Vaccines remain among the most effective public health interventions, yet vaccination policy continues to face challenges around trust, legitimacy, acceptance and uneven uptake. A 2026 analysis in Health Affairs Scholar sets out social vaccinology as a framework for understanding vaccination as both a biomedical intervention and a public governance challenge. The framework places policy design, social influences, ethical considerations, institutional trust and public discourse at the centre of vaccination policy.
Beyond the Biomedical Lens
Vaccination policy often treats vaccines as neutral biomedical tools whose population impact depends on scientific evidence, regulatory approval and effective implementation. Within that view, delayed uptake, selective acceptance or public controversy becomes a downstream problem of misinformation, limited health literacy or communication failure. Policy responses then tend to prioritise information campaigns, technical guidance and enforcement, with an implicit assumption that improved delivery will lead to acceptance.
Experience across vaccines, populations and historical periods challenges this assumption. Resistance, hesitation and erosion of trust can persist even where scientific consensus is strong, health systems are robust and information is widely available. Vaccine hesitancy and selective acceptance therefore remain persistent features of contemporary health systems, rather than temporary deviations from expected behaviour or simple failures of knowledge transfer.
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Vaccination also functions as a socially embedded public practice. It involves collective decision-making, perceptions of authority and coercion, ethical judgements about risk and responsibility and trust in institutions beyond the clinical encounter. A purely biomedical lens can miss these conditions and may respond to social tension with technical or coercive measures that weaken legitimacy over time. Durable acceptance depends on how vaccination policies operate within public life and how communities experience them.
Basic, Programmatic and Social Vaccinology
The framework distinguishes three domains. Basic vaccinology covers the discovery, design and validation of vaccines as biomedical products. It includes laboratory work on immunological mechanisms, antigen selection, platform development and preclinical evaluation. Clinical trials establish safety, immunogenicity and efficacy under controlled conditions, while regulatory approval provides scientific credibility and legal legitimacy. This domain remains indispensable, but it does not determine how vaccines will be interpreted, trusted or valued once introduced into clinical practice and public debate.
Programmatic vaccinology translates validated vaccines into organised health system practice. It includes vaccination schedules, advisory recommendations, target population prioritisation, routine delivery, safety surveillance, pharmacovigilance and, in some settings, compensation mechanisms for adverse events. Coverage, timeliness and epidemiological impact remain essential measures of performance. Yet effective access and strong recommendations do not automatically secure sustained adherence. Uptake remains contingent on how vaccination programmes are experienced and perceived.
Social vaccinology addresses the gap between scientific validation, programme delivery and public acceptance. The framework defines it as the domain concerned with individual and collective behaviours arising from the interaction between vaccination policies, social influences, ethical considerations, institutional trust and public discourse. It complements basic and programmatic vaccinology by clarifying how vaccination policies are interpreted, contested and legitimised in practice.
Trust, Risk and Policy Legitimacy
Institutional trust and legitimacy form a central dimension of social vaccinology. Vaccination policies are more likely to gain acceptance when institutions are perceived as credible, transparent and accountable. Trust extends beyond confidence in evidence and includes perceptions of integrity, fairness and intent in the actions of health authorities and governing bodies. Legitimacy depends not only on the decisions made, but also on how those decisions are justified, communicated and embedded in institutional practice.
Risk and benefit perception forms another key dimension. Individuals and communities do not evaluate vaccines only through epidemiological data. Personal experience, cultural narratives and information environments shape how vaccination is valued against concerns about safety, necessity and urgency. Social norms and collective expectations also influence behaviour. What communities consider acceptable, typical or expected can reinforce both acceptance and resistance through interpersonal networks, professional authority and wider cultural frameworks.
Policy design shapes lived experience. Recommendations, facilitation, incentives and mandates all communicate implicit judgements about responsibility, fairness and inclusion. Their effects depend on whether populations experience them as legitimate or coercive. Monitoring frameworks therefore need to move beyond coverage and epidemiological indicators. Trust, perceived legitimacy and public engagement become integral components of policy performance, especially in complex information environments where misinformation can amplify perception, identity and trust.
Social vaccinology places vaccination policy within a broader framework of public governance. Scientific validation and efficient delivery remain essential, but they offer only a partial account of how vaccination policies function in practice. Trust, social norms, perceptions of risk and institutional legitimacy shape whether vaccination is accepted, contested or sustained over time. The framework supports more anticipatory and adaptive policy approaches, particularly in post-COVID-19 debates marked by uneven uptake, public controversy and challenges to trust. Its value lies in connecting technical effectiveness with social legitimacy, resilience and long-term public acceptance in increasingly complex and contested social environments.
Source: Health Affairs Scholar
Image Credit: iStock
References:
Tuells J (2026) Beyond Biomedical Interventions: Social Vaccinology as a Framework for Vaccination Policy and Public Governance; Health Affairs Scholar: qxag132.
