Sociocultural and psychological
determinants of vaccine resistance in adults aged 19 to 64 years
Determinantes socioculturales y psicológicos de la
resistencia a las vacunas en adultos de 19 a 64 años
Verónica Moncerratte
Soria Salinas
Bachelor's Degree in Nursing. Bolivar State
University
moncesoria24@gmail.com,
https://orcid.org/0000-0002-1968-2393
Clara Patricia Guerra
Naranjo
Bachelor of Science in Nursing
Specialty in Strategic Planning in Health.
Master in Public Health. Professor at the State University of Bolivar,
cguerra@ueb.edu.ec, https://orcid.org/0000-0002-6477-1539
Jessica Maricela Segura
Peñaloza
Bachelor of Science in Nursing. State University
of Bolivar, https://orcid.org/0009-0003-5511-9260, jessica.segura@ueb.edu.ec
)%20(inglés%20(americano)).fld/image002.png){kind=small}
The article analyzes the sociocultural and
psychological determinants of vaccine resistance in adults aged 19 to 64 years,
through a literature review, with a qualitative-descriptive approach. Important
aspects that influence reluctance to immunization in adults of this age range
were identified. Among the sociocultural determinants, religion, education,
beliefs and cultural traditions were noted; on the other hand, among the
psychological factors, fear, misinformation and the perception of the risk of the
side effects of vaccines were identified with great predominance. The findings
showed that, despite the scientific information supporting the effectiveness
and safety of vaccines provided by governments, agencies and health
institutions , there are barriers to acceptance, motivated by lack of
confidence in the safety of vaccines and fear, especially among young adults,
of side effects, who even underestimate the risks of diseases. The review also
showed that the influence of family, social groups and friends has a high
impact on the decision of adults towards immunization. The literature analysis
and interpretation highlighted the importance of addressing and understanding
the sociocultural and psychological determinants of the adult population aged
19 to 64 years and understanding that the acceptance of immunization varies
according to the age range, where adults older than 40 years showed greater
awareness; and those younger than this age present greater doubts and fears.
Key words: determinants, psychological, resistance,
sociocultural, vaccines.
Resumen
El
artículo analiza los determinantes socioculturales y psicológicos de la
resistencia a las vacunas en adultos de 19 a 64 años, a través de una revisión
bibliográfica de la literatura, con un enfoque cualitativo-descriptivo. Se
identificaron aspectos importantes que influyen en la reticencia a la
inmunización en adultos de este rango de edad. Entre los determinantes
socioculturales, denotaron la religión, educación, creencias y tradiciones
culturales; por otro lado, en los factores psicológicos se identificó con gran
predominancia al miedo, la desinformación y la percepción del riesgo de los
efectos secundarios de las vacunas. Los hallazgos permitieron constatar que, a
pesar de la información científica que avala la efectividad y la seguridad de
las vacunas proporcionada por los gobiernos, organismos e instituciones de
salud, existen barreras de aceptación, motivadas por la falta de confianza en
la seguridad de las vacunas y el temor, especialmente de los adultos jóvenes, a
los efectos secundarios, que incluso subestiman los riesgos de las
enfermedades. La revisión también mostró que la influencia de la familia,
grupos sociales y amistades tiene un alto impacto en la decisión de los adultos
hacia la inmunización. El análisis e interpretación literaria permitió resaltar
la importancia de abordar y entender los determinantes socioculturales y
psicológicos de la población adulta de 19 a 64 años y comprender que la
aceptación de la inmunización varía de acuerdo con el rango de edad, donde los
adultos mayores a 40 años mostraron tener mayor concienciación; y los menores a
esta edad presentan mayores dudas y temores.
Palabras clave:
determinantes, psicológicos, resistencia, socioculturales, vacunas.
Introduction
Immunization is an essential process in
preventive medicine, whereby people acquire resistance to infectious diseases
through the administration of vaccines. This procedure not only prevents a wide
range of serious diseases and disabilities, but also significantly reduces
mortality from preventable pathologies, such as cervical cancer, hepatitis B,
measles, polio, rubella and tetanus, among others (Tagle and Urbina, 2023).
