 Addressing these concerns requires clear dialogue, community engagement, and tailored interventions that acknowledge the diverse reasons behind individual hesitancy.

Continued research into the psychological underpinnings of vaccine hesitancy is essential for developing more effective strategies to promote vaccine confidence and protect public health.5

  1. World Health Organization. (2015). Report of the SAGE working group on vaccine hesitancy. https://www.who.int/immunization/sage/meetings/2015/april/1_Report_SAGE_WGVE_April_2015.pdf
  2. dubé, E.,et al. (2021). Vaccine hesitancy: a psychological perspective. Vaccine, 39(34), 5259–5267. https://doi.org/10.1016/j.vaccine.2021.07.009
  3. Larson, H. J., et al. (2018).Understanding vaccine hesitancy: a systematic review. Vaccine, 36(46), 6798–6805. https://doi.org/10.1016/j.vaccine.2018.10.007
  4. Salmon, D. A., et al. (2006). Vaccine safety: addressing the concerns of parents. Pediatrics, 118(5), 2255–2264. https://doi.org/10.1542/peds.2006-1334
  5. Betsch, C., et al. (2017). Drivers of vaccine hesitancy: a systematic review. Vaccine, 35(43), 5893–5903. https://doi.org/10.1016/j.vaccine.2017.08.037