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Confidence in vaccines in developing countries: social, cultural, economic and political influences
  1. K Mulholland1,
  2. V Korczak1,
  3. V Tangcharoensathien2
  1. 1Departments of Epidemiology and Public Health, and Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
  2. 2International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
  1. Correspondence to Kim Mulholland, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT; kim.mulholland{at}

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As a public health measure, vaccination is unique in its extraordinary capacity to control and eliminate diseases. Yet, to achieve this, it is necessary to administer, usually by injection, a potentially harmful substance to healthy children. It is not surprising then that vaccination has provoked heated debates and arguments ever since vaccines were first used.1 Families in developing countries, where the burden of disease is still dominated by infectious diseases, many of them vaccine preventable, are often more enthusiastic about immunisation than those in industrialised countries, where non-communicable diseases have become the dominant burden of disease. Important diseases such as measles and polio are well remembered by the older generation in developing countries, while in industrialised countries these diseases are slipping out of living memory. As this happens, safety issues raised by anti-vaccine groups come to dominate the discussion.2

Confidence in vaccines can be seen as having two dimensions—confidence in the safety of vaccines, and confidence in their effectiveness. In both respects, public confidence is linked to public confidence in the health system. This varies considerably between industrialised countries, from those countries with a high degree of public confidence, such as Finland, to countries with more sceptical populations such as New Zealand. In industrialised countries, discussion about vaccines is dominated by safety, and anti-vaccine groups have been very active spreading doubts about vaccine safety. It is now accepted that the correct response to this is for the scientific and public health communities to thoroughly investigate legitimate safety concerns, while educating the general public with sound, factual information on vaccine safety and effectiveness.3

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  • Competing interests The corresponding author receives support from GAVI for his role as a member of the Executive Committee for the Hib Initiative project.

  • Provenance and peer review Commissioned; not externally peer reviewed.