Over time, immunization has gained greater acceptance in the population, and
its constant evolution has demonstrated high effectiveness. Vaccines stimulate
the immune system, providing long-lasting protection against pathogens and
ensuring effective prevention of these diseases (Eroza and Carrasco, 2020).
Despite these benefits, lack of knowledge
about how vaccines work and are handled remains a major obstacle, particularly
among adults aged 18 to 64 years. The complexity of vaccine production
processes and their characteristics generates difficulties in their
understanding and appreciation by the population (Villagrán et al., 2024). In
addition, the erroneous perception of safety, influenced by the reduction in
the incidence of diseases due to immunization, can lead to a false sense of
protection and underestimation of the risks of infectious diseases
(Maximiliano, 2021).
A study conducted by Caycho et al. (2022)
with adults with an average age of 34.67 years revealed that a considerable
percentage of respondents held conspiratorial beliefs about vaccines,
especially related to COVID-19. While some participants did not express a clear
position, a large majority believed that information about the effectiveness
and safety of these vaccines was fabricated. These results underline the
influence of sociocultural and psychological factors on the perception of
vaccines. From a sociocultural point of view, erroneous beliefs generate
mistrust towards health institutions and even international organizations. From
a psychological approach, fear and anxiety associated with conspiracy ideas
contribute to resistance to immunization.
In a different context, a study in the
province of Cotopaxi, Ecuador, analyzed vaccine resistance in adults from
indigenous communities, with a mean age of 50 years. The findings showed that
erroneous beliefs and low educational level were determining factors in vaccine
refusal. However, those adults who participated in educational talks about
immunization changed their perspectives and accepted vaccination, in contrast
to those who did not receive this training (Hernández et al., 2022). These
results highlight the importance of education as a key factor in vaccine
acceptance by counteracting misinformation and correcting erroneous beliefs.
Resistance to immunization continues to be a
global phenomenon of concern to health systems. Despite scientific evidence
supporting the safety and efficacy of vaccines, a part of the adult population
persists in their refusal, which puts at risk not only their health, but also
the collective immunity needed to prevent pandemics, such as occurred with
COVID-19, . It is essential to understand the sociocultural and psychological
determinants that foster this resistance, in order to develop evidence-based strategies
that promote confidence in immunization and health institutions.
The purpose of this article is to analyze the
sociocultural and psychological determinants that influence vaccine resistance
in adults aged 19 to 64 years, through a literature review. The aim is to
identify how these factors are manifested in different cultural, demographic
and educational contexts, and to provide relevant information to design
effective interventions to promote vaccine acceptance.
Methodology
A literature review was conducted with the
purpose of analyzing the sociocultural and psychological determinants that
contribute to vaccine resistance in adults aged 19 to 64 years. The search was
limited to publications from the last 5 years, using keywords and Boolean
operators, such as "sociocultural determinants" AND "vaccine
resistance" AND "adults aged 19 to 64 years", and other
operators such as OR and NOT. Scientific articles, theses, books and agency
reports were included, consulting databases such as PubMed Central, Scielo,
Elsevier, Scopus, Taylor & Francis, and national and international
university repositories. To ensure broad and diverse coverage, the search was
conducted in English and Spanish, ensuring the inclusion of relevant publications
both globally and in the Latin American region.
Inclusion and exclusion criteria
To ensure the thoroughness of the analysis,
the following criteria were applied:
Inclusion criteria:
Target population: Studies focused on adults
aged 19 to 64 years.
Type of studies: Original research, indexed
in academic databases, addressing vaccine resistance from sociocultural and
psychological contexts.
Period of publication: Studies published
within the last 5 years to ensure relevance and timeliness of information.
Language: Publications in English and
Spanish.
Exclusion criteria:
Non-relevant population: Studies focused on
children or older adults.
Non-academic sources: Non-indexed popular
articles, publications with no empirical basis, theses and documents from
non-accredited websites.
Outdated data: Studies published before the
established period.
During the process, 132 initial articles were
reviewed. Of these, 82 were excluded because they did not meet the criteria,
mainly for dealing with populations outside the defined age range or for coming
from non-academic sources.
