The reasons for vaccine hesitancy in Brazil: an analysis based on the perception of health workers who worked during the COVID-19 pandemicAbstract
The phenomenon of vaccine hesitancy is complex and multifaceted. In this context, the present article analyzes the reasons for vaccine hesitancy perceived by healthcare professionals in their interaction with Brazilian National Health System (SUS) users during COVID-19 vaccination. Interviews were conducted with 86 primary healthcare professionals in four municipalities from different states and the Federal District. The results point to complacency, convenience, confidence, communication, and context as determinants for vaccine hesitancy recognized by healthcare professionals. In the category of complacency, the subcategories “Perception of low risk due to vaccination progress” and “Perception of low risk by downplaying the pandemic” were identified. In the category of convenience, the subcategories “Lack of access to information,” “Geographical location of the vaccination site,” and “Operation of the vaccination site” were mapped. In the category of confidence, the subcategories “Vaccine brands,” “Distrust in the speed of vaccine development,” and “Fear of vaccine side effects” were identified. In the analysis of the communication category, the subcategories “False information communicated by healthcare professionals,” “False information circulating on social media,” and “False information communicated by various political authorities” were identified. Finally, in the category of context, the subcategories “Alignment with political leaders,” “Alignment with religious issues,” and “Socioeconomic conditions” were identified.
Keywords:
Vaccination Hesitancy; Vaccine; COVID-19; Primary Health Care, Health Personnel
Resumo
O fenômeno da hesitação vacinal é complexo e multifacetado. Nesse sentido, este artigo analisa os motivos da hesitação vacinal percebidos pelos profissionais de saúde na interação com os usuários do Sistema Único de Saúde (SUS) na vacinação contra covid-19. Realizado entrevistas com 86 profissionais da Atenção Primária à Saúde (APS) em quatro municípios de diferentes estados e no Distrito Federal. Os resultados apontam complacência, conveniência, confiança, comunicação e contexto como determinantes da hesitação vacinal reconhecidos pelos profissionais de saúde. Na categoria complacência, foram identificadas as subcategorias “Percepção de baixo risco pelo avanço da vacinação” e “Percepção de baixo risco por menosprezar a pandemia”. Na categoria conveniência, foram mapeadas as subcategorias “Falta de acesso à informação”, “Localização geográfica do local de vacinação” e “Funcionamento do local de vacinação”. Na categoria confiança, são identificadas as subcategorias “Marcas das vacinas”, “Desconfiança da velocidade do desenvolvimento das vacinas” e “Medo dos efeitos das vacinas”. Na análise da categoria comunicação, foram identificadas as subcategorias “Informações falsas comunicadas por profissionais de saúde”, “Informações falsas que circulam em redes sociais”, e “Informações falsas comunicadas por diferentes autoridades políticas”. E, por fim, na categoria contexto, foram identificadas as subcategorias “Estar alinhado com lideranças políticas”, “Estar alinhado a questões religiosas” e “Condições socioeconômicas”.
Palavras-chave:
Hesitação Vacinal; Vacina, Covid-19; Atenção Primária à Saúde; Profissionais de Saúde
Introduction
The COVID-19 pandemic has revived the debate on the importance of vaccination for controlling vaccine-preventable diseases. Historically, Brazil has given a prominent place to its immunization program within the health system (Maciel et al., 2022). Characterized as one of the world’s largest and most complete vaccination programs since its creation in 1973, today, the Programa Nacional de Imunizações(PNI - National Immunization Program) is recognized for promoting free vaccination with more than 15 immunogens (Domingues; Teixeira, 2013). In addition, the PNI significantly reduced cases and deaths from vaccine-preventable diseases in the country and increased life expectancy in Brazil (Domingues; Teixeira, 2013). Since the 1990s, childhood vaccination coverage has increased and reached levels above 95% (Domingues; Teixeira, 2013), data indicating the population’s good adherence to vaccination. However, this coverage has declined since 2016 (Sato, 2018; Fernandez; Matta; Paiva, 2022).
