Page 144 - GHES-3-2

Global Health Economics and
Sustainability
Vaccine hesitancy in the US, India, and China

1. Introduction acceptance across different diseases. These barriers are
psychological and physical. In other words, how recipients
Vaccine hesitancy has posed challenges for healthcare perceive the usefulness of taking a vaccine, the associated
providers and public health officials for years. In light of risk of the vaccine, and a host of other factors.
the COVID-19 pandemic, vaccine hesitancy has become
even more relevant and has emerged as a global issue. The Health beliefs influence vaccine hesitancy. Several
SAGE Working Group on Vaccine Hesitancy (WG) defines theories are propounded to explain health behaviors, e.g.,
vaccine hesitancy as a “delay in acceptance or refusal of the health belief model (HBM), protection motivation
vaccination despite the availability of vaccination services” theory, and theory of planned behavior, among others.
(MacDonald et al., 2015). Several conceptual models exist Till today, HBM has remained a dominant theory of
for categorizing vaccine hesitancy; one widely used model health beliefs with its five primary components: Primary
is the “3Cs” model, which the WG incorporated into their sustainability, primary severity, perceived benefits,
definition of vaccine hesitancy. The “3Cs” model consists perceived barriers, and cues to action. In the mid-1980s, a
of three factors: (i) confidence, (ii) complacency, and (iii) sixth component of self-efficacy was added, which reflects
convenience. Confidence represents the trust of the vaccine a person’s confidence in his/her ability to successfully
recipient in the effectiveness and safety of the vaccine perform a behavior (Abraham & Sheeran, 2015). Recently,
and the delivery system. Complacency occurs when the Limbu et al. (2022) have provided a systematic review
perceived risk of the disease is low in view of the recipient; of HBM to COVID-19 vaccine hesitancy, covering
other factors can also contribute to complacency, such as 30,242 participants. These authors identified other HBM
the initial success of the vaccine program. Convenience modifying factors to be associated with COVID-19 vaccine
relates to the availability and accessibility of the desired hesitancy, namely, gender, education, age, geographical
vaccine (MacDonald et al., 2015). Application of the 5Cs location, occupation, income, employment, marital status,
framework was used to study vaccine hesitancy among race, ethnicity, knowledge of COVID-19 prior diagnosis,
pregnant women. The 5Cs model includes constraints, history of flu vaccine, religion, nationality, and political
complacency, calculation, confidence, and collective affiliation.
responsibilities (Casubhoy et al., 2024). The 3Cs and 5Cs Schmid et al. (2017) attempted to classify the barriers
models focus on psychological factors, but cultural and to influenza vaccine uptake into its micro- and macro-
structural influences on vaccination behavior need to be levels. The micro-level barriers are generally psychological
investigated. and physical. These barriers can be related to the theories
of health decision-making and behavior. The authors
Vaccine hesitancy is not unique to the COVID-19
vaccine. As of August 13, 2024, 70.6% of the global identified 258 micro-level barriers. These barriers were
subsequently grouped into the following categories: utility,
population has received at least one dose of the risk perception, social benefit, subjective norm, perceived
COVID-19 vaccine, but only 32.7% of individuals in low- behavioral control, attitude, past behavior, experience,
income countries had received at least a first vaccine by knowledge, and unhealthy lifestyles. Specifically, our focus
April 13, 2024 (Yamanis, 2024; “Deployment of COVID-19 is on respondents’ attitude, sociodemographic factors, and
vaccines,” 2024). Despite high childhood vaccination their risk perception. In addition, we will break down the
rates in developed countries, recent outbreaks of vaccine- COVID-19 vaccine hesitancy rates among the different
preventable diseases, such as measles and mumps, have regions of the US.
demonstrated the existence of clusters of unvaccinated
populations. A national survey of childhood vaccines and The contributing factors for COVID-19 vaccine hesitancy
influenza vaccines in the United States (US) found that can vary. Social media organization (Wilson & Wiysonge,
one in 15 (6.7%) parents were hesitant about childhood 2020), vaccine characteristics (Wong et al., 2021), political
vaccines, while the prevalence for influenza vaccine affiliations (Albrecht, 2022), education level (Zychlinsky
hesitancy was more than one in four (25.0%) parents. In Scharff et al., 2022), employment, risk of infection (Gatto
addition, the same survey found that about one in four et al., 2021), distrust of the COVID-19 vaccine (Nair et al.,
parents believed the influenza vaccine to be effective. 2021), and general vaccine avoidance (Shen & Dubey, 2019).
One in eight (12.5%) parents was also concerned with the Past studies looking into COVID-19 vaccine hesitancy have
side effects of influenza and routine childhood vaccines. used a large-n cross-country regression framework, survey
Prevailing hesitancy toward vaccines in the US begs the with choice-based conjoint analysis, and regression analyses
question: What are the specific factors that contribute to to analyze data in previous studies.
vaccine hesitancy? A theoretical framework guiding the According to Sallam (2021) (based on data up to
current research is to account for variation in vaccine December 25, 2020), the highest COVID-19 vaccine

Volume 3 Issue 2 (2025) 136 https://doi.org/10.36922/ghes.2958