Vaccine hesitancy has been a growing challenge for public health in recent decades. Among factors contributing to vaccine hesitancy, concerns regarding vaccine safety and Adverse Events (AEs) play the leading role. Moreover, cognitive biases are critical in connecting such concerns to vaccine hesitancy behaviors, but their role has not been comprehensively studied. In this study, our first objective is to address concerns regarding vaccine AEs to increase vaccine acceptance. Our second objective is to identify the potential cognitive biases connecting vaccine hesitancy concerns to vaccine-hesitant behaviors and identify the mechanism they get triggered in the vaccine decision-making process. First, to mitigate concerns regarding AEs, we quantitatively analyzed the U.S. Vaccine Adverse Event Reporting System (VAERS) from 2011 to 2018 and provided evidence regarding the non-severity of the AEs that can be used as a communicable summary to increase vaccine acceptance. Second, we focused on the vaccination decision-making process. We reviewed cognitive biases and vaccine hesitancy literature to identify the most potential cognitive biases that affect vaccine hesitancy and categorized them adopting the Precaution Adoption Process Model (PAPM). Our results show that the top frequent AEs are expected mild reactions like injection site erythema (4.29%), pyrexia (3.66%), and injection site swelling (3.21%). 94.5% of the reports are not serious and the average population-based serious reporting rate over the 8 years was 25.3 reports per 1 million population. We also identified 15 potential cognitive biases that might affect people’s vaccination decision-making and nudge them toward vaccine hesitancy. We categorized these biases based on the factors that trigger them and discussed how they contribute to vaccine hesitancy. This paper provided an evidence-based communicable summary of VAERS. As the most trusted sources of vaccine information, health practitioners can use this summary to provide evidence-based vaccine information to vaccine decision-makers (patients/parents) and mitigate concerns over vaccine safety and AEs. In addition, we identified 15 potential cognitive biases that might affect the vaccination decision-making process and nudge people toward vaccine hesitancy. Any plan, intervention, and message to increase vaccination uptake should be modified to decrease the effect of these potential cognitive biases.

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疫苗犹豫：来自免疫接种后不良事件的证据以及认知偏差的作用

近几十年来，疫苗犹豫一直是公共卫生面临的日益严峻的挑战。在导致疫苗犹豫的因素中，对疫苗安全性和不良事件 (AE) 的担忧起主导作用。此外，认知偏差对于将此类担忧与疫苗犹豫行为联系起来至关重要，但尚未对其作用进行全面研究。在这项研究中，我们的第一个目标是解决对疫苗 AE 的担忧，以提高疫苗的接受度。我们的第二个目标是确定将疫苗犹豫问题与疫苗犹豫行为联系起来的潜在认知偏差，并确定它们在疫苗决策过程中被触发的机制。首先，为了减轻对 AE 的担忧，我们定量分析了美国 2011 年至 2018 年的疫苗不良事件报告系统 (VAERS)，并提供了关于 AE 非严重性的证据，可用作可传播的总结以提高疫苗的接受度。其次，我们专注于疫苗接种决策过程。我们回顾了认知偏差和疫苗犹豫文献，以确定影响疫苗犹豫的最潜在认知偏差，并采用预防采用过程模型 (PAPM) 对它们进行分类。我们的结果表明，最常见的 AE 预计会出现轻微反应，如注射部位红斑 (4.29%)、发热 (3.66%) 和注射部位肿胀 (3.21%)。94.5%的报告不严重，8年来平均基于人群的严重报告率为每100万人口25.3例。我们还确定了 15 种可能影响人们疫苗接种决策的潜在认知偏差，并促使他们对疫苗犹豫不决。我们根据引发这些偏见的因素对这些偏见进行了分类，并讨论了它们如何导致疫苗犹豫。本文提供了 VAERS 的基于证据的可传播摘要。作为最值得信赖的疫苗信息来源，卫生从业人员可以使用此摘要向疫苗决策者（患者/父母）提供基于证据的疫苗信息，并减轻对疫苗安全性和 AE 的担忧。此外，我们确定了 15 种可能影响疫苗接种决策过程并促使人们对疫苗犹豫不决的潜在认知偏差。任何计划、干预、