The hesitation on childhood vaccination: A narrative review on the information published on social media regarding vaccination in modern times




Vaccination coverage; Social media; Child; Narrative review.


Vaccines are considered one of the most important public health advancements of the modern age and the most cost-effective preventive method of curbing the spread of several diseases with high morbidity and lethality. However, vaccination coverage rates around the world have been threatened by the vaccine hesitancy phenomenon, considered by the World Health Organization (WHO) as one of the ten greatest menaces to public health in the world. Vaccine opposition is a mentality driven by various interests, as old as the vaccine itself, predominantly using the media and social networks, which have an enormous influence on people. They often spread false information about vaccines, frequently with no adequate scientific backing, negatively impacting vaccination rates. To understand the possible correlation between the information spread on social media and childhood vaccination rates, we performed a narrative review on the subject, with a qualitative approach, in original or review articles, indexed in national and international databases and/or journals, in Portuguese and English, published between 2011 and 2021, available in full and free of charge. One hundred and seventy-two articles were extracted from the literature, 49 of which were submitted to analysis. The use of content analysis in a narrative literature review made it possible to interpret the main publications that in the last decade point to the impact of social media as one of the main factors linked to vaccine hesitancy in children. The articles show that communication is presented as a determinant for adherence or vaccine hesitancy, and social media are a useful tool for disseminating information that can influence and mobilize the population, promoting its acceptance or having a negative impact on childhood vaccine coverage rates. Social Media has become fertile ground for the creation and spread of fake news, hence the importance of the health professional's engagement in strengthening the population's confidence in relation to immunization, minimizing vaccine hesitancy.


Abadura, S. A., Lerebo, W. T., Kulkarni, U., & Mekonnen, Z. A. (2015). Individual and community level determinants of childhood full immunization in Ethiopia: a multilevel analysis. BMC public health, 15(1), 1-10.

Ajovalasit, S., Dorgali, V. M., Mazza, A., d'Onofrio, A., & Manfredi, P. (2021). Evidence of disorientation towards immunization on online social media after contrasting political communication on vaccines. Results from an analysis of Twitter data in Italy. PloS one, 16(7), e0253569.

Bahk, C. Y., Cumming, M., Paushter, L., Madoff, L. C., Thomson, A., & Brownstein, J. S. (2016). Publicly Available Online Tool Facilitates Real-Time Monitoring Of Vaccine Conversations And Sentiments. Health affairs (Project Hope), 35(2), 341–347.

Bardin, L. (2016). L’Analyse de contenu. 3ème éd. Paris: Presses Universitaires, France

Benis, A., Seidmann, A., & Ashkenazi, S. (2021). Reasons for Taking the COVID-19 Vaccine by US Social Media Users. Vaccines, 9(4), 315.

Bobo, F. T., & Hayen, A. (2020). Decomposition of socioeconomic inequalities in child vaccination in Ethiopia: results from the 2011 and 2016 demographic and health surveys. BMJ Open, 10(10), e039617.

Bozzola, E., Spina, G., Tozzi, A. E., & Villani, A. (2020). Global Measles Epidemic Risk: Current Perspectives on the Growing Need for Implementing Digital Communication Strategies. Risk management and healthcare policy, 13, 2819–2826.

Brotas, A. M. P., Costa, M. C. R., Ortiz, J., Santos, C. C., & Massarani, L. (2021). Discurso antivacina no YouTube: a mediação de influenciadores. Revista Eletrônica de Comunicação, Informação e Inovação em Saúde, 15(1).

Byström, E., Lindstrand, A., Bergström, J., Riesbeck, K., & Roth, A. (2020). Confidence in the National Immunization Program among parents in Sweden 2016 - A cross-sectional survey. Vaccine, 38(22), 3909-3917.

Carlson, S., Dey, A., & Beard, F. (2020). An evaluation of the 2016 influenza vaccination in pregnancy campaign in NSW, Australia. Public Health Research & Practice, 30(1).

