Home Institution

University of North Carolina

Publication Date

Spring 2015

Program Name

Switzerland: Global Health and Development Policy


A disease that paralyzes hundreds of children each year, polio is incurable but also entirely preventable through vaccination. Though part of the reason some children are not reached for immunization is that they are in areas too volatile for healthcare workers to access, vaccine hesitancy is increasingly being recognized as an important player. The objective of this study is to ascertain the degree to which vaccine hesitancy affects polio vaccine campaigns in Afghanistan and Pakistan, the countries in South Asia where polio continues to be endemic, to assess the drivers behind hesitancy in this region, and to present recommendations for how these challenges might be overcome.

To best assess vaccine hesitancy in Pakistan and Afghanistan and evaluate its causes, this study integrates two research methods: articles and reports from participating NGOs and governments, and formal and informal interviews with experts in this field. Articles and reports were selected with the purpose of either helping to construct an idea of the emotional and social environments in these countries or to provide reference for what research has been done on vaccine hesitancy in other regions or on a more global scale.

The first finding of this study is that vaccine hesitancy is the exception rather than the rule in almost every setting, but that in order to achieve the global eradication of polio, hesitancy must eventually be addressed. This study further finds that while confidence (trust in the safety of the vaccine and the motives of its providers) has historically been the leading cause of hesitancy by a wide margin and continues to account for most incidences of hesitation today, complacency (not deeming the risk of disease to outweigh the effort or perceived risk of immunization) will be a growing problem in the future as demand for the polio vaccine falls— ironically, as the campaign’s success grows and there are fewer observable cases. Finally, this study makes several recommendations for how vaccine hesitancy can be addressed in Pakistan and Afghanistan, taking into consideration current drivers, future risks, and decision-making psychology.


Community Health and Preventive Medicine | Educational Sociology | Family, Life Course, and Society | International Public Health | Medicine and Health | Near and Middle Eastern Studies | Public Health | Public Health Education and Promotion


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