Article summary: A taxonomy of anti-vaccination arguments

A summary of findings of a systematic review of psychological reasons for anti-vaccination attitudes.

A street sign with one cross street saying vaccine and the other saying no vaccine.
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A recent article in which authors used systematic literature review and meta-analysis methods to consider the underlying psychological reasons, or attitude roots, for those who are vaccine hesitant is summarized in this article to support interaction between primary care providers and their patients. Understanding the lens from which a person views vaccines and vaccine information can be helpful with communication strategies and identifying vulnerable populations in a variety of interactions and settings.

What is Vaccine Hesitancy?

The World Health Organization or WHO defines vaccine hesitancy as a refusal or reluctance to get vaccinated even when vaccines are available. In fact, WHO identified vaccine hesitancy as one of the top 10 global public health threats in 2019. This threat was only exacerbated by the COVID-19 pandemic.

Why the Hesitancy?

Given that vaccines are one of the most effective medical interventions to prevent, reduce, and/or eradicate severe illness and death, researchers conducted extensive analyses of over 150 studies and internet content to determine the main underlying reasons for hesitancy and the rejection of scientific evidence supporting vaccinations. They conducted two studies: (1) a systematic literature review and thematic analysis of six previously identified attitude roots, and (2) a case study on COVID-19 anti-vaccination arguments. Following is a brief summary of the resulting list of attitude roots and descriptive themes. Detailed examples clarifying attitude roots and associate themes are in the original article.

Attitude Roots and Themes

Attitude Root


Conspiracist Ideation

Government cover-up, Big Pharma, population control, made-up threat, targeting the disadvantaged


Negligent healthcare, untrustworthy data, ‘it is just a theory’, exaggerated risk, financial interests, systemic corruption, absence of liability, oppressive outgroups, ‘do your own research’

Unwarranted Beliefs

Alternative medicine, natural is best, overmedicalization, alternatives to vaccination, science denial, absurd causality, vaccinated are a threat, fallacious logic, disease disappears by itself

Worldview and Politics

Science-related populism, libertarianism, politicization of vaccines, traditionalism, rejection of modernity

Religious Concerns

Impurity, appeal to natural order, religious authority, the work of God, religious exemptions

Moral Concerns

Unethical experimentation, anti-abortion position, sexual promiscuity, health is not business, anti-utilitarianism, bad parenting

Fear and Phobias

Side effects, safety concern, dreadful injuries, toxicity hazard, contraindications, immune compromise, trypanophobia

Distorted Risk Perception

Vaccination is unnecessary, disease is not serious, misperception of risk, cost-benefit analysis, ‘vaccination is not for me’

Perceived Self-Interest

Freeriding, luxury measures

Epistemic Relativism

Truth is relative, anecdotal evidence, epistemic superiority, individualistic epistemology, all or nothing


Resisting coercion, personal autonomy, vindication of civil liberties, going against the herd

Important Contributions and Implications

The researchers note two contributions that can assist primary care providers and others during vaccine conversations: (1) understanding domains of behavior (constructs) underlying hesitancy can help predict those who may be vulnerable to misinformation and disinformation, encouraging the development of interventions that can target those specific populations, and (2) considering motivations underlying the oppositions can improve intervention methods beyond message rebuttal or debunking.

The authors provide a web-based tool they developed with medical practitioners in the United Kingdom so providers can address hesitancy without arguing specific points by approaching the underlying reasoning behind hesitancy. In other words, they meet their patients where they are to provide science-based information and care.

If you would like to learn more, explore Michigan State University Extension’s Michigan Vaccine Project and find links to events, podcasts, publications, webinars, and videos related to vaccine education.

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