Vaccination Confidence Scale
WHO Vaccination Confidence Scale (VCS) · Also known as: VCS, WHO Vaccination Confidence Scale
The WHO Vaccination Confidence Scale (VCS) is a multi-domain instrument measuring three conceptually distinct dimensions of vaccine hesitancy: Confidence (trust in vaccine safety and effectiveness), Complacency (perceived need for vaccination), and Convenience (accessibility and practical barriers). Developed by the WHO SAGE Working Group on Vaccine Hesitancy in 2015, it has become the international standard for measuring determinants of vaccination decisions across diverse populations and pathogen contexts.
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When to use it
The VCS is appropriate for population-level surveillance of vaccine confidence trends, identifying domains driving hesitancy in specific regions. Use in intervention development to tailor messaging (education for confidence, risk communication for complacency, system improvement for convenience). Suitable for pre/post measurement in vaccination promotion campaigns. Valuable for cross-national comparisons given WHO translation standardization. Effective for identifying subpopulations (age, ethnicity, geography) with specific hesitancy profiles.
Strengths & limitations
- Theoretically grounded in implementation science; the 3 Cs framework directly informs intervention design, moving beyond barrier identification to actionable solutions.
- Multi-domain structure enables precision targeting; identifies whether hesitancy roots in beliefs (confidence/complacency) vs. logistics (convenience), supporting efficient resource allocation.
- Extensive WHO translation and validation support cross-national comparisons and implementation in low-resource settings without requiring local psychometric re-validation.
- Flexible administration—paper, digital, or interview modality—supporting deployment in diverse settings (clinics, schools, community centers, vaccination sites).
- Domain-level scoring obscures item-specific concerns; an individual may mistrust one specific vaccine while trusting others, lost in aggregate domain score.
- Weak psychometric guidance in original literature; Cronbach α not universally reported, and domain definitions vary across translations and adaptations.
- Convenience domain conflates multiple concepts (cost, distance, wait time, education); may require supplementary assessment to identify specific structural barriers.
- Doesn't measure behavioral intention or vaccination uptake; high confidence does not guarantee vaccination; requires additional behavior-change constructs (intention, normative beliefs, efficacy).
Frequently asked
Is there a single 'vaccine hesitancy' score, or should domains be interpreted separately?
WHO recommends separate domain scores; a single total score obscures actionable information. An individual with high confidence (67+) but high complacency (40+) requires risk communication, not safety education. Report all three domains and identify dominant hesitancy drivers.
What score threshold should public health programs target?
There is no single target; targets depend on disease risk and program goals. For COVID-19 during variants, maintain confidence >70 and complacency <40. For endemic diseases (measles), target confidence >80. Local epidemiological analysis should set thresholds based on outbreak risk and vaccination targets (e.g., 85% uptake).
Can the VCS be adapted for specific vaccines (COVID-19, RSV, mpox)?
Yes. WHO supports vaccine-specific adaptations; replace 'vaccines' with 'COVID-19 vaccine' or target vaccine. Validation of adapted versions recommended but not required if changes are minimal. Be transparent about adaptation when reporting.
How do I distinguish between genuine vaccine hesitancy and rational caution?
Rational caution reflects proportionate risk appraisal (e.g., waiting for Phase 3 trial data before vaccination). Hesitancy often reflects cognitive distortions (overweighting rare adverse events, underweighting disease risk). Use VCS items to identify cognitions; low confidence due to specific safety fears may respond to evidence, whereas fixed distrust requires motivational interviewing.
Sources
- World Health Organization. (2015). Vaccine hesitancy: A growing challenge for immunization programmes. WHO SAGE Working Group on Vaccine Hesitancy. Geneva: WHO. link ↗
- Larson, H. J., Jarrett, C., Schulz, W. S., Chaudhuri, M., Zhou, Y., Dube, E., ... & Wilson, R. (2015). Measuring vaccine hesitancy: The development of a survey tool. Vaccine, 33(34), 4165–4175. DOI: 10.1016/j.vaccine.2015.04.037 ↗
How to cite this page
ScholarGate. (2026, June 3). WHO Vaccination Confidence Scale (VCS). ScholarGate. https://scholargate.app/en/public-health/vaccination-confidence-scale
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