Methods of analysis
The qualitative analysis adopted focused on
identifying patterns, trends and perspectives present in the literature. The
thematic analysis method was used to examine sociocultural and psychological
determinants. This method allowed us to categorize and synthesize relevant
information on factors such as religion, education, trust in health
institutions, misinformation, fear and social identity, among others.
To support this process, NVivo software was
used, which facilitated the coding and grouping of key topics. The main
technique used was the systematic document review, following the guidelines of
the PRISMA-P model (Preferred Reporting Items for Systematic Review and
Meta-Analysis Protocols) as shown in Figure 1. This protocol made it possible
to structure the review in a transparent and reproducible manner, from the
selection of sources to data analysis, .
Qualitative approach
The qualitative approach sought to interpret,
understand and systematize previous findings related to the sociocultural and psychological
determinants that influence vaccine resistance. This approach allowed us to
delve deeper into the meanings attributed by the authors of the studies
reviewed, as well as the methodologies and theories employed. In addition, the
qualitative analysis not only identified general trends, but also the
particularities present in different cultural and demographic contexts.
The qualitative methodology offered a
comprehensive perspective to interpret how social and psychological perceptions
affect adults' attitudes towards immunization. This approach, combined with a
thematic analysis supported by digital tools, ensured the validity and
reliability of the results obtained, providing a solid basis for future
research and intervention strategies.
Figure 1: Literature review-PRISMA method
)%20(inglés%20(americano)).fld/image003.png)
Figure 1 shows the flow diagram of the PRISMA
process used in this study to identify, select, evaluate and include the
articles used in the literature review.
The literature review was structured
chronologically with the aim of illustrating the evolution of knowledge on the
sociocultural and psychological determinants that contribute to vaccine
resistance in adults aged 19-64 years. This organization allows us to identify
how perspectives and approaches have changed over time, highlighting major
contributions in different periods.
It began with older studies within the time
range considered, which focused on fundamental sociocultural determinants, such
as the influence of factors like education, religious beliefs and trust in
health institutions. These studies laid the groundwork by identifying early
patterns of distrust of immunization and their links to specific sociocultural
characteristics.
Over the years, research began to incorporate
deeper psychological approaches, exploring aspects such as fear, anxiety and
the influence of conspiracy theories. This shift marked a significant advance
by integrating cognitive and emotional dimensions that complemented the initial
findings focused exclusively on sociocultural factors.
Finally, in more recent studies, a trend
toward the intersection of multiple determinants was observed. More current
research has highlighted the interplay between sociocultural and psychological
aspects, such as the combined impact of media misinformation and cultural
beliefs, as well as the importance of health literacy in addressing these
barriers. This comprehensive approach has led to the development of more
effective strategies to mitigate vaccine resistance.
Taken together, this review evidences (Table
1) how the understanding of the determinants of vaccine resistance has evolved
from isolated approaches to interdisciplinary perspectives that consider the
complex interactions between social, cultural, and psychological factors. This
progress has laid the groundwork for future research and the implementation of
evidence-based public policies.
