Vaccine Hesitancy in Sri Lanka: A Growing Threat to Public Health Gains

Vaccine hesitancy, identified by the World Health Organization as a top ten global health threat, poses a significant challenge to the public health gains achieved in Sri Lanka. While the country has historically maintained exceptional immunization coverage and eliminated measles in 2019, a resurgence of the disease in 2023–2024 underscores a growing vulnerability. This editorial explores the complex drivers of vaccine hesitancy within the Sri Lankan context, focusing on the "3 Cs" of complacency, convenience, and confidence. Despite a national birth cohort hesitancy rate of less than 0.5%, the clustering of unvaccinated families in specific districts, often driven by misinformation, socioeconomic barriers, and post-pandemic scepticism, has created pockets of susceptibility. The editorial article features a community case study to showcase the growing burden of vaccine-hesitant families in Kandy district, Sri Lanka. In addition, the article highlights the implementation of the Vaccine Acceptance Support Teams (VAST) initiative, which utilises medical students as community facilitators to provide socio-religiously sensitive counselling. This initiative is complemented by other measures taken at the national level to address vaccine hesitancy. By integrating VAST with evidence-informed interventions such as "Master Trainer" programmes and culturally contextualised materials, Sri Lanka can strengthen institutional trust and employ grassroots strategies necessary to address the evolving nature of vaccine refusal. This combined approach underscores the importance of community engagement, culturally sensitive communication, and institutional support in tackling vaccine hesitancy effectively.