Uncertain, Not Opposed: Rethinking Vaccine Hesitancy
A recent editorial in The Lancet highlighted a growing challenge in U. S. healthcare: declining trust in public health institutions and increasing disruption in the systems that guide clinical recommendations. During the COVID-19 pandemic, the percentage of Americans who reported trusting vaccine information from the Centers for Disease Control and Prevention( CDC) fell from 83 % to 63 %, reflecting a broader shift in how patients interpret and act on health information.¹
Public conversations about vaccines often focus on extremes. Headlines highlight refusal, misinformation and outbreaks, while social networks amplify the loudest and most entrenched voices. This can create the impression that vaccine hesitancy is fixed, ideological and growing uniformly. But in the clinical setting, the reality is more nuanced.
Recent data suggest that vaccine hesitancy is not a single, static position. It exists on a spectrum and is shaped by a broader environment of uncertainty. National polling shows that fewer than half of U. S. adults express confidence in federal health agencies to make recommendations about childhood vaccines, and a majority report limited or no trust in those institutions.² In practice, this often looks less like refusal and more like patients trying to sort through conflicting information. That uncertainty is where physicians still have influence.
18 LOUISVILLE MEDICINE
by Heather Felton, MD
Hesitancy Is Not One Group
One of the most important shifts in understanding vaccine hesitancy is recognizing that not all hesitancy is the same. Some patients have specific concerns about safety, side effects or necessity. Others have broader mistrust of institutions, including medicine, public health and government. Still others are influenced by social networks where vaccine skepticism has become normalized. Vaccine hesitancy has long been understood as a complex, context-specific behavior shaped by confidence, complacency and convenience rather than a single belief or decision.³
In practice, these distinctions matter. Concern-based hesitancy often reflects uncertainty about safety or risk. These patients tend to ask questions, seek reassurance and remain open to discussion. In contrast, hesitancy rooted in mistrust may be less about a specific vaccine and more about the systems recommending it. These conversations are often shaped by prior experiences with healthcare, broader institutional skepticism or exposure to conflicting information.
A third group falls somewhere in between: patients who are influenced by what they are seeing and hearing in their daily lives. Social networks, both in person and online, play an increasing role in shaping vaccine decisions. Repeated exposure to conflicting or misleading information can normalize doubt, even among those who previously