Health perceptions and health-related behaviors can change at the population level as cultures evolve. In the last decade, despite the proven efficacy of vaccines, the developed world has seen a resurgence of vaccine-preventable diseases (VPDs) such as measles, pertussis, and polio. Vaccine hesitancy, an individual attitude influenced by historical, political, and socio-cultural forces, is believed to be a primary factor responsible for decreasing vaccine coverage, thereby increasing the risk and occurrence of VPD outbreaks. Behavior change models have been increasingly employed to understand disease dynamics and intervention effectiveness. However, since health behaviors are culturally influenced, it is valuable to examine them within a cultural evolution context. Here, using a mathematical modeling framework, we explore the effects of cultural evolution on vaccine hesitancy and vaccination behavior. With this model, we shed light on facets of cultural evolution (vertical transmission, community influences, homophily, etc.) that promote the spread of vaccine hesitancy, ultimately affecting levels of vaccination coverage and VPD outbreak risk in a population. In addition, we present our model as a generalizable framework for exploring cultural evolution when humans’ beliefs influence, but do not strictly dictate, their behaviors. This model offers a means of exploring how parents’ potentially conflicting beliefs and cultural traits could affect their children’s health and fitness. We show that vaccine confidence and vaccine-conferred benefits can both be driving forces of vaccine coverage. We also demonstrate that an assortative preference among vaccine-hesitant individuals can lead to increased vaccine hesitancy and lower vaccine coverage.
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