When “Sarah,” a nurse with a master's degree, gets her annual flu shot without a second thought, while her neighbor "Jake", who dropped out of high school, refuses all vaccines for his family, it might seem like education is the deciding factor. This scenario, while fictional, reflects patterns that researchers have been studying for years. The relationship between the amount of schooling someone has and their views on vaccines turns out to be both stronger and more complex than many people realize.
The question of whether education influences vaccine acceptance has become especially important during recent health crises. Public health officials want to know: if we can identify who is most likely to refuse vaccines, can we design better strategies to protect entire communities? Researchers have been working hard to answer this question using some of the most rigorous scientific methods available.
The Clear Pattern: More School Usually Means More Vaccines
When scientists look at large groups of people over time, a consistent pattern emerges. . This finding has been consistently reported in studies from various countries and time periods.
Consider the massive study that followed thousands of essential workers throughout the COVID-19 pandemic. Researchers from the tracked healthcare workers, first responders, and other essential workers for months, asking about their vaccine attitudes and actually measuring who got vaccinated. The results were striking: people with higher education levels were much more likely to both say they wanted vaccines and to actually get them.
Similarly, when researchers examined , they found that lacking a high school education was the single strongest predictor of vaccine hesitancy. Counties with higher percentages of residents who hadn't finished high school had significantly lower vaccination rates, even after accounting for other factors like income and healthcare access.
This pattern isn't limited to the United States. A found that "all studies indicated that increased vaccination rates were noted amongst those with higher education, both within participant-level associations and county-level associations.” In Germany, researchers discovered that , regardless of how wealthy or poor their local communities were.
The strength of this relationship is remarkable. In one major longitudinal study that followed individuals for years, receive a vaccination compared to those without a college degree. This wasn't just about intentions or attitudes, but about actual vaccination behavior.
Why Education Matters: It’s About Processing Information
Understanding why education influences vaccine acceptance requires looking at how people process health information. When someone with limited formal education encounters conflicting messages about vaccines, they may struggle to evaluate which sources are trustworthy or to understand complex scientific concepts, such as how vaccines work or what the results of clinical trials (and their methodology) mean.
Consider another fictional example: Maria, who left school after eighth grade to help support her family, sees a social media post claiming that vaccines contain dangerous chemicals. Without the background knowledge to evaluate this claim or the research skills to find reliable sources, she might accept this information at face value. Meanwhile, her cousin David, who holds a college degree in biology, immediately recognizes the post as misleading because he understands the process by which vaccines are made and tested.
This isn’t about intelligence. It’s about having tools to navigate an increasingly complex information environment. that people with less education are more vulnerable to health misinformation and may have lower health literacy (the ability to understand and use health information to make good decisions).
The tracked how people’s vaccine attitudes changed over time and found that those with higher education were better able to update their beliefs as new information became available. When early vaccine data showed high effectiveness and safety, more educated individuals were quicker to revise their initial concerns.
Educational Interventions Can Bridge the Gap
If lack of education contributes to vaccine hesitancy, can targeted educational programs help? The answer appears to be a cautious yes, but with significant limitations.
Several well-designed studies have tested whether teaching people about vaccines changes their attitudes and behaviors. nursing, pharmacy, and medical students before and after they participated in a virtual education program about vaccines. The program significantly increased students' knowledge and confidence in discussing vaccines with patients. Significantly, it also reduced vaccine-hesitant attitudes among nursing students.
Another study with over 200 patients across 18 Michigan counties. Participants received either a video or an infographic about COVID-19 vaccines, then researchers measured changes in knowledge and attitudes. The results were encouraging: patients demonstrated increased knowledge in six out of seven topic areas, and a greater number of people reported trusting vaccines and believing in CDC recommendations following the intervention.
However, a that analyzed 118 different studies found that while educational interventions do work, their effects are relatively modest. Educational approaches increased vaccination rates by about 10% compared to standard care. This is meaningful for public health, but it's not a magic bullet.
Interestingly, when researchers in England using two different educational approaches (a traditional presentation versus an interactive simulation), neither intervention significantly changed attitudes toward vaccination. The students already had fairly positive attitudes toward vaccines, suggesting that educational interventions might be most effective for individuals who are genuinely undecided rather than those who are already strongly opposed.
The Picture Gets Complicated
While the overall relationship between education and vaccine acceptance is clear, the details reveal surprising complexity. uncovered an unexpected finding: among people with college degrees, those who had experienced significant discrimination throughout their lives were actually less likely to get vaccinated. This suggests that education alone isn't enough when trust in institutions has been damaged by negative experiences.
The relationship also varies dramatically by country and economic context. found that education had a positive effect on vaccination rates in low-income countries, an adverse effect in middle-income countries, and no significant effect in high-income countries. This finding challenges simple assumptions about education always leading to higher vaccination rates.
Even within the same country, the relationship can change over time. from their children's birth through age two found that vaccine hesitancy fluctuated significantly. It was highest around the time of birth (when new parents might feel overwhelmed by decisions) and generally decreased as parents gained experience with vaccines. This suggests that hesitancy isn't a fixed trait but can change based on circumstances and experience.
There's also the question of what type of education matters most. While formal schooling is important, that specific health-related education may be more influential than general education levels. Healthcare students who received targeted vaccine education showed the most significant improvements in both knowledge and attitudes.
