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Appendix for Section 3Appendix A3.1: Review of Models of Determinants of Vaccine HesitancyThe 2011 Determinants of Vaccine Hesitancy Model from Canada (Figure A3.1) whileillustrating the wide array of determinants and factors was felt to be thoughtful and useful foracademic work but too complex for practical application in the field.Figure A 3.1 Determinants of Vaccine Hesitancy: Canadian ModelDETERMINANTS OF VACCINE HESITANCYVaccines andimmunizationEmotionPerceivedSeverity andSusceptibility toVPDRationalityGovernmentPerceived Safety &Effectiveness ofvaccineRisk perception andevaluationPharmaceuticalcompaniesHistoric, political andsocio-cultural contextMedical expertiseSocialmediaInternetCommunicationand mediaScienceIndividual reflectionanddecision-making processHealthcare SystemReligious andculturalparticularitiesSocialsupportSpiritualityEmpowermentAttitudesEthicsSelf efficacySubjectivenormTrustVPDHealth promotionand preventionKnowledgeand BeliefsVaccinehesitancyContinuumLaws/IncentivesVaccinationpromotion &communicationIndividual / populationeffectsAvoid VPDepidemicCommunicationskillReligiousliteracyMedical andepidemiologicalknowledgeTrainingRole of healtcareprofessionnalsmd RN Alternative medHesitant professionalsrefusalacceptanceRole ofPublic healthVaccinecoverageCounsellingImpartialityavoidingappearance ofconflict ofinterest Relation oftrustPayment vstime spentcounsellingEducatingPatients/parentsRecommendvaccinationLeave timefor thedecision tobe madeVaccinedeliveryserviceContinuityRelationshipof trustVaccinationprogramsRigorousevaluationandmonitoringVaccinationregistersAdapted from results of the “ Workshop on the cultural and religious roots of vaccine hesitancy: Explanations and implications for the Canadian healthcare system” , Guay andcoll., Sherbrooke University, Longueuil, December 5-6 2012The Working Group also explored arranging factors that impinge on vaccine hesitancy in asystems approach matrix that grouped factors into three main categories of influences:contextual, individual and group and vaccine /vaccination specific influences (Table A3.1,Figure A3.2). Contextual influences were defined as influences that arise due to historic, sociocultural,institutional, economic or political factors; individual and group influences asinfluences that arise from personal perception or influences of the social /peer environment andvaccine /vaccination specific influences as influences directly related to the vaccine orvaccination. Again the Working Group emphasized that Table A3.1 presented a very complexmatrix. Several Working Group members initially commented that while this “influencer” matrixmight work well in high income countries, they had concerns that important factors affecting