Table 1. Articles used in the literature review
|
Author |
Title |
Magazine |
DOI or URL |
Year |
|
Aquino Canchari Christian Renzo, Karla Guillen
Macedo |
Vaccine reluctance as an
increasingly common practice worldwide |
Cuban Journal of Biomedical
Research |
http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-03002020000100002 |
2020 |
|
Martha
Carnalla, Ana Basto-Abreu, Dalia Stern, Sergio Bautista Arredondo, Teresa
Shamah-Levy, Celia M Alpuche Aranda, Juan Rivera Dommarco, Tonatiuh
Barrientos Gutiérrez |
Acceptance,
refusal and hesitancy of COVID-19 vaccination in Mexico: Ensanut 2020
COVID-19. |
Public Health Mex |
DOI: 10.21149/12696 |
2020 |
|
Michael Daly, Eric Robinson |
Longitudinal changes in
psychological distress in the UK from 2019 to September 2020 during the
COVID-19 pandemic: Evidence from a large nationally representative study. |
Research in psychiatry |
https://doi.org/10.1016/j.psychres.2021.113920 |
2021 |
|
Michael Eder, Haris Omic, Jana Gorges, Florian Badt, Zeljko Kikic,
Marcus D. Saemann, Allison Tong, David Bauer, Georg Semmler, Thomas
Reiberger, Heimo Lagler, Bernhard Scheiner |
Influenza
vaccination uptake and factors influencing vaccination decision among
patients with chronic kidney or liver disease |
PLOS ONE |
https://doi.org/10.1371/journal.pone.0249785 |
2021 |
|
Justin Gatwood, Madison
McKnight, Michelle Fiscus, Kenneth C Hohmeier, Marie Chisholm Burns |
Factors influencing
likelihood of COVID-19 vaccination: A survey of Tennessee adults. |
American Journal of
Health-System Pharmacy |
https://doi.org/10.1093/ajhp/zxab099 |
2021 |
|
Bernal
Vaquera Bruno Michel, Morales-Jinez Alejandro, Moreno-Pérez Norma Elvira |
Vaccine
hesitancy: a systematic review to address the phenomenon in Latin America |
Sanus |
https://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S2448-
60942021000100201 |
2021 |
|
Simin Wen, Icon, Zhengyu
Wu, Shuyi Zhong, Mao Li, Yuelong Shu |
Factors influencing the
immunogenicity of influenza vaccines. |
Human Vaccines & Immunotherapeutics |
https://doi.org/10.1080/21645515.2021.1875761 |
2021 |
|
S.E. Kreps, D.L. Kriner |
Factors
influencing Covid-19 vaccine acceptance across subgroups in the United
States: Evidence from a conjoint experiment. |
Vaccine |
https://doi.org/10.1016/j.vaccine.2021.04.044 |
2021 |
|
Halimat Adedeji-Adenola, Olubusola A. Olugbake,
Shakirat A. Adeosun |
Factors influencing
COVID-19 vaccine uptake among adults in Nigeria. |
PLoS ONE |
https://doi.org/10.1371/journal.pone.0264371 |
2021 |
|
Tomás Caycho
Rodríguez, Miguel Gallegos, Pablo D. Valencia and Lindsey W. Vilca |
How much do
Peruvians support conspiracy beliefs about COVID-19 vaccines? |
Primary Care |
https://www.sciencedirect.com/science/article/pii/S0212656722000385 |
2022 |
|
Gleb Donin, Erfanyukov to
Anna, IIya Ivlev |
Factors Affecting Young
Adults' Decision Making to Undergo COVID-19 Vaccination: A Patient Preference
Study. |
Vaccines |
https://www.mdpi.com/2076-393X/10/2/265 |
2022 |
|
Erwin
Hernando Hernández Rincón, Francisco Lamus Lemus, Diana Marcela Díaz Quijano,
Karen Nathaly Rojas Alarcón, Juan José Torres Segura, Luisa Fernanda Acevedo |
Population
resistance to immunization in times of epidemics: a review of Covid 19 |
Rev Panam Public Health |
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9553013/ |
2022 |
|
Andria Papazachariou, Constantinos Tsioutis,
Theodore Lytras, Onoufrios Malikides, Maria Stamatelatou, Nektaria Vasilaki,
Athanasia Milioni, Maria Dasenaki, Nikolaos Spernovasilis |
The impact of seasonal
influenza vaccination uptake on COVID-19 vaccination attitudes in a rural
area in Greece |
Vaccine |
https://www.sciencedirect.com/science/article/pii/S0264410X22015390?via%3Dihub |
2022 |
|
Gi Yon Kim, Taeksoo Shin, Youn-Jung Son, Jihea Choi |
Psycho-behavioural
factors influencing COVID-19 vaccine hesitancy among Korean adults: The
moderating role of age. |
Journal of Advanced Nursing |
https://doi.org/10.1111/jan.15273 |
2022 |
|
Francisco Puche Louzán, María Lourdes Cantero
González |
Nursing diagnosis proposal:
risk of refusal of vaccination. |
Global Nursing |
https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1695-61412023000100018 |
2023 |
|
Julio César
Tagle Arcos, Irasema Isabel Urbina Aranda |
Sociocultural
Factors Influencing Vaccine Reluctance Against Covid-19 in the Population
Assigned to the U.M.F. No. 9 of the IMSS in Acapulco, Gro. |
Ciencia Latina
Multidisciplinary Scientific Journal |
https://doi.org/10.37811/cl_rcm.v7i6.9385 |
2023 |
Note: The table summarizes the articles
included in the literature review on vaccination, vaccine reluctance, and
factors associated with vaccine decision making. Authors, titles, sources, and
relevant links to the articles are presented, which vary among studies and
analyses of attitudes toward vaccines in different countries.