What This Means for Real-World Vaccine Efforts
These research findings have practical implications for public health campaigns and healthcare providers. First, they suggest that one-size-fits-all approaches to vaccine communication may not be effective. Someone who dropped out of high school because of family financial pressures needs different information and different messaging than someone with a graduate degree who has specific concerns about vaccine ingredients.
that simply providing more information isn't always helpful and can sometimes backfire. When people feel like they're being lectured or when information doesn't address their specific concerns, they may become more resistant rather than more accepting. This is why some researchers have started exploring motivational interviewing approaches (conversations designed to help people explore their own motivations for change) rather than traditional education.
The research also suggests that timing matters. seem to work best with people who are genuinely undecided rather than those who are firmly opposed to vaccines. For people who are already strongly resistant, other approaches focusing on building trust and addressing underlying concerns may be more effective.
Healthcare providers can use these insights to tailor their conversations with patients. For someone with limited formal education, it might be more helpful to focus on simple, concrete benefits ("This vaccine will protect you from getting very sick") rather than detailed explanations of immunology. For someone with more education who has specific concerns, a more detailed discussion of research findings might be appropriate.
Building on What We Know
The relationship between education and vaccine acceptance isn't just an academic curiosity. It represents one of the clearest and most consistent patterns in public health research. People with more formal education are significantly more likely to accept vaccines, and this relationship appears across different vaccines, different time periods, and different countries.
However, the research also reveals that this relationship is more nuanced than it might first appear. Education interacts with other factors like trust in institutions, personal experiences with discrimination, and cultural context. Educational interventions can help bridge gaps in knowledge and acceptance, but they're most effective when they're carefully designed and targeted to specific audiences.
Perhaps most importantly, these findings remind us that vaccine hesitancy isn't simply about people being stubborn or irrational. Often, it reflects real challenges in navigating complex health information and making decisions in an environment full of conflicting messages. By understanding how education influences these processes, we can develop more effective and compassionate approaches to promoting vaccine acceptance.
The goal isn't to judge people based on their educational background, but to recognize that different people may need different types of support to make informed health decisions. Whether someone has a PhD or didn't finish high school, they deserve access to clear, trustworthy information that helps them protect their health and the health of their communities.
Sources and Additional Reading
- Cha, S. E., Ryff, C. D., & Song, J. (2024). Predictors of vaccine uptake during a pandemic: The interplay of lifetime discrimination, educational attainment, and family support. Journal of health psychology, 13591053241300102. Advance online publication. https://doi.org/10.1177/13591053241300102
- Khairat, S., Zou, B., & Adler-Milstein, J. (2022). Factors and reasons associated with low COVID-19 vaccine uptake among highly hesitant communities in the US. American journal of infection control, 50(3), 262–267.
- Labbé, S., Bacon, S. L., Wu, N., Ribeiro, P. A. B., Boucher, V. G., Stojanovic, J., Voisard, B., Deslauriers, F., Tremblay, N., Hébert-Auger, L., & Lavoie, K. L. (2025). Addressing vaccine hesitancy: A systematic review comparing the efficacy of motivational versus educational interventions on vaccination uptake. Translational behavioral medicine, 15(1), ibae069. https://doi.org/10.1093/tbm/ibae069
- Lutrick, K., Groom, H., Fowlkes, A. L., Groover, K. D., Gaglani, M., Rivers, P., Naleway, A. L., Nguyen, K., Herring, M., Dunnigan, K., Phillips, A., Parker, J., Mayo Lamberte, J., Prather, K., Thiese, M. S., Baccam, Z., Tyner, H., & Yoon, S. (2022). COVID-19 vaccine perceptions and uptake in a national prospective cohort of essential workers. Vaccine, 40(3), 494–502.
- Rane, M. S., Kochhar, S., Poehlein, E., You, W., Robertson, M. M., Zimba, R., Westmoreland, D. A., Romo, M. L., Kulkarni, S. G., Chang, M., Berry, A., Parcesepe, A. M., Maroko, A. R., Grov, C., Nash, D., & CHASING COVID Cohort Study Team (2022). Determinants and Trends of COVID-19 Vaccine Hesitancy and Vaccine Uptake in a National Cohort of US Adults: A Longitudinal Study. American journal of epidemiology, 191(4), 570–583.
- Reis, M., Michalski, N., Bartig, S., Wulkotte, E., Poethko-Müller, C., Graeber, D., Rosario, A. S., Hövener, C., & Hoebel, J. (2024). Reconsidering inequalities in COVID-19 vaccine uptake in Germany: a spatiotemporal analysis combining individual educational level and area-level socioeconomic deprivation. Scientific reports, 14(1), 23904.
- Takagi, M. A., Hess, S., Smith, Z., Gawronski, K., Kumar, A., Horsley, J., Haddad, N., Noveloso, B., Zyzanski, S., & Ragina, N. (2023). The impact of educational interventions on COVID-19 and vaccination attitudes among patients in Michigan: A prospective study. Frontiers in public health, 11, 1144659.
- Vardavas, C., Nikitara, K., Aslanoglou, K., Lagou, I., Marou, V., Phalkey, R., Leonardi-Bee, J., Fernandez, E., Vivilaki, V., Kamekis, A., Symvoulakis, E., Noori, T., Wuerz, A., Suk, J. E., & Deogan, C. (2023). Social determinants of health and vaccine uptake during the first wave of the COVID-19 pandemic: A systematic review. Preventive medicine reports, 35, 102319.