Measles vaccination and the crisis of confidence in expertise
Canada recently lost its measles elimination status, which it had held since 1998. The recent and sustained resurgence of measles serves as a reminder that the apparent disappearance of a disease does not guarantee its future absence and that it is important to remain vigilant.
Studies on vaccine hesitancy provide essential insights into the causes of the resurgence of measles. For example, complacency may lead some individuals to underestimate the risk of measles due to its recent low circulation, while access issues or logistical constraints may delay or prevent vaccination for others. Trust in vaccines and health institutions also strongly influences vaccine uptake, and deficits in this area can create pockets of vulnerable populations, promoting the spread of a highly transmissible virus such as measles.
A review of current US policies on vaccination also shows that institutional decisions and political polarization have a direct impact on individual behavior and ultimately on vaccination coverage. In some contexts, more permissive legislative frameworks or less clear institutional messages can increase hesitancy and reduce routine vaccination.
The loss of measles elimination status is a reminder that herd immunity relies as much on biological immunity as it does on social and political trust. To restore vaccination coverage and prevent new outbreaks, approaches must be integrated and focus on improving access to vaccines, evidence-based communication, and monitoring behavioral and policy trends in vaccination.
Eve Dubé responded to this news during a segment of the radio program Les années lumière on November 16, 2025.
Vaccine Hesitancy and Recommendation Practices among Healthcare Professionals
Healthcare professionals are a trusted source for the majority of the population, and their recommendation is often one of the main factors leading hesitant individuals to get vaccinated. However, some healthcare professionals themselves may be hesitant about vaccines, making them less likely to address their patients’ concerns and recommend vaccination.
Determinants of Vaccine Hesitancy among Healthcare Professionals
Several factors influence vaccine hesitancy among healthcare professionals (Karlsson, 2019; Luo, 2021; Verger, 2022), such as lack of knowledge, low trust in health authorities, and difficulties in addressing patients’ concerns. Conversely, good understanding of vaccines and strong communication skills are associated with a more positive attitude and a greater likelihood of recommending vaccination.
Challenges Amplified by the Pandemic and Moral Injury
The COVID-19 pandemic highlighted the vulnerability of healthcare professionals facing unprecedented pressure, including heavy workloads and exposure to misinformation. In this context, many reported experiencing moral injury—psychological distress linked to feelings of powerlessness, ethical dilemmas, or a lack of recognition. Such injuries can weaken healthcare professionals’ motivation and ability to recommend vaccination. The Chair is currently partnering in an ongoing study to better understand these issues.
Training Healthcare Professionals: Moving Beyond the Knowledge-Deficit Model
Research shows that interventions based solely on transmitting knowledge can be ineffective, or even counterproductive. Approaches that prioritize interactive exchanges, learning by doing, and relational methods such as motivational interviewing have proven more effective (White, 2025). These approaches help address patients’ concerns through listening and empathy, rather than strictly prescriptive communication.
Measuring and Supporting Commitment to Vaccination
To better understand vaccine hesitancy among healthcare professionals, standardized tools are necessary. For example, the Pro-VC-Be questionnaire, recently validated in several countries including Canada, provides a useful model (Gagneur, 2025). It helps document attitudes and behaviors related to vaccination and identify areas to strengthen. Used alongside other approaches, it can guide the development of targeted strategies:
- strengthening trust in vaccines and institutions,
- supporting empathetic and proactive communication,
- integrating psychological support systems to mitigate moral injury.
Vaccine hesitancy among healthcare professionals is real and results from a combination of individual, relational, and institutional factors. To strengthen their role in recommending vaccination, it is essential to provide interactive training, foster a climate of trust, and acknowledge the impacts of moral injury experienced during the pandemic. The use of tools like Pro-VC-Be contributes to a better understanding of these dynamics and can help guide interventions but must be integrated into a global approach sensitive to real-world contexts.
References
Gagneur, A., Roy, D., Pelletier, C., Trottier, M.E., Lemaire-Paquette, S., Rousseau, M., Dubé, È. & Verger, P. (2025). A cross-sectional study assessing Pro-VC-Be short-form questionnaire in Canada; measuring psychosocial determinants of vaccination behavior in Canadian healthcare professionals. Hum Vaccin Immunother, 21(1), 2499345.