Carlson, S. J., Scanlan, C., Marshall, H. S., Blyth, C. C., Macartney, K., & Leask, J. (2019). Attitudes about and access to influenza vaccination experienced by parents of children hospitalized for influenza in Australia. Vaccine, 37(40), 5994-6001.

Carrieri, V., Madio, L., & Principe, F. (2019). Vaccine hesitancy and (fake) news: Quasi-experimental evidence from Italy. Health Econ, 28(11), 1377-1382.

Chimpololo, A., & Burrowes, V. (2019). Use of Social Mobilization and Community Mobilizers by Non-governmental Health Organizations in Malawi to Support the Eradication of Polio, Improve Routine Immunization Coverage, and Control Measles and Neonatal Tetanus. The American Journal of Tropical Medicine and Hygiene, 101(4_Suppl), 85-90.

Choudhary, M., Solomon, R., Awale, J., & Dey, R. (2018). Demand-side determinants of timely vaccination of oral polio vaccine in social mobilization network areas of CORE Group polio project in Uttar Pradesh, India. BMC Infect Dis, 18(1), 222.

Debie, A., Lakew, A. M., Tamirat, K. S., Amare, G., & Tesema, G. A. (2020). Complete vaccination service utilization inequalities among children aged 12–23 months in Ethiopia: a multivariate decomposition analysis. International journal for equity in health, 19, 1-16.

Delany-Moretlwe, S., Kelley, K. F., James, S., Scorgie, F., Subedar, H., Dlamini, N. R., . . . & Rees, H. (2018). Human Papillomavirus Vaccine Introduction in South Africa: Implementation Lessons From an Evaluation of the National School-Based Vaccination Campaign. Glob Health Sci Pract, 6(3), 425-438.

Domek, G. J., O'Leary, S. T., Bull, S., Bronsert, M., Contreras-Roldan, I. L., Ventura, G. A. B., ... & Asturias, E. J. (2018). Measuring vaccine hesitancy: Field testing the WHO SAGE Working Group on Vaccine Hesitancy survey tool in Guatemala. Vaccine, 36(35), 5273-5281.

Dunn, A. G., Surian, D., Leask, J., Dey, A., Mandl, K. D., & Coiera, E. (2017). Mapping information exposure on social media to explain differences in HPV vaccine coverage in the United States. Vaccine, 35(23), 3033–3040.

Edelstein, M., Müller, M., Ladhani, S., Yarwood, J., Salathé, M., & Ramsay, M. (2020). Keep calm and carry on vaccinating: Is anti-vaccination sentiment contributing to declining vaccine coverage in England? Vaccine, 38(33), 5297-5304.

Faisal-Cury, A., Levy, R. B., Tourinho, M. F., Grangeiro, A., & Eluf-Neto, J. (2020). Vaccination coverage rates and predictors of HPV vaccination among eligible and non-eligible female adolescents at the Brazilian HPV vaccination public program. BMC public health, 20(1), 1-12.

Frugoli, A. G., Prado, R. D., Silva, T. M., Matozinhos, F. P., Trapé, C. A., & Lachtim, S. A. (2021). Fake news sobre vacinas: uma análise sobre o modelo dos 3Cs da Organização Mundial da Saúde. Revista da Escola de Enfermagem da USP, 55.

Galindo-Santana, B. M., Cruz-Rodríguez, E., & López-Ambrón, L. (2019). A Cuban Perspective on the Antivaccination Movement. MEDICC review, 21(4), 64–69.

Grunig, J.E. (2005) Situational Theory of publics. In: Heath, R.L., editor. Encyclopedia of Public Relations. London: SAGE publications 778-80.

Hossain, M. M., Sobhan, M. A., Rahman, A., Flora, S. S., & Irin, Z. S. (2021). Trends and determinants of vaccination among children aged 06-59?months in Bangladesh: country representative survey from 1993 to 2014. BMC public health, 21(1), 1578.

