Addressing Faith-Based Concerns about Vaccination

• Immunization
• Patient Education
• Religion
• Spirituality
• Vaccination

Vaccinations reduce morbidity and mortality from infectious diseases. However, according to data published in 2025 by the Centers for Disease Control and Prevention (CDC) full vaccine coverage among children under 3 years of age is only 72% for all recommended vaccines (DTaP, polio, measles, HiB, HepB, Varicella, and Pneumonococcal), full vaccine coverage among adolescents is only 61% for human papilloma virus (HPV), 88% for meningococcus, and 90% for tetanus, and full vaccine coverage for adults is only 37% for influenza and 41% for tetanus.¹ A 2024 systematic review of 765 studies on caregiver attitudes toward vaccinations for children found vaccine hesitancy can be associated with religious sentiments, personal beliefs, perceived safety concerns, a desire for more information, as well as other factors related to availability and accessibility.² A 2024 review of 14 studies found that specifically religious factors can be significant contributors to vaccine hesitancy,³ It is important to appreciate the roles of spirituality, religion and faith spirituality in health care in general; this article reviews evidence that specifically informs addressing faith-based concerns about vaccination.

While the terms “spirituality,” “religion,” and “faith” are often used interchangeably, a critical review in 2020 demonstrated that in the medical literature “faith” typically refers broadly to “an expression of expectation and expecting something from God”, which may be experienced through an individual’s “spirituality” (“an interconnection of something beyond ourselves and connecting something within ourselves”) or expressed through “religion” (a system of “attitudes, beliefs, and practices”).⁴ Thus, “faith-based” encompasses both the individual’s internal spiritual beliefs and experiences and the external religious expression of that spirituality in personal and community practices.

Religious participation has been associated with hesitancy to receive certain vaccines such as those for HPV, influenza, and COVID-19 at different times in history. A 2016 survey across 67 countries found that while perceptions varied by country, globally approximately 15.4% of individuals thought vaccines were incompatible with their religious beliefs.⁵ A comprehensive review of literature on vaccine hesitancy suggests that religious vaccine skepticism is driven by 1 or more of 5 sets of concerns: 1) a clash with a worldview specific to the patient’s religion, 2) a passive fatalistic trust in divine will, 3) an ethical objection due to vaccine production or effects, 4) an impurity perception that vaccines defile the body, and 5) a conspiracy perception that vaccines target a religious group.⁶ However, a review of canonical and theological teachings in the traditions of Hinduism, Buddhism, Jainism, Judaism, Christianity, and Islam found that only Christian Scientists have a canonical basis for objecting to vaccination.⁷ A survey of publicly available data from 147 countries found that at the global population level, religiosity is strongly and positively correlated with measures of confidence in the safety, importance and effectiveness of vaccines; while this finding documents correlation rather than causation, and does not fully account for variations between individuals within countries, it at least suggests that religiosity per se does not inherently lead to vaccine hesitancy.⁸ Thus, many personal vaccine objections attributed to faith-based reasons are more likely matters of personal faith interpretation rather than based on the teachings or traditions of a religious community.

Faith-based hesitancy or skepticism toward vaccines can be addressed at both the individual level and the community level. HPV vaccination has been perceived with skepticism by some religious parents who feel it is unnecessary as they expect their children to practice sexual purity, and due to beliefs in divine protection from illness. A 2023 randomized, masked trial of educational messages about HPV vaccination compared a CDC vaccine information statement with a message that metaphorically cast Noah as the parents, the flood as HPV, and the ark as vaccination. Christian parents who received the scripture-embedded educational message reported a 35% higher intention to vaccinate their children for HPV than did those who received the standard CDC vaccine information statement.⁹ A 2024 randomized trial conducted in Christian parents tested viewing of a religiously-focused educational video about HPV vaccination, a standard education video, and a control video. While both educational videos increased Christian parents’ intentions to vaccinate children against HPV compared with control, parents who watched the religiously-focused video were 33% less likely to believe that HPV vaccination to be unnecessary due to the family’s values.¹⁰

Health programs in religious organizations have been shown to improve measures associated with chronic health conditions and to increase participation in preventive cancer screenings.¹¹ A 2023 systematic review found that both local-level and national-level involvement of faith-based organizations in vaccination efforts can improve vaccination uptake, and that church-based vaccination efforts can reduce disparities in vaccine coverage among racial or ethnic minority communities.¹²

Despite the perception that religion was perceived to be a barrier for public health measures during the COVID-19 pandemic, a 2021 Pew Research Center survey found that more US adults who attend religious services would trust their physician for information about COVID-19 vaccination (84%) than would trust clergy (61%) or public health officials (60%).¹³ It is important for clinicians to understand both this degree of trust, as well as the fundamental role that faith may play in shaping patient’s worldviews. For individual patients, framing vaccine education in relation to faith-based commitments and teaching may be helpful in reducing vaccine hesitancy and improving vaccine acceptance. For communities, collaborating locally with religious organizations for vaccination outreach or participating in national faith-based vaccine promotion efforts may also help address faith-based concerns about vaccination. Table 1 lists strategies to address faith-based concerns about vaccination.

While scientific evidence¹⁴ may be useful to counter vaccine misinformation, faith-based concerns about vaccination may require a different approach. Faith-based decisions regarding health care may be related to underlying worldview assumptions. Evidence to date suggests faith-based vaccine hesitancy and may be best approached through education that addresses and accounts for the patient's spirituality, and by collaboration with organizations that are connected to patients' religious communities.

• Received for publication January 27, 2025.
• Revision received March 5, 2025.
• Accepted for publication March 11, 2025.