The drivers of vaccine hesitancy are complex and subject to temporal, contextual, and vaccine-specific influences. A reduction in vaccine hesitancy is necessary to bridge the coverage gaps and decrease the recurring incidence of VPDs in North Carolina. ![]() From 2013 to 2018, there were annual reports of seven VPDs in North Carolina, with significant increases in the cases of two VPDs: hepatitis A and hepatitis B. The primary consequence of vaccine hesitancy is under-vaccination-a situation where individuals are not fully protected against VPDs. In addition, many pregnant women decline vaccines that are offered to them, suggesting concerns with vaccine safety and efficacy, rather than convenience or complacency. Although vaccine coverage rates among pregnant women are not readily available for North Carolina, data suggest that only 1 in 2 pregnant women in the southern United States gets the TDaP and flu vaccine. ![]() In parallel, seasonal influenza vaccination rates among individuals aged 6 months and older remain low in North Carolina, with only 1 in 2 people getting the vaccine every year ( Table 1). As the table shows, HPV vaccine coverage is also lower compared to other school-mandated adolescent vaccines in North Carolina (such as the TDaP or MenACWY vaccines), suggesting lower prioritization of non-mandatory vaccines and missed opportunities for prevention of HPV-related cancers. Among adolescents in North Carolina, uptake of the human papillomavirus (HPV) vaccine remains lower than the HealthyPeople 2020 coverage goal of 80% ( Table 1). As a result, childhood vaccine coverage in North Carolina is lower at age 2 compared to kindergarten, where vaccines are required for school entry ( Table 1). Many parents in North Carolina choose to delay or space out vaccines for their young children as opposed to following recommended schedules. According to data from the National Immunization Survey, approximately 20% of parents in North Carolina are vaccine hesitant. Hesitancy is a contributor to vaccine coverage gaps in North Carolina. In this commentary, we discuss challenges in addressing vaccine hesitancy in North Carolina and present recommendations for mitigation strategies. Despite this global acknowledgement, vaccine hesitancy remains the elephant in the room – an uncomfortable and often controversial topic when it comes to the policies, programs, and practices to encourage vaccination. The World Health Organization acknowledges vaccine hesitancy as a universal and significant threat to global health. VPDs result in the diversion of public health resources, increased economic burden, and negative societal ramifications from unnecessary morbidity and mortality. ![]() Vaccine-hesitant individuals tend to cluster geographically, hence, communities where they live are at a greater risk for VPDs. In practice, vaccine hesitancy manifests as delays in receipt of or refusal to accept vaccines, resulting in under-vaccination of individuals. Reduced convenience of or incidental costs associated with accessing vaccinations, and complacency toward vaccine-preventable diseases (VPDs) also contribute to vaccine hesitancy. Vaccine hesitancy arises from concerns about the safety and efficacy of vaccines and from low trust in individuals or organizations promoting vaccines. Individuals’ reluctance to accept vaccines is termed vaccine hesitancy.
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