Factors associated with vaccine hesitations against COVID-19

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This article was exclusively written for The European Sting by Ms. Ana Júlia de Moura Cassita, first year student of the medical course at Unicesumar, in Maringá, Paraná, Brazil and Mr. Manoel Flávio Silva Kanisky, studying medicine (seventh period) at Unicesumar, Maringá city. They are affiliated with the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

In Brazil, throughout the pandemic, strategic actions were mobilized by state and municipal governments to ensure control of exposure to the SARS-CoV-2 virus. An extensive list of non-pharmacological measures was implemented to minimize the magnitude of the disease in the country1. However, a permanent solution is more likely to be achieved with the development, availability and implementation of effective, safe and high-quality vaccines against viruses2.

Vaccination is one of the most economical ways to avoid diseases. Currently, it is estimated that it avoids 2 to 3 million deaths per year and that another 1.5 million could be avoided if the overall coverage for available vaccines improved3. Brazil has one of the largest public immunization programs in the world, offering, in a routine basic calendar and campaigns, an extensive list of vaccines and other special immunobiologicals for specific audiences. However, the high coverage, which was one of its main characteristics, has fallen in recent years. In 2020, pandemic-related factors caused vaccination suspension, reducing the number of doses (n = 57,519,127) and vaccination rates (32.2% in Amapá, 39.2% in Maranhão and 66.1% in the Federal District)4, generating new outbreaks of preventable diseases due to immunobiological use5.

The objective of this work is to contribute with the scientific production of review articles based on quantitative research, updating knowledge on a vaccine hesitation against covid-19. This work aims specifically at beginning researchers. It covers the use of some theoretical-methodological instruments, the required caution when reading source articles, the knowledge enrichment and the proper way to expose the acquired knowledge. Additionally, it points out the many aspects involved in discussing the chosen theme, highlighting and giving examples of the scope of methodological resources that need to be respected even in literature review articles. Finally, the article advises on the commitment to quality research required and on how to prepare and present the resulting material in the proper scientific manner.

Decision-making around vaccination is a complex behavioral phenomenon in relation to its determinants. It involves cultural, geographical, psychosocial, economic, religious, political, cognitive and gender factors. The reasons for vaccination hesitation fall into three interrelated categories: lack of confidence (in efficacy, safety, in the health system that provides vaccines or in the motivations of managers and policymakers to recommend them), complacency (low perception of the risk of acquiring preventable diseases, so that vaccination would not be necessary) and lack of convenience (considers availability,  accessibility and appeal of immunization services, including time, place, language and cultural contexts)6,7.

The prevalence of vaccine hesitation in Brazil and its association with individual, contextual and clinical factors reveal the most resistant groups and contexts that should deserve special attention from public strategies to ensure wide vaccination. It will be necessary to prepare the population with more effective messages about the vaccine, aligning the political, religious and health discourse around the advantages associated with it. These actions can increase confidence, reduce vaccine resistance, and maximize its socioeconomic and public health benefits.


  1. Garcia LP, Duarte E. Intervenções não farmacológicas para o enfrentamento à epidemia da COVID-19 no Brasil. Epidemiol Serv Saude. 2020;29(2):e2020222. https://doi.org/10.5123/s1679-49742020000200009
  2. European Commission. Communication from the Commission to The European Parliament, The European Council, The Council and The European Investment Bank EU Strategy for COVID-19 vaccines. Brussels: EC; 2020 [citado 27 nov 2020]. Disponível em: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX%3A52020DC0245
  • Organização Pan-Americana da Saúde. OPAS pede que países mantenham programas de vacinação durante pandemia de COVID-19. Brasília, DF: OPAS; 2020 [citado 02 dez 2020]. https://www.paho.org/bra/index.php?option=com_content&view=a rticle&id=6152:opas-pede-que-paises-mantenham-programas-de-vacinacao-durante-pandemia- de-covid-19&Itemid=820
  • Shen S, Dubey V. Addressing vaccine hesitancy: clinical guidance for primary care physicians working with parents. Can Fam Physician. 2019;65(3):175-81.
  • Sato APS. Qual a importância da hesitação vacinal na queda das coberturas vacinais no Brasil? Rev Saude Publica. 2018;52:96. https://doi.org/10.11606/s1518-8787.2018052001199

About the authors

First year student of the medical course at Unicesumar, in Maringá, Paraná, Brazil. Student and young researcher. She is currently an athlete of the Paraná Judo Federation. She has experience in physical activity, with emphasis on Judo. Vitamin D Research in Scientific Initiation and Health Extension Project, in addition to social counterpart project: Alimente-se D.

Brazilian; 23-years old; studying medicine (seventh period) at Unicesumar, Maringá city. Member of ‘’Endocrinology and Metabology Interest Group of Maringá City’’. Research director of ‘’Complementary Medicine Interest Group of Maringá City’. Local coordinator of IFMSA-Brazil-Unicesumar.  

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