Hwang, J. H., Lim, C. H., Kim, D. H., Eun, B. W., Jo, D. S., Song, Y. H., & Kim, Y. K. (2017). A Survey of Parental Perception and Pattern of Action in Response to Influenza-like Illness in Their Children: Including Healthcare Use and Vaccination in Korea. J Korean Med Sci, 32(2), 204-211.

Jahan, Y., Moriyama, M., Rahman, M. M., Shahid, A. S. M. S., Rahman, A., Hossain, N., . . . & Chisti, M. J. (2020). Changing trends in measles vaccination status between 2004 and 2014 among children aged 12-23 months in Bangladesh. Tropical Medicine & International Health, 25(4), 475-482.

Jenness, S. M., Aavitsland, P., White, R. A., & Winje, B. A. (2021). Measles vaccine coverage among children born to Somali immigrants in Norway. BMC Public Health, 21(1), 668.

Kang, G. J., Ewing-Nelson, S. R., Mackey, L., Schlitt, J. T., Marathe, A., Abbas, K. M., & Swarup, S. (2017). Semantic network analysis of vaccine sentiment in online social media. Vaccine, 35(29), 3621–3638.

Krishnendhu, V. K., & George, L. S. (2019). Drivers and barriers for measles rubella vaccination campaign: A qualitative study. Journal of family medicine and primary care, 8(3), 881–885.

Lau, J. T., Ng, C. S. M., Wu, A. M., Ma, Y. L., & Lau, M. M. (2018). Low coverage of influenza vaccination among Chinese children aged 12-23 months: Prevalence and associated factors. PLoS One, 13(10), e0205561.

Liao, Q., Fielding, R., Cheung, Y. T. D., Lian, J., Yuan, J., & Lam, W. W. T. (2020). Effectiveness and Parental Acceptability of Social Networking Interventions for Promoting Seasonal Influenza Vaccination Among Young Children: Randomized Controlled Trial. J Med Internet Res, 22(2), e16427.

Massarani, L., Waltz, I., Leal, T., & Modesto, M. (2021). Narrativas sobre vacinação em tempos de fake news: uma análise de conteúdo em redes sociais. Saúde e Sociedade, 30.

Mayerová, D., & Abbas, K. (2021). Childhood immunization timeliness and vaccine confidence by health information source, maternal, socioeconomic, and geographic characteristics in Albania. BMC Public Health, 21(1), 1724.

McClure, C. C., Cataldi, J. R., & O’Leary, S. T. (2017). Vaccine hesitancy: where we are and where we are going. Clinical therapeutics, 39(8), 1550-1562.

Nair, A. T., Nayar, K. R., Koya, S. F., Abraham, M., Lordson, J., Grace, C., . . . & Pandey, A. K. (2021). Social media, vaccine hesitancy and trust deficit in immunization programs: a qualitative enquiry in Malappuram District of Kerala, India. Health Res Policy Syst, 19(Suppl 2), 56.

Newtonraj, A., Vincent, A., Selvaraj, K., & Manikandan, M. (2019). Status of coverage of MR vaccination, after supplementary immunization activities in a rural area of South India: a rapid immunization coverage survey. Rural Remote Health, 19(3), 5261.

Odone, A., Ferrari, A., Spagnoli, F., Visciarelli, S., Shefer, A., Pasquarella, C., & Signorelli, C. (2015). Effectiveness of interventions that apply new media to improve vaccine uptake and vaccine coverage. Hum Vaccin Immunother, 11(1), 72-82.

On, J., Park, H. A., & Song, T. M. (2019). Sentiment Analysis of Social Media on Childhood Vaccination: Development of an Ontology. J Med Internet Res, 21(6), e13456.

Ortiz, R. R., Smith, A., & Coyne-Beasley, T. (2019). A systematic literature review to examine the potential for social media to impact HPV vaccine uptake and awareness, knowledge, and attitudes about HPV and HPV vaccination. Hum Vaccin Immunother, 15(7-8), 1465-1475.