Results
Social perception of vaccines
Immunization differs from other preventive
health methods due to its conceptual complexity and the nature that it does not
tend to offer immediately visible results. For this reason it generates a lot
of uncertainty in people and leads to a limited understanding of its relevance,
especially when grasping or understanding the idea of receiving vaccines that
contain microorganisms that have been weakened or inactivated so that they do
not cause serious diseases in healthy people. Lack of knowledge about how vaccines
work and their purpose leads people to not value or have an adequate
perspective on their important role in disease prevention .
When talking about perception towards
immunization, mention can be made of a study conducted in Costa Rica at the
Hospital "Dr. Rafael Ángel Calderón Guardia", in which the coverage
of vaccination against influenza among nursing personnel was analyzed. The
study revealed that resistance to influenza immunization is influenced by
misinformation, fear of side effects, availability of the vaccine and
unawareness of the dangers of non-immunization. It was found that significant
percentages of adult workers in the age range of 20 to 40 years, among men and
women, who, despite belonging to the health personnel within the hospital,
presented resistance to immunization. The myths and negative attitudes towards
the vaccine showed a high level of misinformation and demonstrated that,
although the workers have the knowledge and preparation in health, the
appreciation towards immunization contradicts their training, revealing the
greater weight of other determinants such as psychological, social and
cultural, over the scientific and educational ones .
Resistance to vaccination is widespread among
young adults, where they determine that vaccination is not necessary because
they are at an age when they perceive themselves to be in good health; or if
they feel they are not at risk of disease, they are less likely to receive the
vaccine. However, despite the reach of immunization, significant challenges
persist that affect the effectiveness of immunization globally. Another major
barrier identified within this adult age group is the fear of side effects,
which raises concerns and impacts immunization
Knowledge, attitudes and behaviors towards
immunization.
The level of knowledge about vaccines in the
population is necessary to shape attitudes toward vaccine acceptance. Clear and
accessible information not only educates people about the safety and
effectiveness of vaccines, but also helps to diminish erroneous beliefs about
vaccines. With respect to attitudes, these directly influence behaviors, which
determine whether people are motivated to get vaccinated or are simply
undecided or reluctant
In the case of COVID-19, young adults are
less likely to accept the vaccine compared to older people. The vaccination
rate in this group of adults shows that, although they are hesitant about the
vaccine, they focus more on the risks of side effects, while those who do
choose to be vaccinated focus on the efficacy of the vaccine. In general,
adults with an average age of 24 years tend to be reluctant or unsure about
immunization, because they prioritize the risk of side effects, a central
determinant for the acceptance of immunization .
Vaccine immunization may be influenced by
age, educational level and income. Adults from 50 to 64 years of age tend to be
more likely to be vaccinated than younger people. In this same age group,
adults with health problems are more willing to be vaccinated than those in
good health .
Therefore, it is essential to promote
education about vaccines and to create an environment that supports and values
immunization as a responsible and preventive act for personal and community
health
Figure 2: Behavioral and social
determinants of immunization.
)%20(inglés%20(americano)).fld/image004.png)
Note: The figure shows the factors
influencing the decision to vaccinate, according to the model proposed by
Brewer et al. (2019) in their review published in Psychological Science in the
Public Interest.
