Understanding vaccine hesitancy: Cha’s story

Seated on the front porch of her house, perched on the side of a mountain in the vibrant green landscape of Yen Bai Province, Vietnam, with the steady sounds of daily life humming in the background, a woman named Cha tells us who she is in her own words.

A young mother of two, she and her children share a household with her mother-in-law, father-in-law, two siblings, assorted ducks, three cows and a long-suffering cat. To provide for her family, she sews clothes during the wedding season and collects wood in the off-season.

Meanwhile, two kilometres away, Senior Health Station Nurse Giang tidies up the clinic in preparation for vaccination day. He worries about vaccine hesitancy in this Hmong community. He thinks it might come from local beliefs, lack of knowledge about vaccines, fear of side effects or the difficulty of travelling to the health facility over mountainous terrain.

But he and his colleagues have been investing in communication, and Cha, who is unsure which vaccines her son is getting, and cannot find her daughter’s vaccination card, has nevertheless heard enough to gather up her family and make her way on foot with her mother-in-law, her children on their backs, over the hills to the clinic.

Concerns like Giang’s about vaccine hesitancy or low demand grow increasingly common as countries attempt to bring vaccines against COVID-19 and other infectious diseases to marginalised communities. A pulse survey conducted in July 2020 indicated that of 260 immunisation professionals in 82 countries, 73% reported a disruption in immunisation demand during the pandemic.

By that time, 15 of 40 Gavi-eligible countries had indicated an increased spread of rumours and misinformation, with 21 noting a moderate or high impact on public trust for immunisation. These findings indicate that the COVID-19 pandemic has likely accelerated global trends of increasing vaccine hesitancy. As we stand on the precipice of an historical moment for immunisation with the rollout of COVID-19 vaccines, the spectre of rumours, misinformation, mistrust and hesitancy poses a growing and complex challenge, particularly in an increasingly digital world.

Cha’s story helps us understand the steps that a caregiver must overcome to vaccinate their child, from gaining knowledge and awareness, to establishing intent to vaccinate, to preparing to act, to accepting the cost and effort, to experiencing an immunisation session at the facility, to experiencing any side effects after vaccination, to deciding to return for more doses. Numbers may tell us the “who, what, where and when” of vaccine hesitancy or low demand for immunisation, and knowledge like Giang’s may allow us to guess at the “why,” but it is difficult to fully understand the decisions of families like Cha’s without taking a walk in their shoes.