Vaccine hesitancy among the people who will one day prescribe, administer, and defend immunization is one of the quiet fault lines of modern public health. A new cross-sectional study from Türkiye now offers one of the most granular portraits yet of how that doubt is distributed among future healthcare professionals, and the results are striking: confidence in vaccines appears to rise steadily as medical students progress through their training, yet it varies dramatically depending on which health discipline a student belongs to. The research, published in BMC Public Health by a team at Zonguldak Bülent Ecevit University, surveyed 1,434 students across the faculties of Medicine, Dentistry, and Pharmacy and measured their attitudes using a validated psychological instrument designed to quantify the subtle spectrum of doubt that sits between full acceptance and outright refusal.
The instrument at the heart of the study is the 21-item Turkish Vaccine Hesitancy Scale, or VHS, an adaptation of a tool originally developed under the umbrella of the World Health Organization’s Strategic Advisory Group of Experts on Immunization. Respondents rate statements about vaccines on a Likert-type scale, and their answers are summed into a total score in which higher numbers indicate greater hesitancy. In this sample, the median total score was 41.0, with an interquartile range spanning 31.0 to 51.0. Because the score distribution was skewed, the researchers turned to non-parametric statistical tests for their initial group comparisons, then built a multiple linear regression model to isolate which factors were independently associated with hesitancy after adjusting for the others.
The most compelling pattern to emerge concerns time. Compared with first-year students, fourth-year students scored on average 7.80 points lower on the VHS, fifth-year students 6.94 points lower, and sixth-year students 11.09 points lower, with all three estimates statistically robust at the 95 percent confidence level. Second- and third-year students, by contrast, did not differ significantly from their first-year peers. In other words, the protective effect of education on vaccine attitudes appears to kick in during the later, clinically intensive years of the medical curriculum, when students rotate through wards, encounter vaccine-preventable diseases in real patients, and absorb the evidence-based culture of clinical practice. The authors are careful to note the cross-sectional design, however: because each student was measured only once, the data show an association between academic stage and hesitancy rather than proving that the curriculum itself transforms attitudes within individuals.
Discipline mattered just as much as seniority. Taking Medicine students as the reference group, Dentistry students scored 4.47 points higher on the hesitancy scale, and Pharmacy students a full 9.49 points higher, both differences statistically significant. This gradient is notable because all three faculties sit on the same campus and are subject to the same national health policies and the same regional epidemiological environment. The divergence suggests that the content and culture of professional training, rather than geography or demographics alone, may shape how future practitioners weigh the risks and benefits of immunization. Pharmacy students, whose curricula emphasize pharmacology and product safety, may be more attuned to adverse-event profiles, while medical students’ exposure to infectious disease wards may reinforce the population-level case for vaccines. The study did not test these mechanisms directly, but the adjusted differences persisted after controlling for sex, parental education, and other covariates.
Two further demographic findings rounded out the regression model. Female students scored 3.85 points lower than male students, indicating greater vaccine confidence among women in this cohort, and students whose fathers had completed high school or above scored 2.67 points lower than those whose fathers had less education. The paternal education effect is a reminder that vaccine attitudes are not formed in lecture halls alone; family background, socioeconomic context, and the health literacy of the household all leave measurable traces on how future healthcare professionals think about immunization before and during their formal training.
Beneath the aggregate scores lie some genuinely unsettling item-level numbers. When asked whether they agreed or partially agreed with specific statements, 77.7 percent of these future healthcare professionals expressed concern about vaccine side effects, 49.8 percent agreed that vaccines benefit manufacturers more than they benefit public health, and 40.7 percent endorsed the claim that vaccines cause autism or learning disorders. That last figure deserves emphasis: four in ten students training to join the healthcare workforce at this university expressed at least partial agreement with a claim that has been thoroughly refuted by decades of epidemiological research involving millions of children. The sheer prevalence of these doubts among an elite, science-selected population illustrates how resilient misinformation can be, even inside institutions whose explicit mission is scientific training.
