Esther Lermytte about her PhD research: “Childhood Vaccines, Parental Hesitancy: A Sociological Inquiry into the Relational and Socio-Cultural Dynamics Shaping Vaccine Hesitancy”

“Childhood Vaccines, Parental Hesitancy: A Sociological Inquiry into the Relational and Socio-Cultural Dynamics Shaping Vaccine Hesitancy”

In high-income countries, childhood vaccination programmes are well-established within public health systems, ensuring widespread availability and accessibility of vaccines. However, studies have shown a decline in public confidence in vaccines and a concurrent rise in vaccine hesitancy. While much of the existing research attempts to explain this trend using individualistic, deficit-based approaches, the health sociological literature has emphasised the importance of situating individuals' vaccine attitudes within broader societal dynamics, underscoring that this is both a public health and a social issue.

Drawing on this health sociological framework, this dissertation investigates how the social worlds of vaccine-hesitant parents, healthcare professionals, and young children interact in the context of the healthcare system. It is based on four empirical studies that utilise both qualitative and quantitative methods and are organised around three main aims: first, to explore how the perspectives of parents and healthcare professionals are shaped by broader social norms; second, to examine how these social worlds interact during childhood vaccination encounters; and third, to analyse how healthcare system characteristics influence vaccine attitudes across European contexts.

The first two empirical chapters focus on hesitant parents and healthcare professionals, respectively. Drawing on literature gendered parenting, risk discourse, healthism, moralisation, and changing patient-professional relations, these chapters show how both groups grapple with socio-cultural expectations of health and parenting. Vaccine-hesitant mothers, for instance, may perceive their decision-making responsibility as empowering, yet this responsibility should equally be considered within the mothers’ broader context of social and gendered vulnerabilities. As such, this dissertation suggests that vaccine hesitancy research and policy may benefit from conceptualising it, at least in part, as related to a disposition in which mothers are socialised from the onset of pregnancy. Healthcare professionals, in turn, experience moral tensions when navigating competing demands related to risk, professional authority, and ideals of "good" parenting. Consequently, their accounts of parental vaccine hesitancy range from internalising and reinforcing moralising discourses to actively resisting them. This complexity indicates that while healthcare professionals are often tasked with addressing vaccine hesitancy, they too require support in navigating the dilemmas stemming from contradictory societal expectations. The third empirical chapter examines the childhood vaccination encounter itself as a site of interaction. Notably, it brings attention to the role of pre-verbal children, whose experiences of vaccine-related pain are often under-recognised. This chapter demonstrates how children are either socialised into the patient role or excluded from it, and how this shapes pain mitigation practices. These dynamics have consequences not only for children's immediate experiences but also for parental and healthcare professionals’ attitudes toward vaccination. The final empirical chapter adopts a broader institutional lens, investigating how the organisation and accessibility of healthcare systems are associated with vaccine hesitancy. It finds that systems characterised by higher accessibility are associated with lower levels of hesitancy, underscoring the importance of structural factors in shaping individual vaccine attitudes.

Overall, this dissertation offers a nuanced, sociologically informed understanding of childhood vaccination and parental hesitancy. By highlighting the relational, socio-cultural, and institutional dynamics at play, it contributes to the ongoing demoralisation and de-individualisation of parental vaccine hesitancy - framing it not as a matter of individual determinants but as a complex social phenomenon.

Supervisor: Prof. dr. Piet Bracke

Co-supervisors: dr. Melissa Ceuterick and dr. Katrijn Delaruelle