Behavioural and social drivers of childhood vaccination in the Netherlands

Abstract Background The Dutch National Immunisation Programme offers childhood vaccination against 13 infectious diseases. Vaccination uptake has been declining, particularly among specific population groups. Understanding the drivers and barriers of childhood vaccination is critical for targeting interventions. The SocioVax project investigates these determinants in a longitudinal study to inform tailored public health strategies. Methods A representative sample of parents of children under 14 years old (round 1: N = 678; mean age = 41 years; 55.9% women) completed a questionnaire with validated items based on the COM-B (Michie et al., 2011) and the BeSD (WHO, 2022) models. We identified latent clusters of determinants of vaccination using structural equation modelling. Probit regression was employed to assess how these clusters predict uptake. Data was collected in June 2024, December 2024, and June 2025. Findings Determinants of vaccination uptake clustered in five latent variables. However, correlations between all clusters were high, suggesting that there is not one specific determinant that largely determines vaccination willingness. Reduced vaccine uptake among parents with lower educational levels or non-Dutch backgrounds was partially explained by lower perceived vaccine importance, higher levels of worry about vaccine safety, and lower levels of generalized trust in institutions. Nonetheless, trust in healthcare professionals was consistently high across all groups. Conclusions Results suggest that vaccination uptake does not depend on a specific belief, but on a complex belief system in which different beliefs are strongly interrelated. Future public health strategies should address vaccine safety concerns, emphasize benefits, and strengthen trust in institutions. The relatively high levels of trust in health care professionals suggest that they can play an important role in vaccination decision making among underserved groups. Key messages • Vaccination decisions are shaped by interrelated beliefs, requiring multifaceted intervention strategies. • High trust in healthcare professionals offers a key opportunity to boost vaccination uptake.