Social Determinants of Vaccine Hesitancy: Implications for Immunization Programmes

Abstract

Vaccination remains one of the most successful public health interventions, yet vaccine hesitancy continues to threaten progress toward universal immunization. While early work on vaccine hesitancy focused on individual attitudes, a growing body of research highlights the central role of social determinants of health in shaping vaccination decisions. This narrative review synthesizes recent evidence on how socioeconomic position, education, health system access, cultural and political context, and the contemporary information environment interact to produce heterogeneous patterns of vaccine hesitancy and uptake. Building on widely used conceptual frameworks of hesitancy, the review emphasizes that doubts about vaccines are rarely the result of “misinformed individuals” alone. Rather, they are patterned along lines of poverty and marginalization, place of residence, historical experiences with state and health institutions, and differential exposure to (mis)information and trust-eroding events. The review concludes by outlining implications for practice: embedding immunization in broader social policy, strengthening primary health care and community engagement, investing in trust-building communication, and designing interventions that are locally tailored and structurally informed. Finally, it identifies priorities for future research, including theory-driven mixed-methods studies and more work in low- and middle-income settings.