During the COVID-19 pandemic, the discussion on vaccine hesitancy has intensified worldwide with the expansion of the vaccine debate. Hesitant individuals may accept all vaccines and remain concerned after receiving them; some may refuse or delay one type of vaccine and accept others, and others may refuse all available vaccines. Thus, we can define vaccine hesitancy as a delay in receiving or refusing vaccines despite their availability in health systems (MacDonald et al., 2015).
The phenomenon of vaccine hesitancy is complex and occurs in specific contexts, varying according to the time in which it happens, the place where it occurs, and the type of vaccine in question (Sato, 2018). While it is not a new phenomenon (Riedel, 2015), a variety of factors influenced the increase in vaccine hesitancy during the COVID-19 pandemic: concerns about the rapid production process of vaccines, the use of new messenger RNA (mRNA) technologies, and possible side effects (Leong et al., 2022), the spread of misinformation and distorted information through social media, access to distorted information on the topic of natural immunity, the effectiveness of vaccines against COVID-19, and the need to apply several doses of the vaccine (Zhong et al., 2021), in addition to the official position of governments that encouraged vaccine hesitancy during COVID-19 (Wise, 2021).
Studies point to different factors and present explanatory models with possible determinants of vaccine hesitancy. Themes such as (i) complacency, which refers to the low individual perception of risk and value attributed to vaccines; (ii) convenience, which involves availability, geographic accessibility to vaccination services, access to information, and the ability to understand; and (iii) confidence, which is the knowledge and perceptions about the safety and efficacy of vaccines, the system that provides them, including health services and professionals, and the motivation of policymakers to recommend them, are widely recognized in this debate (Sato, 2018; MacDonald et al., 2015). With the advancement of studies in the international literature, two more elements that may affect vaccine hesitancy are recognized: (iv) communication, which concerns sources of information and the infodemic, embodied in the excess of information and the dissemination of false information (MacDonald et al., 2015; Razai et al., 2021) and (v) context, which concerns ethnicity, religion, occupation, and socioeconomic factors as structural themes that may lead to low adherence to vaccines in some groups (Razai et al., 2021). Therefore, the determinants of vaccine hesitancy can be presented through the five Cs model (Complacence, Convenience, Confidence, Communication, and Context).
In the debate on vaccine hesitancy, health workers represent a particularly important group for investigating factors linked to the vaccination process and vaccine confidence (Nobre; Guerra; Carnut, 2022). In Brazil, during the health emergency caused by COVID-19, those who worked in the Brazilian National Health System (SUS), on the front line, and in direct contact with the population played a decisive role in the vaccination processes, a fact that already occurred in the pre-pandemic context (Bortoli et al., 2023).
The SUS has accumulated much experience in mass vaccination campaigns. Every year, these professionals are involved in several campaigns. In this context, vaccination campaigns are generally implemented by Atenção Primaria à Saúde (APS - Primary Healthcare) (Brasil, 2014) and have as protagonists mainly nursing professionals (Nerger, 2010), responsible for the organization and qualification of health work and the organization and operation of vaccination rooms throughout the country (Lanzoni; Meirelles; Cummings, 2016). Therefore, vaccination campaigns depend on several professionals who support the process, whether actively seeking out the population or in administrative activities related to vaccination (Brasil, 2014).
The literature points to the need to map the perceptions of these professionals about immunization (Nobre; Guerra; Carnut, 2022; Souto et al., 2024). This is due to the recognition of the influence they exert on the individual decision to get vaccinated, given the relationship of trust between professionals and users of the health system (Sato, 2018). Therefore, we can recognize the critical role of healthcare professionals in understanding the reasons for vaccine hesitancy. In this sense, this article aims to analyze the reasons for vaccine hesitancy recognized by healthcare professionals in their interaction with SUS users during the vaccination process against COVID-19.
