Is there a relationship between vaccine openness and education levels?

Question

I am looking for a reference about the link between vaccine openness and education levels beyond COVID-19. I found a paper Robertson 2021 that mentioned the link between vaccine openness and education but it sticks with COVID-19.

Answer 1

There is a 2016 study (Larson et al.) on 67 countries (Africa is underrepresented, but the rest of the continents have decent coverage). Regarding education it found that

Any level of education elevates pro-vaccine views for importance, efficacy, and religious compatibility but not for vaccine safety.

(I've cropped the table to the relevant part. It has odds ratios and their 95% CIs in a logistic regression model. The paper claims to have followed SAGE-suggested questions in selecting those factors.)

It also says that

Further systematic reviews have highlighted the variability of correlations found between education and vaccine confidence, with no clear pattern except to show that education does not always imply confidence (Brown et al., 2010, Larson et al., 2014a, Larson et al., 2014b).

(They are self-citations to an extent as Larson is also lead author for this 2016 survey)

Of those "Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: A systematic review of published literature, 2007–2012" says (I'm quoting two paras because SES was linked with education):

Level of income/Socioeconomic Status (SES) was identified as a significant factor affecting vaccine acceptance in eight stud- ies. In two studies in the USA, both high and low income/SES were indicated as barriers to vaccination. In Nigeria, low income/SES was identified as both a barrier and promoter, and in Burkina Faso, two studies identified high income/SES as a promoter. In India, higher income was noted as a promoter while in Bangladesh, both high and low income/SES were found to promote vaccination. Middle income was non-significant. The reasons why these factors were influential are not always explained, and when they are, other influencing factors are usually cited. For example, lower income in the USA was linked to issues of trust in the health provider and in Nigeria it was a barrier because it related to both low education as well as to access issues.

Level of education presents an equally mixed set of results. Six studies about India consistently found caregivers’ higher education to be a promoter. Studies about China, Lebanon, Israel, Bangladesh and USA all identified higher education as a potential barrier, whereas studies about Greece, The Netherlands, Nigeria and Pakistan identified it as a promoter of vaccination. Low education was identified as a barrier in studies about Nigeria, India, China, Kyrgyzstan, and as both a promoter and barrier in the USA. In the DR Congo, both high and low educations were represented as barriers. Additionally, low education was reported as having different effects; in India, illiteracy indicates more of an issue with knowledge, whereas in Nigeria and Kyrgyzstan, low education was associated with higher levels of anti-vaccination attitudes. The evidence from this review suggests that individual factors cannot be considered in isolation as multiple influences are at play.

There are about three dozen papers cited in those two paras, so I'm not going to list them here.

Answer 2

Carpiano et al (2019) found that lower parent education is associated with higher odds of being concerned about measles, mumps, and rubella (MMR) vaccination. Kumar et al (2016) discuss the link between vaccine hesitancy and the level of parental education.

SES [socioeconomic status] [(parent education, household income)] differences in KAB [knowledge, attitudes, and beliefs ... about vaccinations] mostly center on vaccine-specific side effect and safety concerns, with lower education and income levels associated with higher odds of being concerned.

Carpiano RM, Polonijo AN, Gilbert N, Cantin L, Dubé E. Socioeconomic status differences in parental immunization attitudes and child immunization in Canada: Findings from the 2013 Childhood National Immunization Coverage Survey (CNICS). Prev Med. 2019 Jun;123:278-287. doi: 10.1016/j.ypmed.2019.03.033. Epub 2019 Mar 20. PMID: 30904601. abstract

Host/parental specific factors
Race, education and income: These individual characteristics may have a direct impact on the person’s concept of the risks and benefits of vaccination along with the risks and sequelae of a VPD. Some studies demonstrate that African-Americans have lower immunization coverage levels compared to other race groups in America. This supports the fact that ethnicity/race is associated with differential levels and types of immunization concerns. However recent data after adjusting for poverty status have not shown significant difference in coverage levels by racial groups [53]. One of the factors implicated in vaccine hesitancy is the level of parental education and studies in the past have demonstrated greater distrust for medical professionals amongst communities with less formal education. Due to the lower education level, their information about vaccines and their effect is less as compared to more educated parents and the parents seek out alternative sources such as family members and other parents in the community or the media for reliable information.

Kumar, D., Chandra, R., Mathur, M. et al. Vaccine hesitancy: understanding better to address better. Isr J Health Policy Res 5, 2 (2016). https://doi.org/10.1186/s13584-016-0062-y: full text