Negotiating vaccine acceptance in an era of reluctance.

Studies to better understand the determinants of vaccine acceptance have expanded to include more investigation into dynamics of individual decision-making as well as the influences of peers and social networks. Vaccine acceptance is determined by a range of factors, from structural issues of supply, costs and access to services, as well as the more demand-side determinants. The term vaccine hesitancy is increasingly used in the investigation of demand-side determinants, moving away from the more polarized framing of pro- and anti-vaccine groups to recognizing the importance of understanding and engaging those who are delaying vaccination, accepting only some vaccines, or who are yet undecided, but reluctant. As hesitancy is a state of indecision, it is difficult to measure, but the stage of indecision is a critical time to engage and support the decision-making process. This article suggests modes of investigating the determinants of vaccine confidence and levers of vaccine acceptance toward better engagement and dialogue early in the process of decision-making. Pressure to vaccinate can be counter-productive. Listening and dialog can support individual decision-making and more effectively inform the public health community of the issues and concerns influencing vaccine hesitancy.