Beyond Nation Averages How Vaccine Hesitancy and Perceived Barriers Warp the Relationship between Vaccination Coverage and Disease Incidence

Abstract

Whereas there is a theoretical negative relationship between vaccination rates and the occurrence of disease, administrative-level data is often unable to represent the distorting impact of local vaccine hesitancy. By a comparative analysis of China, the United States and Nigeria, this paper shows that non-significant findings in national level analysis accurately show the critical nature of perceived barriers (such as the transportation costs, religious resistance) and some cues to action. This leads to the breakdown of the protective effect of high overall vaccination coverage by forming groups of vulnerable people. The conclusion drives home the importance of using finer-grained data to extract the moderating role of vaccine hesitancy and suggests a policy shift toward targeting and interventions at localized levels rather than national overall averages. Consequently, understanding and addressing community-specific attitudes is essential for designing effective immunization programs. Future research should therefore prioritize the collection and analysis of sub-national data to better identify and resolve disparities in vaccine access and acceptance.