Attitudes to vaccination: a critical review.

This paper provides a consolidated overview of public and healthcare professionals' attitudes towards vaccination in Europe by bringing together for the first time evidence across various vaccines- countries and populations. The paper relies on an extensive review of empirical literature published in English after 2009- as well as an analysis of unpublished market research data from member companies of Vaccines Europe. Our synthesis suggests that hesitant attitudes to vaccination are prevalent and may be increasing since the influenza pandemic of 2009. We define hesitancy as an expression of concern or doubt about the value or safety of vaccination. This means that hesitant attitudes are not confined only to those who refuse vaccination or those who encourage others to refuse vaccination. For many people- vaccination attitudes are shaped not just by healthcare professionals but also by an array of other information sources- including online and social media sources. We find that healthcare professionals repor