Methods
Research design and data collection
This qualitative study interviewed 86 healthcare professionals in four Brazilian municipalities (Rio de Janeiro (RJ), Rondonópolis (MT), Feira de Santana (BA), and São Paulo (SP), and Brasília in the Federal District. The cities were chosen for convenience, with no sampling intention, and seeking to include cities from different Brazilian states. In addition, the choice was guided by the need to capture a variety of local and urban/rural contexts to provide a diverse view of practices and perceptions related to vaccination.
Interviewees were recruited, and data were collected from January to December 2022. Healthcare professionals who worked in APS during this period were interviewed through a convenience sample of health units in the different locations studied. Participants were selected by the manager of the selected unit, considering the inclusion criteria indicated by the research. From there, the selection continued using snowball sampling to broaden the scope of the study and capture diverse narratives about the perception of the phenomenon of vaccine hesitancy. The inclusion criterion was to be a healthcare professional and to have worked for at least six months between 2020 and 2022. This study did not aim to obtain a representative sample of Brazilian healthcare professionals. Even so, including participants from different states allowed for diverse responses and the analysis’s broadening.
Data collection was carried out through semi-structured interviews, in person and remotely, with a questionnaire divided into four thematic blocks: (1) sociodemographic profile; (2) experience with vaccination against COVID-19 and vaccine hesitancy; (3) health inequality in the territories; and (4) challenges of vaccination and experiences and opinions on COVID-19 vaccination. The interviews lasted, on average, 45 minutes.
Regarding the sociodemographic profile and distribution of participants according to the municipality under study, we observed that 29 (33.7%) participants were from Rio de Janeiro (RJ), 22 (25.6%) from Rondonópolis (MT), 20 (23.3%) from Feira de Santana (BA), 8 (9.3%) from São Paulo (SP), and 7 (8.1%) from Brasília (DF). Of the 86 participants, 70 (81.4%) defined themselves as female, the majority (41.9%) ranged from 37 to 56 years of age, and 39.5% declared themselves White, followed by Brown/Mixed-race people with 36% and regarding the data on profession, nurses, community health agents, and nursing technicians had the highest number of interviewees (25, 21, and 20, respectively), totaling 66 people (76.8%). Physicians, dentists, and others accounted for 20 people (23.2% of the interviewees).
Data organization and analysis
The study carried out a qualitative analysis that included systematizing the data and deepening the research question and objectives in line with theoretical aspects present in the literature. The 86 interviews were transcribed and subsequently coded using Dedoose software to perform a thematic analysis of the perceptions shared by the healthcare professionals interviewed (Miles; Huberman; Saldaña, 2018).
The interviews were coded in two stages. The first, from a deductive perspective, identified five categories indicated by the literature as determinants of vaccine hesitancy, namely (i) complacency, (ii) convenience, (iii) confidence, (iv) communication, and (v) context. From an inductive perspective, the second identified subcategories for each category based on the narratives. Table 1 presents the categories and their respective subcategories.
Ethical recommendations for research involving human beings were followed at all stages of the study (Resolution No. 466/2012, Resolution No. 510/2016, and Resolution No. 580/2018). In addition, the study was approved by the Ethics Committee of the Sergio Arouca National School of Public Health/Oswaldo Cruz Foundation (ENSP/Fiocruz), No. 5,430,488.
Results
Based on the interviews conducted, we analyzed the main reasons for hesitancy that emerged from the narratives presented in this study. They are organized based on the five Cs model, i.e., observing the categories of complacency, convenience, confidence, communication, and context. Each category comprises subcategories that detail healthcare professionals’ perceptions and express the specificities of their understanding of the phenomenon.
Complacency
The “Complacency” category, which refers to the low individual perception of risk and the value attributed to vaccines, has two subcategories: “Perception of low risk due to vaccination progress” and “Perception of low risk by downplaying the pandemic.”
