Blog by Helen Donovan – Self-Care Forum Chair, and Trevor Gore – Self-Care Forum Treasurer
The World Health Organization’s Immunization Week 2026 (24–30 April) is built around a simple but powerful message, “For every generation, vaccines work.” Research published in 2024 demonstrated that over the last 50 years vaccines have saved around 150 million lives, which equates to 6 lives every minute of every day (Andrew Shattock et al 2024). This has contributed to the reduction in child mortality which means of course, children go on to live productive lives. The UKHSA (UK Health Security Agency) has recently published data (UKHSA February 2026) showing that the pre-school vaccination programme saves around 5000 deaths and over 220,000 hospitalisations in England every year.
Vaccines obviously work, yet across many countries vaccination rates are falling. This raises an important question for those of us working in public health, behavioural science, and self-care.
If vaccines work so well, why aren’t more people taking them?
The term ‘Vaccine Hesitancy’ is defined as ‘delay in acceptance or refusal of vaccines despite availability of vaccination services. We know that the reasons for it are complex, including factors such as complacency, convenience and confidence. Part of the answer lies in human behaviour. We tend to assume that all vaccine decisions are rational, that people weigh up risks and benefits and make the “right” choice, for some of course this is true. In reality, however, behavioural economics tells us that decisions are often shaped by biases, social influences, convenience, trust, and emotion, the reasons will often overlap but it is where behavioural insights can help.
What behavioural economics tells us about vaccination.
Research shows that small changes to how choices are presented can have a big impact on behaviour. These “nudges” don’t remove choice, but they make the healthier option easier or more salient. Some, but by no means all, of the approaches that have shown promise include, making vaccination the easy default, and based on a presumption that the individual will get the vaccine they are eligible for; things like, pre-booked appointments, opt-out systems, or reminders that say “your vaccination is scheduled for…” can all significantly increase uptake.
Reducing friction can also improve uptake rates. Simple things like convenient clinic hours, pharmacy access, or workplace vaccination, remove barriers that often matter more than attitudes. Using trusted messengers also has a part to play, the way people are greeted when they contact the service and the way the messages are given, having a welcoming and friendly service helps to make people feel valued.
People are more likely to accept vaccines when the message comes from someone they trust and feel they can talk to.
It is accepted that health care professionals are generally the most trusted source of information (UKHSA 2025) but a trusted, community leader, teacher or peer will also often be more trusted than a national campaign.
Speaking to people about local needs and recognising any community issues are important, messages such as “most parents in your community vaccinate their children” can reinforce positive behaviours. This is part of the FOMO phenomenon (fear of missing out) or harnessing social norms. But behavioural economics also teaches us something important, that not all vaccine hesitancy is the same.
As said, vaccine hesitancy is recognised as being complex it is vaccine and context specific and varies across time. The term itself needs to be considered because individuals won’t recognise themselves as hesitant but say they have questions, which is surely to be expected for any vaccine, treatment or other medication. The reasons for vaccine hesitancy and the questions people have are often vaccine specific. the same nudge doesn’t work equally well for every vaccine. COVID-19 vaccination hesitancy often reflected mistrust in institutions, politicisation of the pandemic and concerns about speed of development. In these cases, nudges alone had limited impact. Trust-building and credible messengers mattered more.
MMR hesitancy, on the other hand, is often driven by misinformation (such as lingering myths around autism, even though this is completed refuted), perceived low risk of measles, parental risk aversion. Here, behavioural strategies that highlight social norms, child protection, and community immunity can be more effective.
In other words, different behavioural problems require different behavioural solutions.
What could we do differently?
As vaccination rates decline globally, the challenge isn’t just scientific or medical. It’s behavioural. Some promising directions include designing vaccination services around convenience and defaults, using trusted local voices rather than distant institutions, tailoring interventions to specific vaccines and communities, and combining behavioural insights with frontline clinical relationships.
It is seen as increasingly important that health care professionals are able to talk about vaccines with confidence using good communication skills, listening to what people are saying and addressing their individual concerns (WHO 2025).
