RSV information and awareness platform Türkçe Frequently asked questions

Scientific background

Vaccine confidence

The success of immunisation programmes depends as much on how the evidence is perceived by the public, who conveys it and under what system conditions it is delivered, as on the existence of the evidence itself.

Key message Vaccine hesitancy cannot be reduced to a lack of information; it is a multi-layered psychological, sociocultural and structural phenomenon. For RSV interventions, trust and accurate communication are decisive.

Vaccines are among the most effective public health interventions for preventing infectious disease. Yet vaccine hesitancy — defined as delay in acceptance or refusal of vaccination even where vaccines and services are accessible — is a complex, multidimensional public health problem that threatens those gains.1 The World Health Organization's classification of vaccine hesitancy in 2019 as one of the leading threats to global health shows it is not an individual decision problem but a strategic risk.2

From 3C to 7C: the conceptual framework

The 3C model developed by the WHO Strategic Advisory Group of Experts on Immunization (SAGE) explains hesitancy through confidence, complacency and convenience. The framework was later extended with risk–benefit calculation and collective responsibility3; during and after the pandemic, conspiracy beliefs, misinformation and social norms were added.4

  • Confidence

    Belief in the safety and effectiveness of the vaccine, and in health workers, the health system, public authorities, scientific institutions, regulators and manufacturers.

  • Complacency

    Seeing vaccination as unnecessary because disease risk is perceived as low.

  • Convenience / access

    Physical, economic and logistical accessibility of immunisation services.

  • Risk–benefit calculation

    The assessment an individual makes in reaching a vaccination decision.

  • Collective responsibility

    The sense of social responsibility to protect others.

  • Pandemic additions

    Conspiracy beliefs, misinformation and social norms.

Attitudes to vaccination vary by time, place, vaccine type, target group and epidemiological context. Acceptance or refusal is therefore better treated as a decision spectrum shaped by circumstances than as a fixed behaviour.5

The post-pandemic confidence crisis and the infodemic

The COVID-19 pandemic moved vaccine hesitancy beyond individual decision-making into a broader crisis of social trust. Rapid vaccine development, emergency use authorisations, debates over mandates and restrictions increased confidence in scientific capacity among part of the public while deepening suspicion of institutional transparency, the pharmaceutical industry and public authorities among another.678

A recent study in Türkiye shows the COVID-19 period adversely affected parents' confidence in vaccines.14 This suggests the loss of confidence was not confined to COVID-19 vaccines but fed a broader climate of doubt extending to routine childhood vaccines and new immunisation products.

A further dynamic is the infodemic. Accurate information circulating alongside incorrect, incomplete or deliberately distorted content makes it harder for people to reach reliable sources.1326 On digital platforms misinformation can spread faster than evidence-based information; algorithmic feeds and echo chambers expose people more often to content reinforcing existing beliefs.8 The effect is most pronounced in sensitive areas such as pregnancy, infant health and new immunisation technologies.

Low uptake does not always mean hesitancy

Hesitancy is often presented as an individual "choice", but immunisation cannot be explained by attitude and willingness alone. Access to services, cost, reimbursement coverage, ease of appointment, geographical reach and health literacy all shape vaccination behaviour.10111 Someone may hold entirely positive views of vaccination and still be unable to benefit from a preventive service because of structural access barriers.

Where health literacy is limited, short, simple, emotionally charged misleading messages can become more persuasive.11 But high educational attainment does not always mean high acceptance either; intensive information-seeking, selective appraisal of evidence and confirmation bias can weaken trust in evidence-based recommendations in some groups.12 Hesitancy may also relate to cognitive flexibility, perceptions of authority and values.16

The RSV case: terminology and risk perception

New RSV immunisation strategies offer a current example for assessing public acceptance of new preventive products after the pandemic. That nirsevimab is not a vaccine but a long-acting monoclonal antibody providing passive protection through the RSV season, and that maternal RSV vaccination works by transferring antibodies formed in the mother, both raise the importance of accurate terminology and clear communication.1920

The novelty of these products, safety concerns relating to pregnancy and infant health, and the perception of RSV as merely a childhood infection all point to distinct forms of hesitancy that could limit acceptance.2122

What effective communication looks like

Presenting scientific data alone is not enough to reduce hesitancy. The form and tone of communication, how concerns are addressed, and who delivers the message matter at least as much as the content. Blunt corrective messaging, accusatory language or fear tactics can in some circumstances reinforce false beliefs.13

