Project description

VAX-TRUST (2021-2024) examines vaccine hesitancy among parents and healthcare professionals in Europe. Based on the gained insights, tailored interventions will be developed to aid healthcare professionals in convincing vaccine hesitant parents. The project is funded by the European Commission (Horizon 2020), is led by Dr. Pia Vuolanto (Tampere University, Finland) and carried out in collaboration with several other European universities  (Jagiellonian University, University of Turin, University of Lisboa, Charles University, University of Cassino and Southern Lazio, University of Nottingham, Finnish Institute for Health and Welfare). More information about this project can be found on:

Prof. Piet Bracke is the leader of Work Package 2, which aims to investigate macro-level determinants of vaccine hesitancy.

Research results

Importance of contextual determinants

The VAX-TRUST project studies vaccine hesitancy as a broad social phenomenon from a sociological perspective. The project pursues three major objectives: (i) to obtain up-to-date sociological knowledge about vaccine hesitancy, (ii) to gain insight into the interactions between healthcare professionals and parents with doubts and the related challenges, and (iii) to develop an intervention based on these insights. The intervention aims to improve the experience of healthcare professionals and patients when dealing with the subject of childhood vaccination and possible concerns and doubts.

In the first phase of the project, the contextual determinants of vaccine hesitancy were examined in the broad European population. Quantitative analyses were carried out on European data to discover to what extent the country in which someone lives determines the attitudes people hold towards vaccines. In addition, an analysis was conducted on the reporting on vaccines in traditional and alternative media channels.

These analyses showed that some characteristics of countries have an impact on attitudes towards vaccination. For example, corruption in healthcare can be linked to negative attitudes towards vaccination. In countries where bribes are widespread in healthcare, people rate the importance and effectiveness of vaccines lower. The mandatory nature of vaccines also has an impact. In countries where almost all vaccines are mandatory, people rate the importance and effectiveness of vaccines lower. Finally, social cohesion also plays an important role. In countries where people have greater trust in each other and there is a lot of social cohesion, people rate the importance and effectiveness of vaccines higher.

Perspective of parents and healthcare professionals

In a second phase of the project, we studied vaccine hesitancy among parents in the Flemish context. Initially, we conducted interviews with 15 parents who have doubts and concerns about vaccinating their child. We also conducted 39 interviews with healthcare professionals involved in the vaccination of children. Finally, we conducted observations in 6 consultation offices of the Office de la Naissance et de l'Enfance (ONE). These analyses provide insight into the perspective of parents, the perspective of healthcare providers, and the importance of the interaction between parents and healthcare providers.

The interviews showed that vaccine hesitancy can be represented on a continuum; each situation is different and brings the necessary nuances with it. We also found that doubts about vaccines are specific to each vaccine and may also depend on the situation and (medical) history of the child or parent.

Firstly, parents with vaccine hesitancy indicate a need for clarity. The differences between mandatory, recommended, or optional childhood vaccines creates confusion and influences the parents' decision to administer a vaccine or not. Changes in vaccination policy can also raise doubts. Sometimes, a vaccine was not included in the basic vaccination schedule for a previous child and therefore, parents consider it unnecessary.

Secondly, previous experiences with vaccination, but also other experiences with healthcare, are linked to vaccine hesitancy. For example, parents point out the importance of the course of their children’s previous vaccinations, but their experiences with regular healthcare also play a role in considering whether to vaccinate their child or not. Positive experiences, especially a good trust relationship with their healthcare professional, can reassure parents with doubts or concerns, while negative experiences can exacerbate concerns and doubts.

Thirdly, vaccine hesitancy among parents can also be related to their broader vision of health and immunity. Parents may pursue other ways to optimize their children's immune system. They believe that these alternative methods are better than vaccines, as they often perceive vaccines as harmful. Parents may feel a strong sense of responsibility for safeguarding and optimizing their children's health, which is why they do not consider vaccination as an evident decision but rather a well-considered decision that has a significant impact on the child's overall health and development.

Furthermore, when faced with the decision of whether or not to vaccinate their child, parents also take into account the opinions of people from their family, friends, and broader (online) social network.

The interviews with healthcare professionals showed that they generally have a pro-vaccination attitude. However, their attitude towards parents with doubts varies from person to person and depends on several factors. Some healthcare professionals showed a lack of understanding for vaccine hesitancy, especially from their position as experts on vaccination, while others understood the doubts and concerns that parents experience, knowing that vaccination is no longer an evident decision for many parents. Still, others even considered it good that parents adopted a critical attitude in making decisions about their child's health and simply saw vaccine hesitancy as a result of this. This variation in attitude arises from their own vision of health and the institutional context in which they work, as well as their own position as a parent.

Healthcare professionals face several challenges in their consultations regarding childhood vaccination. Many of them reported having moral difficulties in promoting paid vaccines out of concern for vulnerable populations. Additionally, they report a lack of practical tools to have a conversation with parents about vaccine hesitancy.

Interaction between parents and healthcare professionals

A relationship of trust between parents and healthcare professionals is very important. This can be established by adopting an individual approach and engaging in a conversation with parents where they are given space to ask questions and express any doubts. Parents also indicated that it is important that sufficient attention is paid to the side effects of vaccines and that they are not minimized. They also want to be given the space to express their interest in complementary and alternative medical practices.

Conclusion of research results

From the interviews with parents and healthcare professionals, and the observations, some good and bad practices were identified to promote a relationship of trust. Bad practices include being too pushy, trying to instil fear in parents, being patronizing or authoritarian, and avoiding the subject of vaccination or considering it as "settled." Good practices include using arguments from personal experience, asking permission to have a conversation about vaccine hesitancy, and demonstrating empathy. Above all, it is essential that both parents and healthcare professionals recognize that they both have a common goal, namely that they both want what is best for the child.

We can conclude that each parent needs a different approach regarding vaccination since different factors underlie their hesitancy. Attention to reflexivity among healthcare professionals promotes the relationship between healthcare professional and patient. Based on these insights, an e-learning intervention was developed. The goal of this e-learning is to provide a set of practical tools that can improve the experience of both healthcare professionals and parents when the topic of vaccination arises during consultations.



Tampere University, Jagiellonian University, University of Turin, University of Lisboa, Charles University, University of Cassino and Southern Lazio, University of Nottingham, Finnish Institute for Health and Welfare

Dutch version

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