Rebuilding Vaccine Confidence Through Community-Centered Health Promotion: A Call for Trust, Engagement, and Sustainable Immunization.

Vaccination remains one of the most effective public health interventions, yet declining vaccine confidence has emerged as a major threat to global immunization programs. Vaccine hesitancy, shaped by misinformation, institutional mistrust, sociocultural factors, and inequitable access to reliable health information and services, has contributed to stagnating vaccination coverage and the resurgence of vaccine-preventable diseases. This Perspective, which draws on a purposive rather than systematic reading of the literature, argues that rebuilding vaccine confidence requires moving beyond predominantly supply-oriented and one-way communication strategies toward sustained, community-centered health promotion, delivered alongside, not instead of, investment in the health systems that communities are asked to trust. Drawing on contemporary evidence, we examine how trusted community health workers, religious and community leaders, health literacy initiatives, school-based education, participatory community dialogue, and culturally competent healthcare provider communication can strengthen public trust and improve vaccine acceptance. We also set out the documented limits of these approaches, including fragile sustainability once external funding ends, elite capture, tokenism, uneven cost-effectiveness, and an evidence base dominated by small, single-site studies. We further discuss the importance of integrating health promotion into primary healthcare, institutionalizing community participation in immunization governance with safeguards for genuine power-sharing, and establishing systems to routinely monitor trust and vaccine confidence alongside vaccination coverage. Particular attention is given to fragile and conflict-affected settings, using Somalia, where approximately 60% of children are zero-dose, to examine how community engagement operates where health systems are weakest and structural barriers most binding. Sustainable vaccine confidence depends not only on vaccine availability but also on long-term investment in trust. Embedding community-centered health promotion within national immunization policies, as a core pillar that complements rather than substitutes for structural investment, can help improve vaccine uptake, reduce health inequities, and strengthen resilience against future public health threats.