Karlsson, L. C., Lewandowsky, S., Antfolk, J., Salo, P., Lindfelt, M., Oksanen, T., Kivimäki, M., & Soveri, A. (2019). The association between vaccination confidence, vaccination behavior, and willingness to recommend vaccines among Finnish healthcare workers. PloS one, 14(10), e0224330.
Luo, C., Yang, Y., Liu, Y., Zheng, D., Shao, L., Jin, J., & He, Q. (2021). Intention to COVID-19 vaccination and associated factors among health care workers: A systematic review and meta-analysis of cross-sectional studies. American journal of infection control, 49(10), 1295–1304.
Verger, P., Botelho-Nevers, E., Garrison, A., Gagnon, D., Gagneur, A., Gagneux-Brunon, A., & Dubé, E. (2022). Vaccine hesitancy in health-care providers in Western countries: a narrative review. Expert Rev of vaccines, 21(7), 909–927.
White, P., Alberti, H., Rowlands, G., Tang, E., Gagnon, D., & Dubé, È. (2024). Vaccine hesitancy educational interventions for medical students: A systematic narrative review in western countries. Human vaccines & immunotherapeutics, 20(1), 2397875.
The Emergence of a New Pandemic: An Ever-Present Risk
The COVID-19 pandemic has contributed to several health, social, and economic transformations. It also demonstrated the vulnerability of modern societies to the spread of new pathogens, accelerated by globalization, mass movement, and the Anthropocene.
Although this crisis is over, the threat of a new pandemic remains ever-present as cases of H5N1 flu increase. A new pandemic would pose not only a medical and scientific challenge but also a social and political one. Indeed, the collective response to public health interventions, including adherence to preventive measures, is largely influenced by sociocultural, historical, and political factors. In the post-COVID context, these challenges are even more pronounced, as communities face pandemic fatigue and heightened awareness of inequalities and divergent opinions regarding risk management.
Adherence to Preventive Measures in the Post-COVID Context
In risk management, community adherence to preventive measures is essential for their effectiveness. The COVID-19 pandemic highlighted the diversity of perceptions and reactions to health measures such as lockdowns, mask-wearing, and vaccination. Some population groups saw these measures as a violation of individual freedoms, while others adopted them as a moral obligation to protect others.
Furthermore, a study conducted by SteelFisher and colleagues measured American public support for future pandemic management measures. While about half of the respondents supported these measures, the observed support varied depending on several factors, including political and ideological orientations and daily concerns. The study also highlights the group dynamics and social polarization that emerge in managing health crises, especially in a context where economic and political inequalities could exacerbate social tensions. The results underscore the importance of understanding and addressing these social and political divisions in a nuanced way to ensure the engagement of all communities.
Key Strategies to Strengthen Adherence to Preventive Measures
To ensure community adherence to preventive measures in a post-pandemic future, several factors need to be considered:
- Intercultural and Contextual Communication: Transparency and clarity of information are essential to building trust, but this communication must be sensitive to local cultural contexts. Indeed, each community has its own trust references, and the involvement of community leaders and local figures is important to bridge cultural and ideological divides. Adapting messages according to cultural codes and considering the specifics of each group is necessary (for studies addressing this issue, see Supplement 1 on the sociocultural and behavioral factors that affect community response to public health measures, available in the Canadian Journal of Public Health).
- Addressing Social and Geographical Inequalities: Structural inequalities also play a key role in how communities respond to policies and preventive measures. Equity-seeking groups are often the most vulnerable to diseases but also the most skeptical of preventive measures. To strengthen adherence, these measures must be inclusive, accessible, and focused on the most vulnerable communities.
- Strengthening Collective Resilience: It is essential to strengthen the collective resilience of communities in the face of health crises. This includes cultural preparedness for health risks, which must be done through health education and community involvement in pandemic planning and preparedness. The integration of participatory methods and local representations of health can improve the effectiveness of preventive measures while reducing social stigma.
Conclusion
Community adherence to preventive measures is an important factor in limiting the impacts of a future health crisis. However, this adherence cannot be summarized by its scientific or medical aspects; it must also take into account the social, political, and cultural factors that influence the perception of health risks.
Thus, it is important to build renewed collective trust by considering cultural contexts and social inequalities, while engaging communities inclusively. Only by integrating an anthropological perspective on health can we not only prevent a new pandemic but also strengthen collective resilience in the face of future health threats.