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[This corrects the article DOI: 10.1371/journal.pone.0278967.].

The first comprehensive history of efforts to vaccinate children from contagious disease in US schools.As protests over vaccine mandates increase in the twenty-first century, many people have raised concerns about a growing opposition to school vaccination requirements. What triggered anti-vaccine activism in the past, and why does it continue today? Americans have struggled with questions like this since the passage of the first school vaccination laws in 1827. In Vaccine Wars, Kim Tolley lays out the first comprehensive history of the nearly two-hundred-year struggle to protect schoolchildren from infectious diseases. Drawing from extensive archival sources—including state and federal reports, court records, congressional hearings, oral interviews, correspondence, journals, school textbooks, and newspapers—Tolley analyzes resistance to vaccines in the context of evolving views about immunization among doctors, families, anti-vaccination groups, and school authorities. The resulting story reveals the historic nature of the ongoing struggle to reach a national consensus about the importance of vaccination, from the smallpox era to the COVID-19 pandemic. This well-researched and engaging book illustrates how the history of vaccination is deeply intertwined with the history of education. As stopping the spread of communicable diseases in classrooms became key to protection, vaccination became mandatory at the time of admission to school, and the decision to vaccinate was no longer a private, personal decision without consequence to others.Tolley's focus on schools reveals longstanding challenges and tensions in implementing vaccination policies. Vaccine Wars underscores recurring themes that have long roiled political debates over vaccination, including the proper reach of state power; the intersection of science, politics, and public policy; and the nature of individual liberty in a modern democracy.

•The term ‘vaccine hesitancy’ is increasingly used to explain sub-optimal vaccination coverage.•The accepted definition includes ‘confidence’, ‘complacency’ and ‘convenience’.•We contend the inclusion of ‘convenience’ is problematic.•Insufficient emphasis is given to the social determinants of vaccination.•Accurate terminology is needed for researchers and providers to address under-vaccination. Although vaccination uptake is high in most countries, pockets of sub-optimal coverage remain posing a threat to individual and population immunity. Increasingly, the term ‘vaccine hesitancy’ is being used by experts and commentators to explain sub-optimal vaccination coverage. We contend that using this term to explain all partial or non-immunisation risks generating solutions that are a poor match for the problem in a particular community or population. We propose more precision in the term ‘vaccine hesitancy’ is needed particularly since much under-vaccination arises from factors related to access or pragmatics. Only with clear terminology can we begin to understand where the problem lies, measure it accurately and develop appropriate interventions. This will ensure that our interventions have the best chance of success to make vaccines available to those who want them and in helping those who are uncertain about their vaccination decision.

After the COVID-19 pandemic, vaccination has become synonymous with an opaque biopower that legislates compulsory immunization at a distance. Contemporary illness narratives have become outlets for distrust, misinformation, reckless denialism, and selfish noncompliance. In The Smallpox Report , Fuson Wang rewinds this contemporary impasse between physician and patient back to the Romantic-era origins of vaccination. The book offers a literary-historical account of smallpox vaccination, contending that the disease’s eventual eradication in 1980 was as much a triumph of the literary imagination as it was an achievement of medical Enlightenment science. Wang traces our modern pandemic-era crisis of vaccine hesitancy back to Edward Jenner’s publication of his treatise on vaccination in 1798, the first rumblings of an anti-vaccination movement, and vaccination’s formative literary history that included authors such as William Wordsworth, William Blake, John Keats, Mary Shelley, and Arthur Conan Doyle. The book concludes with a re-examination of the current deeply contentious public discourse about vaccines that has arisen in the wake of the COVID-19 pandemic. By recovering the surprisingly literary genres of Romantic-era medical writing, The Smallpox Report models a new literary historical perspective on our own crises of vaccine refusal.

Understanding factors associated with hesitancy about pediatric COVID-19 vaccination is important for identifying strategies to improve vaccination rates. Our objective was to describe beliefs about COVID-19 vaccination among caregivers who had not yet vaccinated their children against COVID-19. From July 2022 to February 2023, caregivers of children unvaccinated for COVID-19 across 15 states within the IDeA States Pediatrics Clinical Trial Network were recruited into a randomized, controlled trial of a COVID-19 vaccine communication phone app. Recruitment sites served high numbers of children from rural areas or of backgrounds other than non-Hispanic White. At baseline, caregivers answered questions from the SAGE Vaccine Hesitancy Scale (VHS), and questions about trusted sources of information about COVID-19. We compared responses by rurality, race, and ethnicity using chi-square tests, and used multivariable modeling of a composite outcome of summed VHS scores to identify factors associated with vaccine hesitancy. A total of 725 caregivers were randomized; 512 completed the baseline survey. Many caregivers lived in a rural area (34.9 %) and nearly half were of non-White race (47.3 %). Over 80 % somewhat or strongly agreed that vaccines are important, that childhood vaccines are effective, and that vaccination is a good way to protect children from disease. Rural caregivers were more likely than non-rural caregivers to state that they generally do what their doctor recommends with regard to childhood vaccines (46.93 % vs. 37.00 %, p < .0021). In the multivariable model, the combined group of Asian, Native Hawaiian, Other Pacific Islander or multiracial caregivers, and Black or African American caregivers, had a higher vaccine hesitancy compared to White caregivers (25.25, 25.91, 22.50 respectively) (p < .0001). As we navigate work to build vaccine confidence, this study provides support for additional directions of study to better understand particular populations and could be further reproduced to look at intentions with other vaccines.

