![]() ![]() Measles, a highly contagious acute viral respiratory infection, is a major cause of mortality and morbidity, particularly among children younger than five. Vaccines are the most effective public health measures against infectious diseases. Combating MMR vaccine misinformation and hesitancy requires intersectoral and multifaceted approaches at various socioecological levels to address the social drivers of vaccine behavior. They had low parental trust, low perceived disease susceptibility, and were skeptical of vaccine safety and benefits. ![]() Vaccine hesitancy to MMR and other childhood vaccines clustered in middle- to high-income areas among mothers with a college-level education or higher who preferred internet/social media narratives over physician-based vaccine information. Fear of autism was the most cited reason for MMR hesitancy. Social factors, such as income and education, exerted a bidirectional influence, which facilitated or hindered vaccine compliance depending on how the social determinant was experienced. The social drivers of vaccine hesitancy included primary care/healthcare, education, economy, and government/policy factors. Through a qualitative systematic review of published literature ( n = 115 articles 7 databases), we determined major themes regarding parental reasons for MMR vaccine hesitancy, social context of MMR vaccine hesitancy, and trustworthy vaccine information sources. The geographic clustering of hesitancy to MMR indicates the presence of social drivers that shape parental perceptions and decisions on immunization. Its resurgence points to lower parental vaccine confidence and local pockets of unvaccinated and undervaccinated individuals. Ongoing outbreaks of measles threaten its elimination status in the United States. ![]()
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