City Research Online

Abstract

Immunisation remains one of the most effective public health interventions, preventing millions of deaths worldwide each year. However, in many regions vaccination rates remain insufficient to ensure community protection. A key factor of this growing concern is vaccine hesitancy – the delay or refusal of vaccines despite availability. This thesis examines its determinants, transmission, and potential avenues for mitigation. The first empirical chapter analyses socioeconomic and attitudinal factors associated with vaccine hesitancy across the European Union and the United Kingdom (UK), drawing on large-scale survey data. Higher trust in credible institutions is linked to greater vaccine acceptance, whereas reliance on social media and lower vaccine literacy correlate with higher hesitancy. The study also identifies context-specific differences between routine and COVID-19-related hesitancy, highlight the need for tailored strategies to strengthen immunisation uptake. The second empirical study evaluates a gamified misinformation-detection intervention designed to improve vaccine-related attitudes and behaviours, tested through an incentivised online randomised control trial in the UK and Slovakia. Results show context-dependent improvements in media literacy and to a lesser extent in vaccine-related attitudes. Effects are strongest among initially hesitant groups, particularly ethnic minorities in the UK and higher-educated young adults in Slovakia, highlighting the potential of low-cost, scalable tools to strengthen critical engagement with vaccine information. The final empirical chapter explores intergenerational transmission of vaccine hesitancy using longitudinal UK data. Parental vaccine attitudes are strongly associated with filial vaccine confidence, with household structure, ethnicity, education, and early-life conditions shaping long-term beliefs. Robustness checks confirm the persistence of these relationships. Findings stress the importance of sustained and family-focused interventions to break cycles of vaccine hesitancy. Overall, this thesis demonstrates that vaccine hesitancy is dynamic, socially embedded, and often transmitted across generations. It argues for responses that prioritise trust-building, tailored communication, and interventions that equip individuals to navigate uncertainty and misinformation.

Publication Type:	Thesis (Doctoral)
Subjects:	H Social Sciences > HV Social pathology. Social and public welfare R Medicine > R Medicine (General) R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RC Internal medicine
Departments:	School of Policy & Global Affairs > Department of Economics School of Policy & Global Affairs > School of Policy & Global Affairs Doctoral Theses Doctoral Theses

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