To improve immunization coverage, it is
essential to identify the reasons behind low vaccine uptake. Training programs
should gather information on the perceptions, motivations and feelings of the
population. In addition, the social and practical determinants that facilitate
or complicate the decision to vaccinate should be known. This allows the
development of strategies based on reliable evidence that promote
self-acceptance of vaccination
Vaccine reluctance is known as a stance
between acceptance and total rejection of vaccines. It is established as a
phenomenon with many implications and complications. According to the Strategic
Advisory Group of Experts on Vaccine Hesitancy (SAGE), which is a group of
experts in charge of advising the World Health Organization (WHO) on policies
and strategies regarding vaccines, they indicate that reluctance is a delay in
the acceptance or rejection of vaccines, even if they are accessible and
available. This type of behavior is influenced by various personal, cultural
and community determinants and is directly related to the health system, which
tends to diversify with the times and the reality of the population .
The World Health Organization (WHO) has
developed models that allow a better understanding of reluctance, such as the
3Cs model, which refers to competence, confidence and convenience, which have
been evolving and adapting towards the 5s, where communication and context are
incorporated. This model provides confidence, through the exposure of safety
and effectiveness of vaccines, informing and clarifying the different
perceptions about the risk associated with diseases, as well as the
accessibility and ease of vaccination. These models seek to assess the quality
and impact of the information received within the sociocultural and political
environment that encompasses the topic of vaccines
Social influences on adults play an important
role in the decision to vaccinate, as they outweigh the scientific knowledge
they have. In the study by Adedeji et al. (2022), they state that adults with
an average age of 40 years have a high level of awareness and are willing to
receive vaccines. However, distrust in vaccines and concerns of, whether they
are safe or not are evident in the population. Despite showing a moderate
disposition and perception towards the efficacy of immunization, many of them show
doubts due to aspects external to the scientific context. Among the factors
influencing immunization awareness, religion, occupations, education and, in
most of the cases, they look for previous diagnoses of whether they suffer from
any disease to do so .
Acceptance or rejection of vaccines may be
influenced by social pressure and the opinions of peers, family members, public
figures, and pro- and anti-immunization movements. Resistance to immunization
may increase due to the presence of anti-vaccine movements that are currently
the most influential factor within the world population
The perceived risk of vaccine-preventable
diseases may be underestimated if people do not experience outbreaks,
conditions or serious health complications, which leads to a lower priority for
immunization. Among the most relevant determinants is the fear caused by the
side effects of vaccines, which are usually amplified by misinformation and
provoke significant resistance in the population. On the other hand, there is
anxiety, caused by insecurity about the effectiveness of vaccines
Psychological determinants that influence
people's behavior, thinking and emotions include elements such as beliefs about
the safety of vaccines, emotions associated with health and previous
experiences with the health system, which can influence the decision to be
vaccinated or not. Also, the perception and motivation to protect oneself and
others are determinants in the willingness to receive the vaccine. For this
reason, all these psychological aspects are understood as essential in the
process of information, communication and the increase of immunization coverage
in the population, framing how people process information about vaccines,
including emotional and rational cognition and their response to immunization .
Antivaccine movements and their impact on
immunization resistance
The anti-vaccine movement can be defined as
different groups of people who, for religious, philosophical, political,
scientific or health reasons, establish and propose risks in vaccines. These
people aim to spread unverified and unverified information with no identified
basis regarding immunization. These movements have achieved a great resistance
in immunization rates in large populations in several countries and even
increased the number of these followers
From the above, it can be established that
resistance to vaccines is as old as immunization itself
Table 2 presents the main sociocultural and
psychological determinants that influence resistance to vaccination. They are
divided into three categories: contextual determinants, behavioral and peer
influences, and factors directly related to the vaccine.
