Childhood vaccines, parental hesitancy : a sociological inquiry into the relational and socio-cultural dynamics shaping vaccine hesitancy

Parental hesitancy regarding childhood vaccines is both a public health and a social issue. In high-income countries, childhood vaccination programmes are well-established within public health systems, ensuring widespread availability and accessibility of vaccines. However, studies have shown a decline in public confidence in vaccines and a concurrent rise in vaccine hesitancy. While much of the existing research attempts to explain this trend using individualistic, deficit-based approaches, the health sociological literature has emphasised the importance of situating individuals' vaccine attitudes within broader societal dynamics. These include the neoliberalisation of healthcare – characterised by increasing individualisation, patient-consumerism, and healthism – the centrality of risk, and prevailing discourses around intensive motherhood. Additionally, recent scholarship in this area has called for greater attention to how vaccine hesitancy develops within relational and contextual frameworks. This dissertation contributes to such an understanding of parental vaccine hesitancy in three ways. First, it explores how the social worlds of vaccine hesitant parents and healthcare professionals develop in relation to these broader societal characteristics, revealing the complexities and fluidity in their perspectives. Second, it examines how these social worlds intersect during childhood vaccination encounters, foregrounding the role of (pre-verbal) paediatric patients. Third, it situates vaccine hesitancy within the institutional context of healthcare systems across Europe, contributing to a more contextualised understanding. These aims are addressed through four empirical studies and various qualitative and quantitative methods that collectively respond to the dissertation’s central research question: “How do the social worlds of vaccine-hesitant parents, young children, and healthcare professionals interact in a relational manner within the context of the healthcare system?” The four studies are organised as follows. The first two focus on how the perspectives of hesitant parents and healthcare professionals, respectively, reflect how individuals engage with broader socio-cultural expectations of health and parenting. Drawing on sociological literature concerning gendered parenting, risk discourse, healthism, moralisation, and changing patient-professional relations, they uncover the nuanced and often contradictory ways in which vaccine hesitancy is understood. The latter two studies focus on how these social worlds are embedded within healthcare systems – one through an interactional lens and the other through a contextual one. The interactional study analyses the vaccination encounter itself as a space where the social worlds of parents, children, and professionals converge. It begins with the observation that vaccine-related pain in children is a key factor influencing parental hesitancy, yet it remains consistently under-recognised and under-treated. By incorporating the experiences of pre-verbal children, the study explores how variations in pain mitigation relate to the socio-cultural dynamics of the vaccination encounter and the extent to which children are recognised as patients in their own right. The contextual study adopts an institutional lens to examine how healthcare system characteristics influence vaccine attitudes. It posits that vaccine hesitancy is shaped in part by how healthcare is organised. The empirical findings give rise to four overarching conclusions that can be drawn from this dissertation. First, both parents’ and professionals’ understandings of vaccine hesitancy are complex and fluid, benefitting from a relational perspective. Vaccine-hesitant mothers, for instance, may perceive their decision-making responsibility as empowering, yet this responsibility should equally be considered within the mothers’ broader context of social and gendered vulnerabilities. As such, this dissertation suggests that vaccine hesitancy research and policy may benefit from conceptualising it, at least in part, as related to a disposition in which mothers are socialised from the onset of pregnancy. Second, healthcare professionals are found to navigate moral dilemmas arising from conflicting societal expectations around risk, their professional role, and ideals of "good" parenting. Consequently, their accounts of parental vaccine hesitancy range from internalising and reinforcing moralising discourses to actively resisting them. This complexity indicates that while healthcare professionals are often tasked with addressing vaccine hesitancy, they too require support in navigating the dilemmas stemming from contradictory societal expectations. Third, by embedding the perspectives of parents, young children, and professionals into the healthcare interaction, this dissertation shows how paediatric patients are either socialised into the patient role or excluded from it, with significant implications for their pain mitigation care. Hence, this dissertation finds that it is important to consider that enhanced pain mitigation in childhood vaccination consultations may improve the immediate experience of paediatric patients and foster more positive vaccine attitudes among parents in the long term. Finally, this dissertation demonstrates that healthcare systems that are overall characterised by greater accessibility are associated with lower levels of vaccine hesitancy. This underscores the importance of policy interventions at the structural level in addressing individuals’ vaccine hesitancy. Overall, this dissertation offers a nuanced, sociologically informed understanding of childhood vaccination and parental hesitancy. By highlighting the relational, socio-cultural, and institutional dynamics at play, it contributes to the ongoing demoralisation and de-individualisation of parental vaccine hesitancy – framing it not as a matter of individual determinants but as a complex social phenomenon.