According to healthcare professionals, vaccine hesitancy may be linked to the progress of vaccination itself. As vaccination progresses, people feel less exposed to the risk of COVID-19 due to the changes that vaccination brings to the epidemiological scenario. In this sense, one professional states: “In my experience, from the moment there was a large mass vaccination, and people began to see that the number of deaths decreased, […] the issue of rules began to be relaxed, of staying isolated, of staying closed for 15 days, so they thought they didn’t need to get vaccinated” (Nurse, Rondonópolis, MT).
Another professional states that “[…] people have gotten used to the vaccine, they have lost their fear because the talk of ‘I don’t know how many thousand people have died’ is over, people are no longer being hospitalized, today people are having more mild symptoms, it’s just the flu like everyone else is having” (Nurse, Feira de Santana, BA). Therefore, for professionals, people perceive a low risk due to the progress of the vaccination process.
In the context of Complacency, we also identified in the speech of healthcare professionals the perception of low risk due to the disregard for the pandemic by a portion of the population. In this sense, one professional states: “I think it’s a false feeling that there’s no problem happening, that these vaccines, a lot of them are unnecessary, in fact, they think they’re unnecessary. […] But I think it’s more this false feeling that nothing is happening and that there’s no need to vaccinate” (Community health agent, Rondonópolis, MT).
Convenience
The “Convenience” category, which involves availability, geographic accessibility to vaccination services, access to information, and the ability to understand, can be discussed based on three subcategories: “Lack of access to information,” “Geographical location of the vaccination site,” and “Operation of the vaccination site.”
Professionals point out that vaccine hesitancy is linked to a lack of access to information: “I think it’s a lack of information. Parents generally don’t take their children to health units to get vaccinated, and that’s how it is; they don’t know the risk of the disease and don’t take them” (Nursing technician, Feira de Santana, BA). In addition, the geographic location of the vaccination room is linked to hesitancy to get vaccinated: “Imagine coming to the unit, I mean from my workplace or my area, my area is already a more distant area, so for some people to come here, it’s a half-hour walk” (Nurse, Feira de Santana, BA).
Finally, professionals point out the scheme of the operation of the vaccination site, which can lead to long waiting times in lines, as something related to hesitancy in getting vaccinated.
We need to better characterize this issue of access nowadays. I think the waiting time for the vaccine and these bureaucratic steps are barriers to access. The patient has to wait 2 hours, 3 hours, 4 hours to get a vaccine, this is a physical access barrier […], of life dynamics, you have to miss work, you have to miss another activity, it’s not a simple thing (Physician, Brasília, DF).
The issue of health unit opening hours was also highlighted as a potential factor in reducing access to vaccination: “I think the vaccination hours should be open, lunch hours, extended hours at night, and open on Saturdays and Sundays, but they managed to do this for a long time with the vaccination center, which they called” (Physician, Rondonópolis, MT).
Confidence
The “Confidence” category concerns knowledge and perceptions about the safety and efficacy of vaccines, the system that provides them, including healthcare professionals and services, and the motivation of policymakers to recommend them. We identified three subcategories in the debate on Confidence: “Vaccine brands,” “Distrust in the speed of vaccine development,” and “Fear of vaccine side effects.”
Regarding distrust of vaccine brands, professionals point out that fake news about specific vaccine manufacturers impacted the search for vaccines. “At first, they had this doubt: ‘Ah, which vaccine do you have?’ ‘Do you have AstraZeneca?’ ‘Oh no, I want CoronaVac because they said it’s working better.’ There were these situations” (Community health agent, Rio de Janeiro, RJ).
Another distrust pointed out is related to the speed of vaccine development. A healthcare professional stated: “I have countless patients who have not taken any doses. There were many, and they said: ‘No, because I’m still going to see what’s going to happen and so on,’ so I think there is a distrust in the speed at which the vaccine was made available, and it wasn’t that fast” (Nurse, Brasília, DF).
