Ongoing outbreaks of
measles threaten its elimination status in the United States. Its resurgence points to lower parental
vaccine confidence and local pockets of unvaccinated and undervaccinated individuals. The geographic clustering of hesitancy to MMR indicates the presence of social drivers that shape parental perceptions and decisions on immunization. Through a qualitative systematic review of published literature (n = 115 articles; 7 databases), we determined major themes regarding parental reasons for
MMR vaccine hesitancy, social context of
MMR vaccine hesitancy, and trustworthy
vaccine information sources. Fear of
autism was the most cited reason for MMR hesitancy. The social drivers of vaccine hesitancy included primary care/healthcare, education, economy, and government/policy factors. Social factors, such as income and education, exerted a bidirectional influence, which facilitated or hindered
vaccine compliance depending on how the social determinant was experienced. Fear of
autism was the most cited reason for MMR hesitancy. Vaccine hesitancy to MMR and other childhood
vaccines clustered in middle- to high-income areas among mothers with a college-level education or higher who preferred internet/social media narratives over physician-based
vaccine information. They had low parental trust, low perceived
disease susceptibility, and were skeptical of
vaccine safety and benefits. Combating
MMR vaccine misinformation and hesitancy requires intersectoral and multifaceted approaches at various socioecological levels to address the social drivers of
vaccine behavior.