Behavior, fortunately, lagged less far behind belief than those numbers might suggest. 81.9 percent of the students reported receiving at least one dose of a COVID-19 vaccine, a figure that reflects both the intensity of the pandemic-era vaccination campaign in Türkiye and the practical accessibility of the vaccines to young adults. Still, the gap between uptake and attitude is instructive. A student can accept a vaccine under social pressure, institutional mandate, or perceived personal risk while privately harboring doubts about side effects or pharmaceutical motives, and those private doubts are precisely what the VHS is designed to surface. When such students later become physicians, dentists, or pharmacists, their unspoken reservations may color the way they recommend vaccines to patients, in some cases softening the confident endorsement that public health communication depends on.
The methodological architecture of the study strengthens its central claims. The authors followed the STROBE reporting guidelines for observational research, obtained ethical approval from their university’s non-interventional clinical research ethics committee, and collected anonymous questionnaires with informed consent from all participants. In the regression model they checked for multicollinearity using variance inflation factors, and their use of quantile-quantile plots to assess the distribution of VHS scores justified the non-parametric approach to group comparisons. The sample of 1,434 students, drawn across six academic years and three faculties, is large enough to detect the effect sizes reported, and the confidence intervals around the key estimates do not approach the null, lending credibility to the discipline and year gradients that form the study’s core contribution.
What the study cannot do is explain why the gradients exist, and the authors are explicit about this limitation. Cross-sectional data capture a snapshot, not a trajectory; it remains possible, for example, that students with more vaccine-confident dispositions progress through the curriculum at different rates, or that cohort effects rather than educational effects explain the year-by-year differences. Nor does the single-university setting in the Western Black Sea region of Türkiye guarantee that the same patterns hold in other regions or countries. The authors themselves frame their conclusions cautiously, identifying educational stages and disciplines as potential targets for intervention while insisting that whether early, discipline-sensitive educational programs actually improve vaccine confidence is a question that only future intervention studies can answer.
Even with those caveats, the implications are hard to ignore. If vaccine confidence among medical students consolidates mainly in the clinical years, then the early preclinical years represent an unclaimed window in which structured education about vaccine science, safety surveillance, and the economics of immunization could be deployed, particularly for disciplines such as pharmacy and dentistry where hesitancy runs highest. The finding that nearly half of these students suspect vaccines serve manufacturers more than public health points to a specific curricular gap: few programs teach students how vaccine safety systems, regulatory oversight, and benefit-risk calculations actually work. As health systems worldwide grapple with resurgent measles, wavering COVID-19 booster uptake, and the looming challenge of new vaccines against resistant pathogens, this study suggests that the front line of vaccine advocacy may need to be built not in clinics but in classrooms, and built early, before doubt has a chance to calcify into professional habit.
Subject of Research: Vaccine hesitancy among medicine, dentistry, and pharmacy students across educational stages at a Turkish public university
Article Title: Vaccine hesitancy across educational stages and health disciplines among healthcare students at a public university in the Western Black Sea region of Türkiye: a cross-sectional study
Article References: Açıkgöz, B., Ekemen, A., Meydan, M. C., & Ayoğlu, F. N. (2026). Vaccine hesitancy across educational stages and health disciplines among healthcare students at a public university in the Western Black Sea region of Türkiye: a cross-sectional study. BMC Public Health. https://doi.org/10.1186/s12889-026-29815-7
Image Credits: AI Generated
DOI: 10.1186/s12889-026-29815-7
Keywords: vaccine hesitancy, healthcare students, medical education, Vaccine Hesitancy Scale, Türkiye, dentistry, pharmacy, COVID-19 vaccination, public health, cross-sectional study, vaccine confidence, health communication
News Source: Kristina Jarvis. (October 8, 2026). Medical Students Grow More Vaccine-Confident as They Advance, Turkish Study Finds. Scienmag.
