Public trust in vaccination: an analytical framework.

While vaccination is one of the most successful public health interventions, there has always been a parallel movement against vaccines. Apart from scientific factors, the uptake of vaccinations is influenced by historical, political, sociocultural and economic factors. In India, the health system is struggling with logistical weaknesses in taking vaccination to the remotest corners; while on the other hand, some people in places where vaccination is available resist it. Unwillingness to be vaccinated is a growing problem in the developed world. This trend is gradually emerging in several parts of India as well. Other factors, such as heightened awareness of the profit motives of the vaccine industry, conflicts of interest among policy-makers, and social, cultural and religious considerations have eroded the people's trust in vaccination. This paper develops an analytical framework to assess trust in vaccination. The framework considers trust in vaccination from four perspectives - trust in the health system, the vaccine policy, vaccination providers and specific vaccines. The framework considers specific issues involved in vaccination trust, including the increasing scepticism towards medical technology, perceptions of conflicts of interest in the vaccine policy, and of lack of transparency and openness, the presence of strong alternative schools of thought, influence of the social media. The paper will conclude by arguing that engaging with communities and having a dialogue about the vaccination policy is an ethical imperative.