1 WHO

Ten threats to global health in 2019. 2 European Commission

Eurobarometer 91.2, 2019. Vaccination is the most successful measure to improve public health; however, vaccine hesitancy is growing worldwide. WHO selected vaccine hesitancy as one of the top ten threats to global health.This phenomenon might be linked to public confidence in governments since vaccination is a public health intervention implemented by governments. Europeans' attitudes towards vaccination, as documented in the Eurobarometer survey, have been recently published by the European Commission.Here, we investigate the association between confidence in governments and the percentage of respondents who did not have vaccination in the past 5 years because of safety concerns, grouped by country.

Figure Correlation between vaccine hesitancy and trust in government in 28 European countries Show full caption The dotted line indicates the regression line. In a survey based on a multiple-choice questionnaire, health authorities were the third highest resource of information for people consulting about vaccination (28%), behind general practitioners (79%), and other health-care workers (31%). We found a negative linear regression between no recent history of vaccination and trust in national government (standardised coefficient β=–0·45; p=0·02). Trust in political parties (β=–0·42; p=0·03), local government (β=–0·40; p=0·04), and national parliament (β=–0·48; p=0·01) also showed significant correlations in univariate analysis, but the trust in media and the EU did not (ie, the highest absolute coefficient of correlation was found in national parliament, figure ). Of note, the four elements of trust were closely correlated with each other (Pearson correlations [r]>0·76 and p<0·001).

3 Omer SB

Betsch C

Leask J Mandate vaccination with care. 4 Ward JK

Peretti-Watel P

Bocquier A

Seror V

Verger P Vaccine hesitancy and coercion: all eyes on France. No history of vaccination in the past 5 years because of safety concerns was associated with lower trust in national parliament, and with lower trust in local and national government and political parties in the Eurobarometer survey. Health-care professionals were the top two resources of information on vaccination, followed by health authorities. The most common resource was a general practitioner, doctor, or a paediatrician, and the second most common resource was a health-care worker such as nurse or a specialist doctor. A hidden solution to overcoming vaccine hesitancy could be the establishment of trust among government, parliament, and health-care professionals to promote clear policy making on vaccination, rather than coercive measures, such as extension of mandatory vaccination and elimination of non-medical exemption.In France, the relationship between health authorities and medical professionals was degraded, which might be responsible for these professionals discouraging patients from being vaccinated.

Our results should be carefully interpreted since vaccination history is affected by age, immunological status, and social events such as travel and migration. Further studies are warranted to elucidate how people communicate with health-care professionals, governments, and public organisations around vaccinations.

We declare no competing interests.