Shades of doubt: Measuring and classifying vaccination confidence in Europe.

The anti-vaccination movement, vaccine hesitancy, and wavering vaccination confidence have increasingly become matters of public interest, in parallel with an increasing normalization of representations of vaccination as risky. In this study, we used data on vaccination beliefs and behaviors from two Eurobarometer surveys to classify attitudes towards vaccination and to discuss comparability, acquiescence, and other measurement issues. Through cluster analysis, we found that individuals in the European Union (EU27) can be classified into five opinion types, differentiating the poles ("vaccine-trusting" and "vaccine-distrusting") from the "hesitant & free choice" cluster and from two relatively uncommitted clusters, the "agreeable" (or acquiescent) and the "fence-sitters." Opinion configurations on vaccination were linked to the broader social structures of age, gender, and educational attainment, to experiences of adult vaccination, and trust in different information sources. We found that trust, distrust, and confusion about vaccination have permeated all social strata in EU countries. The pandemic years have amplified uncertainty concerning vaccine safety and its effectiveness. We also noticed a decrease of trust in the voices of mainstream medical experts during the pandemic period, from about 92 % in 2019 to 73 % in 2021, and a significant increase in people who declared that they "don't know" whom to trust about vaccine information, ranging from 1 % to about 13 %. Measurements of vaccination confidence in Europe should control for acquiescence, through positively and negatively formulated items, and ensure comparability in time. We strongly recommend the inclusion of a battery of critical items in all future European Commission-funded surveys on vaccination to allow the monitoring of European public confidence in vaccination and in the relevant information sources, including trust in pharmaceutical companies; this will provide an avenue for re-establishing a broader confidence among citizens, health authorities, and specialists.

Social amplification of risk and "probable vaccine damage": A typology of vaccination beliefs in 28 European countries.

BACKGROUND: Despite lacking scientific support, vaccine hesitancy is widespread. While serious vaccine damage as a scientific fact is real yet statistically highly uncommon, emerging social and technological forces have amplified perceptions of risk for "probable vaccine damage", making it a widely shared intersubjective reality. METHODS: Using the Eurobarometer 91.2 survey on a statistically representative EU27-UK sample interviewed in March 2019, we documented perceptions of vaccine risks and identified three belief configurations regarding vaccine effectiveness, safety, and usefulness, through exploratory cluster analysis. RESULTS: The public beliefs in significant vaccine risks are frequent. Approximatively one-tenth of the EU27-UK population consider that vaccines are not rigorously tested before authorization, one-third believe that vaccines can overload or weaken the immune system and that they can cause the disease against which they protect, and almost one-half believe that vaccines can cause serious side effects. We identified three belief configurations: hesitant, confident, and trade-off clusters. The hesitant type (approx. 11% of EU27-UK respondents) is defined by the perception that vaccines are rather ineffective, affected by risks of probable vaccine damage, not well-tested, and useless; the confident type (approx. 59%) is defined by beliefs that vaccines are effective, safe, well-tested, and useful; and the trade-off type (approx. 29%) combines beliefs that vaccines are effective, well-tested and useful, with perceptions of probable vaccine damage. The vaccine-confident and the trade-off types have similar vaccination histories, indicating the significant role of other factors besides beliefs in inducing behavior. CONCLUSIONS: The high proportion of varying public beliefs in significant vaccine risks and the presence of a trade-off type of vaccination assessment indicate the social normality of beliefs in probable vaccine damage. Communication campaigns should take into account the social normality of the perceived risk of "probable vaccine damage" across various social types, and patterns of concomitant trust and mistrust in vaccination.