Signed, sealed, delivered? A cross-contextual investigation of determinants, communication strategies and voices that shape vaccination confidence and decision-making

Abstract:Vaccination remains one of the most effective interventions for preventing disease and promoting health equity, yet its success is increasingly challenged by growing distrust and emotional uncertainty. In recognition of these challenges, in 2019, the World Health Organization identified vaccine hesitancy as one of the top ten threats to global health. The COVID-19 pandemic further exposed these dynamics, as countries with strong technical capacity did not always succeed in reaching high vaccine uptake, revealing a critical disconnect between vaccine availability and uptake. This dissertation explores vaccine confidence as a complex, socially shaped phenomenon, with a particular focus on the role of communication in enabling or undermining trust in vaccination. It draws from five empirical chapters that investigate how people make sense of vaccination in a changing landscape, examining intentions, emotional concerns, healthcare provider perspectives, and participation in vaccine trials. Different communication strategies are explored, including autonomy-supportive messaging, two-sided communication, and targeted approaches. Three conceptual cornerstones guide the analysis: currents of vaccination behaviour, capturing the emotional and social undercurrents that drive doubt or refusal; orchestrating the message, examining how framing and tone affect perceptions and motivation; and voices of vaccination, highlighting the role of trusted messengers in shaping public engagement. Together, these insights point to the need for communication strategies that move beyond persuasion, towards approaches that foster relevance, respect autonomy, and strengthen trust in public health.

Publication year:2025

Keywords:Sociology

Accessibility:Open