  1. Convey scientific consensus plainly

    Translating complex evidence into comprehensible language is a precondition for trust.23

  2. Explain uncertainty honestly

    Possible side effects, safety signals, uncertainties about real-world effectiveness and data limitations should be shared promptly and clearly alongside expected benefits.23

  3. Do not dismiss concerns

    Supporting decision-making without belittling people’s concerns is among the strategies that can increase acceptance.24

  4. Make decision processes transparent

    That new immunisation products are developed by commercial firms can strengthen the perception in some groups that commercial interests come before public health priorities. It is therefore important to share not only clinical data but also assessment processes, conflicts of interest and the reasoning behind decisions.23

  5. Clarify terminology

    It should be conveyed clearly that nirsevimab is not a vaccine but a long-acting monoclonal antibody used within an immunisation strategy.19

Sustainable vaccine acceptance is possible not merely by making products accessible, but by strengthening trust, transparency, health literacy, social solidarity and equitable service delivery.

Related pages

Sources

  1. MacDonald, N. E. (2015). Vaccine hesitancy: Definition, scope and determinants. Vaccine, 33(34), 4161–4164. doi.org/10.1016/j.vaccine.2015.04.036
  2. World Health Organization (WHO). (2019). Ten threats to global health in 2019. www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019
  3. Betsch, C., Schmid, P., Heinemeier, D., Korn, L., Holtmann, C., & Böhm, R. (2018). Beyond confidence: Development of a measure assessing the 5C psychological antecedents of vaccination. PLoS ONE, 13(12), e0208601. doi.org/10.1371/journal.pone.0208601
  4. Geiger, M., Rees, F., Lilleholt, L., Santana, A. P., Zettler, I., Wilhelm, O., Betsch, C., & Böhm, R. (2021). Measuring the 7Cs of vaccination readiness. European Journal of Psychological Assessment, 37(5), 360–369. doi.org/10.1027/1015-5759/a000663
  5. Palmieri, C., & Tafuri, S. (2026). Vaccine hesitancy: An evolving challenge. The Lancet, 407(10526), 311–312. doi.org/10.1016/S0140-6736(26)00112-X
  6. Blukacz, A., Obach, A., Vásquez, P., Campana, C., Huerta, C., Bernal, Y., & Cabieses, B. (2025). Determinants of COVID-19 and non-COVID-19 vaccine confidence in low- and middle-income countries: A systematic review of qualitative evidence and thematic synthesis. Vaccine, 44, 126546. doi.org/10.1016/j.vaccine.2024.126546
  7. Sapienza, A., & Falcone, R. (2022). The role of trust in COVID-19 vaccine acceptance: Considerations from a systematic review. International Journal of Environmental Research and Public Health, 20(1), 665. doi.org/10.3390/ijerph20010665
  8. Truong, J., Bakshi, S., Wasim, A., Ahmad, M., & Majid, U. (2022). What factors promote vaccine hesitancy or acceptance during pandemics? A systematic review and thematic analysis. Health Promotion International, 37(1), daab105. doi.org/10.1093/heapro/daab105
  9. Whitaker, M., Elliott, J., Gerard-Ursin, I., Cooke, G. S., Donnelly, C. A., Ward, H., Elliott, P., & Chadeau-Hyam, M. (2026). Profiling vaccine attitudes and subsequent uptake in 1.1 million people in England: A nationwide cohort study. The Lancet, 407(10532), 612–624.
  10. Bedford, H., Attwell, K., Danchin, M., Marshall, H., Corben, P., & Leask, J. (2018). Vaccine hesitancy, refusal and access barriers: The need for clarity in terminology. Vaccine, 36(44), 6556–6558. doi.org/10.1016/j.vaccine.2018.09.033
  11. Lorini, C., Santomauro, F., Donzellini, M., Capecchi, L., Bechini, A., Boccalini, S., Bonanni, P., & Bonaccorsi, G. (2018). Health literacy and vaccination: A systematic review. Human Vaccines & Immunotherapeutics, 14(2), 478–488. doi.org/10.1080/21645515.2017.1392423