•Individual/group influence is the main vaccination barrier in Latin America.•Low socio-economic group, less educated and age contribute to low vaccine uptake.•Education and trust in healthcare professionals enhances vaccine acceptance.•More data is needed within target population subgroups, countries and vaccine type. Current vaccination coverage rates in Latin America and the Caribbean (LAC) are lower than the region-wide rates set by the Pan American Health Organization. To improve vaccination uptake, it is crucial to identify barriers to vaccination. We conducted a systematic literature review to identify the key barriers to vaccination in the LAC region, and to classify and quantify factors affecting vaccination coverage using the barrier categories outlined by the Strategic Advisory Group of Experts (SAGE) working group. We mapped knowledge gaps in the understanding of region-specific and population-specific vaccine hesitancy. Nine databases (Medline via PubMed, Web of Science, LILACS, MedCarib, SciELO, Scopus, PATH, SAGE Online and Google Scholar) were searched for articles published in English, Spanish and Portuguese up to 15 July 2017. A total of 6867 articles were identified of which 75 were included in the review. Majority of the articles were quantitative in nature and nearly half from Brazil. Many other countries in LAC have limited published evidence on barriers to vaccination. The most commonly investigated target population was parents (of children <8 years of age [yoa] and adolescents 9–10 yoa) but there was a balance in the number of publications that reported on influenza, childhood and human papillomavirus vaccination. There was limited direct evidence which reported insights on the new generation of childhood vaccines (pneumococcal or meningococcal vaccines) or studies targeting adolescents and pregnant women. Among the SAGE barrier categories, ‘individual/group influences’ were the most frequently reported barrier category (68%) followed by ‘contextual influences’ (47%). Adverse socioeconomic factors, a low level of education, lack of awareness of diseases and their vaccines, religious and cultural beliefs are commonly cited as obstacles to vaccination acceptance. Additional evidence is needed to fully understand the barriers to vaccination for different target populations, countries in the region and specific vaccine types.

•Trust is a major component of parents’ vaccine confidence.•Confidence involves control, experience, satisfaction, and certainty in a decision.•Building confidence could benefit from acknowledging factors at the root of concerns.•There is value in using short videos to illustrate key immunization concepts. Public confidence in immunization is critical to maintaining high vaccine-coverage rates needed to protect individuals and communities from vaccine-preventable diseases. Recent attention has been placed on factors influencing confidence in vaccination in the US and globally, but comprehensive understanding of what drives or hinders confidence in childhood vaccination is yet to be reached. As such, assessing parents' confidence in childhood vaccination and the ways in which educational materials affect confidence is needed. We sought to (1) learn how mothers who are hesitant about vaccination characterize confidence in health-related products for young children, including the recommended vaccines; (2) gain insights on what influences vaccine confidence beliefs; and (3) assess whether short, education materials affect parental confidence in childhood vaccinations. Eight moderator-lead focus groups (n=61), stratified by socioeconomic status, were undertaken with mothers of children 5years of age of less who are hesitant about vaccines. Four of the groups were held in the Philadelphia, PA area and four were held in the San Francisco/Oakland, CA area. Three educational material pairs, each consisting of a 2–3min video and an infographic poster about an immunization-related topic, were reviewed and assessed for influence on confidence. Qualitative data analysis was used to identify overarching themes across the focus groups. Themes, insights, and illustrative quotes were identified and provided for each of the major discussion areas: primary health concerns for young children; confidence beliefs and perceptions, including for recommended vaccines; facilitators and barriers to confidence; and reactions to the educational materials. Results provide helpful insights into how mothers who are hesitant about vaccines perceive confidence in childhood vaccines and health-related products, suggestions for how to improve confidence, and support for the value and use of short videos as part of vaccination education efforts. Findings can aid those developing vaccination education materials and resources designed to foster vaccine confidence.

Whether vaccination during pregnancy could reduce the burden of respiratory syncytial virus (RSV)-associated lower respiratory tract illness in newborns and infants is uncertain. In this phase 3, double-blind trial conducted in 18 countries, we randomly assigned, in a 1:1 ratio, pregnant women at 24 through 36 weeks' gestation to receive a single intramuscular injection of 120 μg of a bivalent RSV prefusion F protein-based (RSVpreF) vaccine or placebo. The two primary efficacy end points were medically attended severe RSV-associated lower respiratory tract illness and medically attended RSV-associated lower respiratory tract illness in infants within 90, 120, 150, and 180 days after birth. A lower boundary of the confidence interval for vaccine efficacy (99.5% confidence interval [CI] at 90 days; 97.58% CI at later intervals) greater than 20% was considered to meet the success criterion for vaccine efficacy with respect to the primary end points. At this prespecified interim analysis, the success criterion for vaccine efficacy was met with respect to one primary end point. Overall, 3682 maternal participants received vaccine and 3676 received placebo; 3570 and 3558 infants, respectively, were evaluated. Medically attended severe lower respiratory tract illness occurred within 90 days after birth in 6 infants of women in the vaccine group and 33 infants of women in the placebo group (vaccine efficacy, 81.8%; 99.5% CI, 40.6 to 96.3); 19 cases and 62 cases, respectively, occurred within 180 days after birth (vaccine efficacy, 69.4%; 97.58% CI, 44.3 to 84.1). Medically attended RSV-associated lower respiratory tract illness occurred within 90 days after birth in 24 infants of women in the vaccine group and 56 infants of women in the placebo group (vaccine efficacy, 57.1%; 99.5% CI, 14.7 to 79.8); these results did not meet the statistical success criterion. No safety signals were detected in maternal participants or in infants and toddlers up to 24 months of age. The incidences of adverse events reported within 1 month after injection or within 1 month after birth were similar in the vaccine group (13.8% of women and 37.1% of infants) and the placebo group (13.1% and 34.5%, respectively). RSVpreF vaccine administered during pregnancy was effective against medically attended severe RSV-associated lower respiratory tract illness in infants, and no safety concerns were identified. (Funded by Pfizer; MATISSE ClinicalTrials.gov number, NCT04424316.).