Achieving high and equitable vaccination coverage requires more than improving vaccine supply. Increasingly, research shows that vaccination decisions are shaped by individuals’ trust in both vaccines and the broader health system. Declining trust has contributed to a decline in vaccination demand globally, thereby increasing the risk of outbreaks.
A recent study published in The Lancet Global Health introduces a new Vaccine Trust Framework that conceptualizes trust as a multidimensional construct and provides a validated tool for measuring and addressing vaccine hesitancy.
The framework was developed using mixed-method research in Nigeria, Kenya, and Pakistan. Qualitative findings revealed that trust in vaccination decisions involves two components: trust in promise, whether people believe vaccines and health systems are intended to benefit them, and trust in delivery, whether these promises are fulfilled in practice. These components apply to both health systems and vaccines, producing four domains: health system promise, health system delivery, vaccine promise, and vaccine delivery. Within these domains, the authors identified fifteen measurable dimensions, including fairness, affordability, accessibility, competence, compassion, confidentiality, safety, benefit, relevance, and adequacy of information.
To operationalize the framework, researchers developed a 65-item survey tool and conducted nationally representative surveys in Kenya and Pakistan. Statistical analyses demonstrated good structural validity, and higher trust scores were consistently associated with greater likelihood of previous vaccination across multiple vaccines, including routine childhood vaccines, HPV, and COVID-19 vaccines. These findings confirm that vaccine trust is not merely theoretical but directly linked to vaccination behavior.
Importantly, the study highlights that low vaccination uptake often reflects broader dissatisfaction with health system experiences rather than concerns about vaccine safety alone. Weaknesses in fairness, affordability, and accessibility were commonly identified across settings. This suggests that interventions focusing only on information campaigns may be insufficient. Instead, rebuilding trust requires improving service delivery, reducing financial barriers, strengthening communication, and fostering long-term community relationships.
The Vaccine Trust Framework offers practical applications for immunization programs. It can be used to identify populations with low trust, guide targeted interventions, and evaluate the effectiveness of trust-building strategies. As countries introduce new vaccines such as HPV and COVID-19 vaccines, measuring and addressing trust systematically may help build resilient and sustainable immunization demand.
Content Editor: Tianyi Deng
Page Editor: Ruitong Li
Source:
The Vaccine Trust Framework: mixed-method development of a tool for understanding and quantifying trust in health systems and vaccines https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(25)00245-1/fulltext
