Vaccine hesitancy crisis: Gender roles expose hidden barriers to immunization in Ethiopia

Vaccine acceptance remains high in Ethiopia, but gendered attitudes and social dynamics continue to drive significant hesitancy, according to a new study published in Vaccines.

The research, “Gender Dynamics in Vaccine Acceptance and Hesitancy Among Primary Caregivers in Ethiopia: A Mixed-Methods Study”, surveyed nearly 1,000 caregivers across four regions and combined quantitative data with interviews from health workers and community leaders.

It found that while more than nine in ten caregivers accept childhood vaccination, more than half still show hesitancy when measured through behavior and beliefs. The study warns that gender norms, urban living, and employment patterns are creating new barriers to immunization.

Why vaccine acceptance remains high but hesitancy lingers

The findings reveal a paradox: 93.5 percent of caregivers report willingness to vaccinate their children, yet 51.1 percent demonstrate some level of hesitancy based on a composite index of behaviors and attitudes. This gap underscores how caregivers may publicly endorse vaccination while privately struggling with doubts, misinformation, or practical barriers.

Confidence in vaccines is strong overall, with most caregivers viewing them as important, safe, and effective. Trust in health workers is also high, and families often benefit from both household and religious support to vaccinate children. These strengths explain the high coverage levels observed in many communities.

Yet hesitancy persists. The study identifies it as a silent barrier that does not always result in refusal but can cause delays, missed appointments, or selective vaccination. Researchers emphasize that this form of hesitancy can weaken immunization systems over time, especially when coupled with rapid social change in urban settings.

What factors predict vaccine acceptance and hesitancy?

The study pinpoints several predictors that influence whether caregivers fully accept or hesitate over vaccines.

Education emerges as a consistent factor. Caregivers with primary, secondary, or higher education levels are more likely to accept vaccination compared with those who have no formal education. Education also reduces hesitancy, particularly at the secondary level, where it almost halves the odds of reluctance. However, the study notes that small groups of highly educated caregivers in urban areas may still be vulnerable to misinformation circulating online.

Social support strongly predicts acceptance. Caregivers with encouragement from their families or religious leaders are more likely to vaccinate. This finding highlights the critical role of community norms and the influence of trusted local figures in shaping decisions.

Health worker contact also doubles the likelihood of acceptance. Caregivers who had recent interactions with health professionals were significantly more likely to follow recommended vaccination schedules. This points to the importance of consistent outreach and accessible frontline services.

By contrast, several factors increase hesitancy. Caregivers who believe vaccination is solely a mother’s duty show 69 percent higher odds of hesitancy. Urban residents are more likely to hesitate than rural ones, largely due to greater exposure to competing messages and rumors. Employment status also plays a role, with working caregivers showing higher hesitancy, often because of time constraints and reliance on online sources of information.

How gender norms shape immunization outcomes

Caregivers who agree with the idea that mothers alone are responsible for child vaccination display significantly higher hesitancy. This belief system excludes fathers from active participation, reducing shared responsibility and increasing the chance of delays or refusals when mothers face logistical or social pressures.

The research underscores that gender is not only about who brings children to health facilities but also about how families discuss, decide, and act on vaccination. Male caregivers in the study consistently reported higher levels of hesitancy compared with female caregivers. This finding suggests that current immunization strategies, which often focus messaging on mothers, may be missing an opportunity to engage fathers and reduce household-level doubts.

The authors call for a gender-responsive approach to immunization. This includes designing programs that actively involve both parents, developing campaigns that address men’s concerns directly, and ensuring that outreach materials are inclusive. Adjusting clinic hours and outreach services to accommodate working parents could also reduce practical barriers.

Policy implications for Ethiopia and beyond

The study’s findings carry important lessons for Ethiopia’s immunization program and for other countries with similar social and cultural dynamics. The authors argue that health authorities should:

• Integrate gender-disaggregated indicators into immunization monitoring systems to track differences between men and women.
• Train health workers to recognize and address gendered patterns of hesitancy in communities.
• Strengthen partnerships with faith-based organizations and community leaders to amplify pro-vaccination messages.
• Expand outreach efforts to urban and employed caregivers, who face unique challenges in balancing schedules and filtering misinformation.

By highlighting the interplay between gender norms, education, and social support, the study reframes vaccine hesitancy as more than an individual choice. Instead, it is a social phenomenon shaped by family roles, community dynamics, and structural barriers.