Finally, in the debate on confidence, healthcare professionals still point to the fear of vaccine side effects-long-term effects and adverse reactions-as a relevant factor for vaccine hesitancy. Others report fear more diffusely: “So they don’t explain exactly why they’re afraid, but they say they’re afraid, that they don’t want to, that they’re only going to do it because they need to get a document, go to a place where they’re demanding it” (Nurse, Feira de Santana, BA).
Communication
The “Communication” category deals with excess information and the dissemination of false information. We identified three subcategories in this category: “False information communicated by healthcare professionals,” “False information circulating on social media,” and “False information communicated by various political authorities.”
Many interviewees reported difficulty dealing with conflicting information on social media when questioned by patients and family members: “[…] I found it difficult. So we often had to research or look for instructions, the summary we had about the vaccines to clear up any doubts, to show that it was false information” (Nurse, São Paulo, SP).
Excess information, professionals who are openly against the vaccine and who spread false information were frequently cited as reasons for the increase in vaccine hesitancy: “[…] so we also saw healthcare professionals spreading false information, I think that is one of the reasons” (Nurse, São Paulo, SP).
In addition, the circulation of false information on social media was cited as an issue linked to hesitancy: “Many people did not take the vaccine, mainly because of rumors on social media, lies saying that the vaccine caused strokes, that the vaccine paralyzed, that the vaccine caused other diseases, that it killed” (Nurse, Brasília, DF).
The professionals identified messaging apps as essential to spreading false information about vaccines. “Regarding the people on the other side of the fake news, it’s ‘bang bang,’ they communicate very easily, very quickly in WhatsApp groups, for example” (Physician, Brasília, DF).
Professionals also point to the influence of the circulation of false information communicated by political authorities on vaccine hesitancy: “And we are getting to the point where she says […] the president did not vaccinate, saying it is just a little flu, that everyone will catch it, and this so-called immunity, I don’t know what” (Nurse, Brasília, DF); “There was really a lot of fake news circulating, issues that came from the president himself” (Nurse, São Paulo, SP).
Context
The “Context” category concerns the structural issues that can lead to low vaccine adherence in some groups. We identified three subcategories in “Context”: “Alignment with political leaders,” “Alignment with religious issues,” and “Socioeconomic conditions.”
The associations between vaccination and political ideology were significant aspects that emerged spontaneously from the narratives of healthcare professionals. Statements about politics were mainly associated with the anti-vaccine stance of the acting president, Jair Bolsonaro, and his supporters.
I know many people who didn’t even take the first [dose] because of the president, […] he said he wouldn’t get the vaccine, and he didn’t take it. Many people didn’t take it because of this: politics. Even though we said it had nothing to do with it, he said no, ‘the president didn’t take it, so we won’t take it either’ (Community health agent, Feira de Santana, BA).
In the same vein, professionals highlighted that religious issues were linked to the decision to get vaccinated. “So, I think that religion often gets in the way and has gotten in the way a lot in this vaccination issue, you know?” (Physician, Rio de Janeiro, RJ). They also stated that “Catholics got it, but people who were evangelicals, believers, hadn’t taken it much […]” (Community health agent, Feira de Santana, BA).
Finally, healthcare professionals linked socioeconomic characteristics to the issue of hesitancy. These indicate that they find a greater propensity to hesitate to get vaccinated among people who are less socially vulnerable. Therefore, on one side, we have:
[…] a part of the elite that thinks it is very enlightened, that it favors so-called alternative treatments, and so on, and that distrusts hegemonic medicine. […] These people consider themselves progressive in general, but deep down, they are very conservative and selfish because they do not agree to participate in collective protection strategies (Physician, São Paulo, SP).
On the other side, when assisting people in situations of social vulnerability, they state that:
I did not notice much resistance concerning the political aspect of these people who are homeless. I think that, perhaps, because-I think it’s a more complex discussion, but-these are people for whom, for better or for worse, the State is present, considering that the State is also the police, it’s also the municipal guard that produces much violence against these people (Nurse, São Paulo, SP).
