Vaccine decision-making among Serbian parents in the Netherlands: vaccine hesitancy in the ‘Post-Trust’ world

Vaccine hesitancy is a major contemporary threat to global health leading to the delay or refusal of vaccines. Quantitative studies on vaccination attitudes generally state that vaccine hesitancy is higher among immigrants. However, qualitative studies show a spectrum of vaccine-related attitudes and behaviours among immigrant parents, from refusal over delay to acceptance of all childhood vaccines. This paper is based on a 2020 qualitative study among Serbian parents living in the Netherlands. It discusses childhood vaccine compliance, focusing on parents with at least one fully vaccinated child. In general, the Serbian parents interviewed made decisions relating to vaccination based on their sociocultural background (ie, viewing vaccines as a part of 'traditional' upbringing), intersubjective norms (ie, they trust the state, vaccines, health officials, peers) or they lack sufficient language proficiency or information regarding vaccines. More importantly, the results also show that some participants exhibit vaccine hesitancy because they do not trust the vaccines, the government, health officials or pharmaceutical companies. The intriguing results confirm that vaccine hesitancy does occur among both the highly educated and lower educated, informed and uninformed, as well as users of complementary medicine and the religious (here, Serbian Orthodox Christian) and non-religious. Thus, this study interprets contemporary vaccine hesitancy as a rational response among vaccine-accepting parents to live in a post-trust world burdened by regulatory scandals, scientific pluralism and the availability of alternative information. Consequently, the study indicates that contemporary vaccine hesitancy requires understanding as a contemporary 'risk management strategy' outside of contextual, individual/group and vaccine-related factors.