Europe has been named as the most sceptical region on vaccine safety in the world, in the largest ever global survey of vaccine confidence.

Researchers from Imperial College London and their collaborators surveyed nearly 66,000 people from 67 countries to explore their views on whether vaccines are important, safe, effective, and compatible with their religious beliefs. The study, published in the journal EBioMedicine, found that although overall sentiment towards vaccines was positive across the surveyed countries, there was significant variation in attitudes around the world.

In particular, the researchers found that seven of the ten countries that were least confident in vaccine safety were in Europe: France, Bosnia & Herzegovina, Russia, Greece, Ukraine, Slovenia, and Armenia.

Lack of confidence in the importance, safety, and effectiveness of vaccines has previously led to public health issues such as outbreaks of measles and setbacks in global efforts to eradicate diseases such as polio. With recent disease outbreaks triggered by people refusing vaccination, these findings could provide valuable insights to help policymakers identify and address key issues in the way vaccines are perceived.

The team found that France was the country with least confidence in vaccine safety, with 41 per cent of those surveyed disagreeing that vaccines are safe. This is more than three times the global average of 12 per cent. Following close behind was Bosnia & Herzegovina on 36 per cent, Russia on 28 per cent, and Mongolia on 27 per cent. Greece, Japan and Ukraine were all equally less confident of the safety of vaccines, at 25 per cent.

The authors say the negative attitudes in France may come as a result of a number of controversies in the country over the past two decades. These include the controversy over suspected side effects of the Hepatitis B and HPV vaccines, and hesitancy among a significant proportion of GPs as to the usefulness of some vaccines.

Bangladesh, Ecuador, and Iran had the highest proportion of people who agreed that vaccines are important, while Russia, Italy and Azerbaijan reported most scepticism around their importance.

Although the researchers found that in some countries particular religious groups were more sceptical of vaccines than others, no single religion was associated with negative attitudes worldwide. They say this indicates that the impact religion has on attitudes towards vaccines is dependent on the local context, rather than being driven by religious doctrine itself.

Another finding suggested that people aged 65 and over globally had more positive views on vaccines than other age groups.

The study also showed that many countries, particularly France, Bosnia & Herzegovina, Japan, Iran, Mongolia and Vietnam, display much greater confidence in the importance of vaccines than in their safety. This suggests a disconnect between perceptions of vaccine importance and their relative safety, with possible negative health consequences if views on vaccine importance worsen.

Dr Nick Jones, co-author from the Department of Mathematics at Imperial, said: “Today’s study showed that for many countries with lower incomes there was high confidence in vaccines, but low vaccination rates, suggesting that improving delivery could improve vaccination rates. However, for developed regions such as Europe, we recently found that factors such as delivery played less of a role in vaccination rates. Public confidence in vaccines, or lack thereof, likely influences vaccination rates in Europe.”

Alex de Figueiredo, co-lead author from the Department of Mathematics at Imperial, said: “The results from this study were taken at one point in time. Repeated surveys will give us a better understanding of the complex interplay between the different factors at work that influence immunisation rates. This study therefore highlights the need for continuous worldwide monitoring of public confidence in vaccines, so that policymakers can measure how effective their interventions are on people’s attitudes.”

The study was co-led by Dr Heidi Larson from the London School of Hygiene & Tropical Medicine, and involved researchers from the University of Birmingham and the National University of Singapore.

Dr Larson added: “It’s striking that Europe stands out as the region most sceptical about vaccine safety. And, in a world where the internet means beliefs and concerns about vaccines can be shared in an instant, we should not underestimate the influence this can have on other countries around the world.”

The authors point out that the findings cannot reveal whether attitudes were related to specific vaccines, or give reasons behind the attitudes expressed. They hope future surveys will provide these insights, and that this study can be used as a baseline to monitor change in attitudes towards vaccines over time.

Today’s findings complement another of the researchers’ papers, published on 25 August in The Lancet Global Health, which highlighted 53 underperforming countries in terms of vaccination rates.

"The State of Vaccine Confidence 2016: Global insights through a 67-country survey" by Heidi J. Larson et al is published in EBioMedicine, 9 September 2016. 

“Forecasted trends in vaccination coverage and correlations with socioeconomic factors: a global time-series analysis over 30 years” by Alexandre de Figueiredo, et al is published in The Lancet Global Health, 25 August 2016. 

This story was adapted from a press release by the London School of Hygiene and Tropical Medicine, published 9 September 2016.