Discussion
The low perception of risk of illness that emerges due to the slowdown of the pandemic and the progress of immunization in the municipalities is one of the forms of complacency identified. Other studies point to complacency as a vital factor in vaccine hesitancy. Other studies share similar findings. A systematic review carried out based on 84 studies on vaccine hesitancy in Latin American countries and countries on the African continent shows that the options “perception of low risk of contracting COVID-19” and “the immune system could be better able to fight COVID-19 than the vaccine” appear, respectively, as reasons for vaccine hesitancy in around 7.4% and 14.8% of the cases analyzed (Gonçalves et al., 2023).
The complacency associated with the perception of low risk due to underestimating the pandemic collides with the high mortality rate from COVID-19 in Brazil, where more than 700 thousand deaths occurred in 2023 (Brasil, 2023). The low perception of risk in one of the countries with the highest number of fatalities brings reflections on health misinformation and its impact on the population. According to Frugoli et al. (2021), the complacency category is related to misinformation about vaccines, given that the potential risk of death or sequelae resulting from immunizations is, at times, false or at excessive levels. Still, regarding complacency, it is essential to highlight the underestimation of the pandemic as an expression of the phenomenon of misinformation. Other studies have already correlated complacency with misinformation and the false perception of the low risk of COVID-19 (Macinko et al., 2021).
Even though Brazil has the SUS and the PNI, which provide free access to the population to the vaccines in the national calendar, the convenience category should not be underestimated when discussing vaccine hesitancy. The convenience determinant is crucial to understanding the practical barriers people face when accessing vaccination services and how these barriers can contribute to vaccine hesitancy. The functioning of vaccination sites, including waiting times in lines and opening hours of health units, is also relevant, as they constitute an actual barrier for many people. Therefore, offering extended hours, including weekends and holidays, can facilitate vaccine access.
It is necessary to expand and democratize access to vaccines. For example, initiatives such as vaccination in schools have proven effective in different scenarios (Viegas, 2019), contributing to the care of children and adolescents. However, our findings point to structural difficulties and difficulties in access to vaccination. Reports on the functioning of vaccination sites associated with structural challenges must be contextualized in the context of fiscal austerity, accentuated by Constitutional Amendment No. 95 of 2016. The Amendment established the constitutional limitation of public spending for up to two decades, strengthening the reduction of the State and the hollowing out of social policies in Brazil. Thus, solidarity pillars of social security in the 1988 Constitution, such as the SUS and the PNI, were gradually defunded (Viegas, 2019). Thus, when the COVID-19 pandemic began to rise, the precariousness of the SUS was a government project that demonstrated its consequences in several sectors, including low vaccination rates (Menezes; Moretti; Reis, 2019).
As identified in other studies (Gonçalves et al., 2023), fear of side effects is one of the main reasons for hesitancy when debating confidence. A survey reveals that 60% of individuals did not plan to receive the COVID-19 vaccine due to fear of adverse effects (Vizcardo et al., 2022). Similarly, 53% of childcare providers interviewed at a hospital in Bauru (SP) reported fear of serious side effects from the vaccine (Martins et al., 2018).
Increased distrust is a reality in the face of a pandemic scenario permeated by misinformation and narrative disputes. It is essential that healthcare professionals who work daily in the vaccination process, considering the importance of their work in contexts of health crises (Fernandez et al., 2023), be prepared to address these fears by providing information about vaccines and highlighting that the benefits of vaccination far outweigh the risks. The literature indicates that poorly qualified professionals working in the vaccination room can compromise confidence in immunizations (Martins et al., 2018). By providing adequate information, the vaccination room can be a strategic place for healthcare professionals to work on the population’s risk perception.
