In addition, because public health vaccination programs are about health rather than profit, there are ethical issues such as beneficence and justice that need to be considered. Further, while commercial sector firms face competition from other product or service offerings, vaccination programs struggle with anti-vaccine movements, political groups that oppose or ban vaccination, and social/cultural norms within certain communities. If lack of trust underlies vaccine hesitancy, the source or issue may or may not be vaccine-related – often, distrust in vaccines may reflect or emanate from a broader distrust of health providers, the health system or the government and/or politics [22].