Table 2: Main sociocultural and psychological
determinants of vaccine resistance.
|
DETERMINANTS |
DESCRIPTION |
|
Contextual |
- Education |
|
Behavioral and peer influences |
-
Personal, family or community experiences regarding vaccination |
|
In relation to the vaccine |
- Vaccine campaigns |
Rejection of immunization
In recent years, there has been an increase
in the number of people expressing doubts and resistance to vaccines,
especially in terms of safety, side effects and effectiveness
Regarding information and educational level
on immunization, the findings have shown great volatility, which establishes
that the individual determinants of each person should not be analyzed in
isolation, since there are different contextual influences in each part of the
world and in each community
In this same context, it is observable how
philosophical and religious exemptions in the population have been influencing
and increasing, which has contributed to significant outbreaks of diseases that
could be prevented with immunization
The World Health Organization (WHO) and the
Pan American Health Organization (PAHO) point out that a clear case is that of
the Americas region, where measles coverage is lower compared to other regions
of the world, such as African communities that present exorbitant amounts of
measles. It concludes that geographic barriers and limited access to
immunization campaigns are relevant determinants affecting the immunization
process
Table 3: Vaccines targeted to adults aged 19 to 64
years.
|
Age range |
Vaccines you need |
Other Vaccines |
|
19 to 26 years old |
- Varicella vaccine |
- MenB vaccine (meningococcal disease) for adults up
to 23 years old. |
|
27 to 49 years old |
-
COVID-19 vaccine |
-
Varicella (chickenpox) vaccination if born in 1980 or later |
|
50 to 64 years old |
- COVID-19 vaccine |
- Hepatitis B vaccine (recommended up to age 59
years) |
Table 3 shows the recommended vaccines for
adults between 19 and 64 years of age, dividing the needs by age range. This
vaccination schedule reflects the evolving immunologic needs of the adult
population and underscores the importance of maintaining immunization
throughout life, especially for preventable diseases such as COVID-19,
influenza, and HPV. This information was obtained from .
Table 4: Changes in influenza immunization in the
United States.
)%20(inglés%20(americano)).fld/image005.png)
Table 4 presents changes in the influenza
vaccination rate in the United States by different age ranges. The percentage
of vaccination increases significantly with age, being highest among persons
aged 60 years and older, which may reflect a higher perceived risk of serious
influenza-associated complications in older persons. The difference in
vaccination percentage between age ranges highlights how vaccine uptake tends
to increase with age, with a notable increase in older adults. Retrieved from .
Figure 3: Influenza vaccination
coverage, overall and by selected demographic groups and jurisdictions, among
adults aged 18 years and older, 2021-22 through 2024-2025.
)%20(inglés%20(americano)).fld/image006.png)
Figure 3 presents influenza vaccination rates
for three age ranges: 18-49 years, 50-64 years, and 65 years and older, during
the period 2021-2022 to 2024-2025. The data provide an overview of vaccination
coverage, reflecting how vaccination rates vary by age group. Retrieved from
(CDC, 2023).
Thus, resistance to immunization manifests
itself alarmingly through the persistence of cases of preventable diseases,
such as influenza and even COVID-19. Despite global efforts to increase
immunization, the data show that the group with the highest resistance to
influenza and COVID-19 vaccines are young and middle-aged adults between 18 and
49 years of age, with only 37% coverage, reaffirming the findings of several
studies included in this review.
Immunization has been considered one of the
most widely used tools to prevent diseases and avoid their spread. Despite the
advantages and effective results that immunization provides, its acceptance has
faced many challenges in adult populations. According to the literature review
worldwide, immunization rates have increased considerably in the last decades
and gaps in coverage exist, due to the great skepticism towards vaccines. These
challenges have demonstrated the evident problem between knowledge, attitude
and behavior of the population.
Within the immunization process, it is
important to recognize that resistance to vaccines is not a recent phenomenon,
but has been passed from generation to generation for many years, which has
been fed by erroneous beliefs and misinformation. However, today resistance has
changed with technological advances and the globalization of information. The
emergence of the internet and social networks has allowed anti-vaccine
movements to make themselves heard in all parts of the world and to misinform
and create fear and mistrust of vaccines.
Many people do not understand that, although
the effects of vaccines are not immediate or visible, their advantages and
benefits are long-term. The idea that a vaccine contains weakened or inactive
microorganisms generates a natural rejection in those who do not have a deep
knowledge about its safety and benefits. According to several studies such as
those by Perez and Campos (2023), erroneous beliefs about the side effects and
risks of vaccines continue to be one of the main obstacles to increasing acceptance.