By analyzing the determinant of “Communication” in the context of COVID-19, we identified the emergence of a new barrier to acceptance and adherence to vaccination. In the narratives on communication, we observed the critical view of healthcare professionals on the challenges we face in a world saturated with information and political polarization. Information overload is highlighted as a significant problem. Some studies support our findings, indicating that vaccine hesitancy was higher in areas with greater access to the internet and social media (Fares et al., 2021).
The changing nature of vaccine acceptance behavior requires new analytical models that capture different social, cultural, and political dynamics and characteristics. In this sense, analyzing the local context is essential regarding vaccine hesitancy. Inconsistencies in discourses and the dissemination of false and incorrect information by healthcare professionals and people in authority also directly influence vaccine hesitancy. Institutionalized scientific denialism, the dissemination of fake news, inaccurate information about vaccines, and criticism of vaccines by political authorities are essential factors influencing vaccine hesitancy (Maciel et al., 2022). Inconsistent discourses by heads of state and political authorities based on scientific denialism represent a critical catalyst for distrust in vaccines (Fernandez; Matta; Souto, 2022; Souto et al., 2024).
In addition, the influence of religious issues has also been related to the acceptability of COVID-19 vaccines. According to other studies, this is a driving factor for vaccine hesitancy in the so-called Global South countries. In Venezuela, non-religious people were more willing to receive the COVID-19 vaccine than Catholics and Protestants, with Venezuelan Pentecostals being the most hesitant (Andrade, 2021).
Concerning socioeconomic conditions, our findings support studies that identify greater vaccine hesitancy among individuals from more privileged classes. These individuals generally have greater access to alternative information about vaccines and to anti-vaccine groups and tend to be more distrustful of traditional vaccines (Hudson; Montelpare, 2021). In contrast, vulnerable individuals and populations appear to hesitate, mainly due to greater exposure to false or unreliable information and multiple barriers to accessing health services, such as geographic, organizational, and economic barriers and the quality of care provided (Matta et al., 2024).
Final considerations
This study sought to examine the reasons for vaccine hesitancy in the pandemic scenario with interviews with healthcare professionals with experience in vaccination. In this context, the determinants of vaccine hesitancy presented from the 5 Cs model contributed to the understanding of the phenomenon of vaccine hesitancy during the period of COVID-19 confrontation. Complacency, convenience, confidence, communication, and context are factors highlighted by healthcare professionals as determinants of vaccine hesitancy.
Understanding the phenomenon of vaccine hesitancy is essential for implementing more effective immunization strategies that include elements beyond distribution strategies, storage, and logistical aspects of vaccination. Strategies to reduce hesitancy and expand vaccination coverage must be advanced. In this sense, the categorization process proposed in this article contributes to identifying adversities in immunization policies and strategies and, consequently, thinking about strategies to combat hesitancy.
The theoretical framework used in this study, which organizes the determinants of vaccine hesitancy into the five major categories listed as a strategy for organizing the data, is comprehensive and in line with the narratives of healthcare professionals. However, it is necessary to point out some gaps in the analysis presented. It seems insufficient to analyze each category in isolation, given that each is intertwined in the reported experiences. In addition, it is necessary to expand the analysis by considering an intersectional perspective, i.e., recording the differences that professional category, race, and gender can generate in the results analyzed. Therefore, we believe that these research agendas remain open for future studies.
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Funding
This work is part of the project “A COVID-19 no Brasil 2: análise e resposta aos impactos sociais da imunização, tratamento, práticas e ambientes de cuidado e recuperação de afetados,” [COVID-19 in Brazil 2: Analysis and response to the social impacts of immunization, treatment, practices, and environments of care and recovery of affected] which is developed by the MCTI COVID-19 Humanities Network. It is part of the MCTI Virus Network’s set of actions funded by the Ministry of Science, Technology, and Innovation to combat the pandemic (FINEP/UFRGS Agreement 1212/21). The research was also partially supported by the project “Vaccine Hesitancy and Online Misinformation Consumption and Distribution among Frontline Healthcare Workers,” funded by the John Fell Fund.