Palencia-Sanchez, F., & Echeverry-Coral, S.J. (2020)—Aspectos sociales que han afectado la aceptación de la vacunación contra el Virus del Papiloma Humano en Colombia. Una revision sistemática [Social considerations affecting acceptance of HPV vaccination in Colombia. A systematic review]. Revista Colombiana de Obstetricia y Ginecología, 71(2), 178-194.

Pisaniak, P., Tarczon, A., Konarska, M., & Ozga, D. (2021). Parents' Opinions and Knowledge About Vaccination in Poland - A Cross-Sectional Observational Study. Int J Gen Med, 14, 3235-3242.

Porat, T., Garaizar, P., Ferrero, M., Jones, H., Ashworth, M., & Vadillo, M. A. (2019). Content and source analysis of popular tweets following a recent case of diphtheria in Spain. Eur J Public Health, 29(1), 117-122.

Porreca, A., Scozzari, F., & Di Nicola, M. (2020). Using text mining and sentiment analysis to analyze YouTube Italian videos concerning vaccination. BMC Public Health, 20(1), 259.

Rother, E.T. (2007). Revisão sistemática X revisão narrativa. Acta Paulista de Enfermagem, 20(2), 5-6,

Robinson, P., Wiley, K., & Degeling, C. (2021). Public health practitioner perspectives on dealing with measles outbreaks if high anti-vaccination sentiment is present. BMC Public Health, 21(1), 578.

Rodríguez-Blanco, N., & Tuells, J. (2019). Knowledge and Attitudes about the Flu Vaccine among Pregnant Women in the Valencian Community (Spain). Medicina (Kaunas), 55(8).

Sheikh, A., Iqbal, B., Ehtamam, A., Rahim, M., Shaikh, H. A., Usmani, H. A., . . . Aftab, A. A. (2013). Reasons for non-vaccination in pediatric patients visiting tertiary care centers in a polio-prone country. Arch Public Health, 71(1), 19.

Signorelli, C. (2019). Forty years (1978-2018) of vaccination policies in Italy. Acta Biomed, 90(1), 127-133.

Stockwell, M. S., & Fiks, A. G. (2013). Utilizing health information technology to improve vaccine communication and coverage. Hum Vaccin Immunother, 9(8), 1802-1811.

Succi, R. C. D. M. (2018). Vaccine refusal-what we need to know?. Jornal de pediatria, 94, 574-581.

Tesema, G. A., Tessema, Z. T., Tamirat, K. S., & Teshale, A. B. (2020). Complete basic childhood vaccination and associated factors among children aged 12–23 months in East Africa: a multilevel analysis of recent demographic and health surveys. BMC Public Health, 20(1), 1-14.

Tuckerman, J. L., Kaufman, J., Danchin, M., & Marshall, H. S. (2020). Influenza vaccination: A qualitative study of practice level barriers from medical practitioners caring for children with special risk medical conditions. Vaccine, 38(49), 7806-7814.

Vosgerau, D.S.R. & Romanowski, J.P. (2014). Estudos de revisão: implicações conceituais e metodológicas. Rev. Diálogo Educ, 14(41), 165-189, jan/abr.2014.

Vrdelja, M., Kraigher, A., Vercic, D., & Kropivnik, S. (2018). The growing vaccine hesitancy: exploring the influence of the internet. European journal of public health, 28(5), 934–939.

Wu, A. G., Shah, A. S., Haelle, T. S., Lunos, S. A., & Pitt, M. B. (2018). Choosing the perfect shot - The loaded narrative of imagery in online news coverage of vaccines. PLoS One, 13(6), e0199870.




How to Cite

Lisboa de Vasconcelos, M. V., Freire, C. de J., Cavalcante de Melo, C., Gomes de Souza Silva, A., Valente de Lima Melo , A. C., Lourenço Leitão , I., Silva Pedrosa, C. M., & Queroz Gurgel, R. (2023). The hesitation on childhood vaccination: A narrative review on the information published on social media regarding vaccination in modern times. New Trends in Qualitative Research, 16, e662.