Suboptimal vaccine uptake and vaccine hesitancy in the United States: current challenges and future directions

INTRODUCTION: Vaccination is an important tool to prevent infectious disease morbidity and mortality. Increased vaccine hesitancy and declining vaccination are contributing to larger infectious disease outbreaks. This review presents the current state of research and knowledge on vaccine hesitancy, focused on the United States (US). AREAS COVERED: This review covers the history of vaccination and vaccine hesitancy, recent and ongoing outbreaks, and updates in understanding of vaccine hesitancy and use of new psychology-based tools to address it. Articles for inclusion were sourced from extant understanding of the vaccine hesitancy literature as well as PubMed searches to ensure appropriate context. EXPERT OPINION: Population-level outreach and effective communication about vaccines is a central component to addressing vaccine hesitancy and restoring and maintaining trust in the vaccination system. With new ways of understanding vaccine hesitancy rooted in the psychology of decision-making, there is a need for research into outreach, message development, and implementation, within the information and social media environment that allows even faster dissemination of mis- and dis-information. Balancing the rigor of communications and implementation research with the need for timely communications is a pressing challenge to be faced by public health and medical professionals when addressing vaccine hesitancy.