  12. Larson, H. J., Jarrett, C., Eckersberger, E., Smith, D. M., & Paterson, P. (2014). Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: A systematic review of published literature, 2007–2012. Vaccine, 32(19), 2150–2159. doi.org/10.1016/j.vaccine.2014.01.081
  13. Whitehead, H. S., French, C. E., Caldwell, D. M., Letley, L., & Mounier-Jack, S. (2023). A systematic review of communication interventions for countering vaccine misinformation. Vaccine, 41(5), 1018–1034. doi.org/10.1016/j.vaccine.2022.12.057
  14. Teker, A. G., Yüce, H. N., Erkal, Ç. E., Sağlam, G., Çatar, A., Uçar, Y., Yılmaz, S., & Aklan, Ş. Y. (2026). Vaccine hesitancy regarding childhood vaccinations among parents. The Journal of Pediatric Research, 13(1), 45–52.
  15. Bhattacharya, O., Siddiquea, B. N., Shetty, A., Afroz, A., & Billah, B. (2022). COVID-19 vaccine hesitancy among pregnant women: A systematic review and meta-analysis. BMJ Open, 12(8), e061477. doi.org/10.1136/bmjopen-2022-061477
  16. Gomes-Ng, S., Wood, J. K., & Cowie, S. (2024). Cognitive flexibility predicts attitudes towards vaccination: Evidence from a New Zealand sample. BMC Psychology, 12(1), 550. doi.org/10.1186/s40359-024-01990-2
  17. Moore, R., Purvis, R. S., CarlLee, S., Hallgren, E., Kraleti, S., Willis, D. E., & McElfish, P. A. (2023). Understanding vaccination among hesitant adopters of the COVID-19 vaccine using the increasing vaccination model. Journal of Health Communication, 28(7), 458–476. doi.org/10.1080/10810730.2023.2223841
  18. Willis, D. E., Moore, R., Purvis, R. S., & McElfish, P. A. (2024). Hesitant but vaccinated: Lessons learned from hesitant adopters. Vaccine, 42(20), 126135. doi.org/10.1016/j.vaccine.2024.06.012
  19. Esposito, S., Fainardi, V., Capra, M. E., Aricò, M., Lanzoni, A., Campana, B. R., Niceforo, M., Neglia, C., Valletta, E., & Biasucci, G. (2025). Acceptance of nirsevimab for the prevention of respiratory syncytial virus infection in neonates: A cross-sectional survey in Emilia-Romagna, Italy. Vaccines, 13(9), 896. doi.org/10.3390/vaccines13090896
  20. Micheletto, C., Lorenzini, G., De Grazia, S., Di Marco, F., Di Matteo, R., Faverio, P., Gramegna, A., Vicentini, M., & Blasi, F. (2025). Awareness of respiratory syncytial virus and other respiratory disease vaccines among healthcare professionals and their patients in Italy. Human Vaccines & Immunotherapeutics, 21(1), 2552557. doi.org/10.1080/21645515.2025.2552557
  21. Gatt, D., & Hazan, G. (2025). Respiratory syncytial virus vaccination: Likely and less likely outcomes. Current Opinion in Pediatrics. doi.org/10.1097/MOP.0000000000001350
  22. Nuzhath, T., Khobragade, N., Regan, A. K., Pinkney, J. A., Wise, L., & Callaghan, T. (2025). Pregnant women's perceptions of RSVpreF vaccine and nirsevimab for infant RSV prevention. Vaccine, 62, 127590. doi.org/10.1016/j.vaccine.2024.127590
  23. Iannizzi, C., Andreas, M., Bohndorf, E., Hirsch, C., Zorger, A.-M., Brinkmann-Paulukat, J., Bormann, B., Kaufman, J., Lischetzki, T., & Monsef, I. (2025). Communication-based interventions to increase COVID-19 vaccine willingness and uptake: A systematic review with meta-analysis. BMJ Open, 15(5), e072942. doi.org/10.1136/bmjopen-2023-072942
  24. Jwa, S., Imanishi, Y., Ascher, M. T., & Dudley, M. Z. (2025). Communication interventions to reduce parental vaccine hesitancy: A systematic review. Vaccine, 61, 127401. doi.org/10.1016/j.vaccine.2024.127401
  25. T.C. Sağlık Bakanlığı. (2024). 2024–2028 stratejik planı. T.C. Sağlık Bakanlığı.
  26. The Lancet Respiratory Medicine. (2025). Public trust: The vaccine against vaccine hesitancy. The Lancet Respiratory Medicine, 13(4).

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The information on this site is for general guidance only and does not replace examination, diagnosis or treatment by a clinician.