In addition, the influence of sociocultural
determinants on attitudes toward immunization cannot be ignored. In many
communities, traditional beliefs or experiences with the health system play a
key role in immunization-related decisions. Risk perception is also a
determining factor; when a disease has been controlled or eradicated in many
parts of the world, people tend to underestimate its threat potential. This
phenomenon, known as complacency, is clearly observable in countries where
diseases such as measles have almost completely disappeared thanks to
immunization. In this context, populations do not perceive the need to protect
themselves, and are therefore less motivated to get vaccinated.
The COVID-19 pandemic has been a clear
example of how epidemic outbreaks can expose the fragilities of immunization
systems. Despite advances in science and the availability of vaccines,
skepticism persisted and even increased in some quarters. In this regard, it is
important to note that misinformation comes not only from anti-vaccine groups,
but also from a lack of trust in health institutions. In many cases, people
feel insecure due to the amount of contradictory information, where fear and
anxiety towards the unknown are two of the biggest psychological obstacles
facing immunization programs.
Despite the challenges presented by
immunization, positive progress has been observed in some regions where more
effective educational strategies have been implemented. Interventions that not
only inform, but also seek to create an environment of trust in vaccines have
proven to be more successful. The inclusion of community leaders and authority
figures to convey clear and confident messages can make a significant
difference. Campaigns should be designed not only to inform about vaccine
safety, but also to connect emotionally with people's concerns and fears.
Throughout the review, it has been determined
that vaccine resistance is multifaceted and varies according to the context,
since in some countries the main barrier is misinformation, in others, such as
in certain rural or impoverished areas, limited access to vaccines remains a
critical problem. In this sense, social determinants, such as geographic
location, socioeconomic status and access to medical care, are determinants
that must be considered in any immunization strategy.
The findings have also established that fear
and mistrust continue to be key elements in the resistance to immunization, but
so is the lack of continuing education and the adaptation of messages to the
cultural and social realities of each population. Future immunization campaigns
should take these determinants into account and offer not only scientific
facts, but also empathy and understanding of different groups such as adults
aged 19-64 years. In addition, it is essential not to underestimate the importance
of trust in information sources, as growing skepticism towards official
institutions can undermine any immunization effort.
It is clear that immunization is not only a
public health issue, but also an issue of education and social trust. To combat
resistance, a more holistic approach is needed that not only addresses the
technical aspects of immunization, but also recognizes the emotions, beliefs
and values that influence vaccine acceptance.
Conclusions
Cultural beliefs and traditional values are
key factors in vaccine acceptance, underscoring the importance of designing
culturally sensitive immunization strategies tailored to the particularities of
each community. To improve the effectiveness of these interventions, it is
essential to engage community leaders and respect local cultural practices,
fostering open and collaborative dialogue.
Social pressure and the influence of
community groups also play a significant role in immunization decisions.
Harnessing these social dynamics can be an effective strategy to promote
positive messages about vaccines and counter resistance through the normalization
of vaccination practices within communities.
The misperception of disease risk, coupled
with fear of vaccine side effects, reinforces the need for evidence-based
health education campaigns. These campaigns should directly address population
concerns, provide clear information about the benefits of vaccines, and
minimize unfounded fears.
In addition, misinformation continues to be a
critical challenge affecting public perception of immunization. To combat this
phenomenon, it is recommended to implement effective communication strategies
that use accessible and reliable means to disseminate accurate information.
Collaboration with digital platforms to monitor and mitigate the spread of
false information is an essential measure in this context.
Recommendations include the development of
educational materials that integrate specific cultural aspects and are
distributed in local languages.
Involve community leaders and organizations
in immunization campaigns to increase confidence and participation.
Establish educational programs aimed at
correcting misconceptions about disease risk and vaccine side effects.
Collaborate with digital platforms and media
outlets to counter misinformation and ensure the availability of reliable
sources.
Evaluate the impact of interventions through
measurable indicators, such as vaccine uptake rates and confidence levels in
immunization.
These actions will not only contribute to
improving vaccination rates, but will also strengthen trust in health
institutions, reducing socio-cultural and psychological barriers that affect
vaccine acceptance.
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