Public sentiment towards vaccination: characterizing global patterns and drivers of scientific research

IntroductionNegative public sentiment towards vaccination (PSV) poses significant challenges to the effectiveness of immunization programs, with dramatic effects on morbidity and mortality for vaccine-preventable diseases. Yet, health research is often shaped by economic and geopolitical factors rather than countries epidemiological or healthcare needs. This study examines global patterns and drivers of PSV research on five vaccines -polio, measles, human papillomavirus, influenza, and SARS-CoV-2- and evaluates the COVID-19 pandemics impact on research volume, focus, and distribution. MethodsWe conducted a machine-learning-assisted literature search on PSV without geographical, language or time constraints. Using natural language processing, network and statistical analyses, we examined the global PSV research landscape and identified geographical, epidemiological, and economic drivers. ResultsWe analysed 13,287 articles and detected consistent literature growth from 1980 onwards, with vaccine-specific peaks following key licensing events. After 2020, publication volumes rose above projections for influenza (32%; 95%CI = 20%, 46%) but declined for polio (-56%; 95%CI = -68%, -26%) and measles (-17%; 95%CI = -33%, 9%). Although PSV research had global coverage, its distribution was markedly imbalanced, largely shaped by country-specific economic factors. A few high-income countries (HIC) produced 72% of publications and the likelihood of a country being studied varied by income and vaccine. Foreign authorship also increased as the income of the studied country decreased (over 75% in LMIC vs. below 50% in HIC). ConclusionPSV research reveals persistent inequities, with a misalignment between countries leading research and populations most in need of its outcomes. These inequities, further exacerbated by COVID-19 disruptions, reflect systematic imbalances in global health. Our findings underscore the need to decolonise research by fostering leadership, agenda-setting, and accountability that centres on the necessities of affected communities. Achieving this will require funding and publication reforms that promote equitable collaborations and elevate local priorities alongside long-standing global health objectives. Key messages What is already known on this topicPublic sentiment towards vaccination (PSV) significantly influences vaccination campaign outcomes. While bibliometric studies have explored PSV research patterns, economic and contextual drivers in this research field remain underexplored, and international collaboration dynamics lack in-depth analysis. What this study addsThis study identifies significant economic disparities shaping PSV research, with high-income countries dominating the field and directing studies toward low-income settings with limited local author representation. It also highlights the COVID-19 pandemics role in shifting research focus from critical childhood vaccines to SARS-CoV-2, exacerbating these imbalances. How this study might affect research, practice or policyBy revealing inequities in PSV research, this work underscores the need for more equitable and inclusive research initiatives, prioritizing public health needs while addressing systemic disparities in global health research and policy.