Table 3 Supposed Causes and Potential Solutions of Vaccine refusals by regions
From: Unvaccinated children as community parasites in National Qualitative Study from Turkey
Regions | Supposed reasons for vaccine refusal | Potential Solutions |
|---|---|---|
Istanbul | ||
Vaccine additives (pig blood and gelatin, monkey blood etc.) Overload the immune system Adverse reaction after previous vaccinations Vaccines do not work Religious factors; specific religious lifestyle Distrust of foreign pharmaceutical companies Anti-vaccine groups in social media | Initiatives to solve anti-vaccine politics of the sect or community leaders Imposing sanctions on non-vaccination families (financial penalties, inability to benefit from health discounts, premium punishment, inability to use family medicine system, etc.) Prevention of anti-vaxx broadcasting through social media channels and media organs Preparation of pro-vaccination publications approved by the MoH, explaining the contents Training children for vaccine advocacy Creation of common working areas with the Presidency of Religious Affairs Requirement for being fully vaccinated form at the school enrollment of children | |
West Marmara | ||
Vaccine additives (thimerosal and aluminum) Possible adverse reaction after previous vaccinations HCWs’ negative information about vaccination Anti-vaccine publications in social media and newspapers | Prevention of anti-vaccine publications in the media Making public information spots Increasing pro-vaccination campaigns and broadcast publications in social media channels | |
East Marmara | ||
Possible serious acute and long-term adverse reactions Specific religious lifestyle (sect); vaccine additives is harmful, forbidden by religion Distrust of foreign pharmaceutical companies Distrust of government health authorities Anti-vaccine groups in social media | Preparing a strategy for the leaders of the congregation/cult structures, especially in the region Establishment of vaccination centers to vaccinate and follow adverse events Preparation of short films and public spots containing subliminal messages Development of an action plan with the Ministry of Education for school vaccination | |
West Black Sea | ||
Harmful vaccine additives May make the child sick (autism, SSPE and cancer) Parental right to choose whether or not to immunize their child Specific religious lifestyle and beliefs about vaccine and additives Anti-vaccine groups in social media Problematic health literacy Anti-vaccine publications in social media and newspapers | Informing the public about the vaccination and vaccine content by written and visual publications Preventing non-scientific publications Provision of legal regulations (inability to benefit from payments for Social Security Institution, no coverage of health expenses, increasing premium payments) Raising awareness of mothers about vaccines; Use of message systems such as SMS, MMS and social media tools such as twitter, instagram, facebook Adding a training program on the management of vaccine refusal to the curricula of HCWs To ensure the participation of the district imams in persuasion visits | |
East Black Sea | ||
Vaccine additives (pig blood and gelatine) Belief that vaccine changes genetic code Doubting the need for some vaccines Anti-vaccination attitudes of some religions Negative attitudes of obstetricians about vaccination Anti-vaccine publications in social media and newspapers | Bringing legal obligations to families who do not allow their children to be vaccinated | |
Northeast Anatolia | ||
May make the child sick (autism, SSPE and cancer) Serious acute adverse reactions Religious beliefs about vaccine additives Lack of information among some health workers Problems in the structure of the national health system Distrust of HCWs Distrust of foreign pharmaceutical companies Anti-vaccine publications in social media and newspapers | Collaboration with the Presidency of Religious Affairs in solving vaccination problems Ensuring the employment of health personnel who know the region and know their problems, reducing short-term appointments | |
West Anatolia | ||
Anti-vaccine opinions of sect leader: Vaccine additives are not appropriate to religion. Believing that vaccine changes genetic code and causes infertility Parental right to choose whether or not to immunize their child Potential for long-term adverse events Belief that vaccines are unnecessary Lack of required information on vaccine efficacy and ingredients among HCWs Negative attitudes of obstetricians about vaccination Distrust of HCWs or government health authorities Distrust of foreign pharmaceutical companies Anti-vaccine publications in social media | Providing counseling services for cases with vaccine adverse events and vaccine hesitancy and rejection Establishment of operational committees to assess families who refuse vaccination and to develop strategies to ensure persuasion, Providing postgraduate training to ensure consensus among physicians, Health personnel should be fully informed about the vaccines they apply and should use standard informative brochures about the benefits of the vaccine, Providing positive publications about vaccines in the national vaccination schedule on the media, using public spots, Labelling vaccine boxes to indicate that the vaccine has been controlled by MoH and is halal. | |
Central Anatolia | ||
May make the child sick (autism, SSPE and cancer) Serious acute adverse reactions Belief that vaccine changes genetic code or causes infertility because of vaccine additives Religious beliefs about immunization Misinformation about vaccine by health workers Distrust of foreign pharmaceutical companies | Health personnel should be fully informed about the vaccines they apply, Public spots | |
Central East Anatolia | ||
Belief that vaccine changes genetic code or causes infertility Vaccine additives Serious acute adverse reactions May make the child sick (autism, SSPE and cancer) Not all vaccines are necessary Parental right to choose whether or not to immunize their child Specific religious life (sect) and religious opinions Some HCWs’ inadequate knowledge about vaccine Distrust of health workers or government health authorities Distrust of foreign pharmaceutical companies Anti-vaccine publications in social media | Ensuring that all HCWs are properly informed about the vaccines and their contents, Revision of the curricula of pre-graduate education of health personnel, Use of correct communication techniques in the community (some rejections can be prevented through giving “fatwa” in the region) Giving vaccine information during pregnancy follow-up Information via mobile phones More attention should be paid to the application of cold chains to the area Transition to oral vaccines instead of parenteral vaccines Accelerating the production of domestic vaccines Explaining that the decrease in infant mortality rates in the region is related to vaccination | |
Southeast Anatolia | ||
May make the child sick (autism, SSPE and cancer) Belief that vaccine changes genetic code or causes infertility Serious acute adverse reactions Vaccine additives Not believing that vaccine-preventable diseases can be serious. Disease is more “natural” than vaccine Specific religious life, religious beliefs; sin Some HCWs’ misinformation about vaccine Parental right to choose whether or not to immunize their child Distrust of foreign pharmaceutical companies | Adding vaccine application to the positive performance criteria of family physicians Publishing the scientific information to counteract false information Correct information about the causes of SSPE cases in the region Establishing vaccine information channel between obstetricians and family health workers. Development of legal measures against non-vaccination families; e.g., withdrawal of health insurance cover, penal arrangements to be made in premium payments, direct fines, interruption of financial support of individuals receiving conditional cash transfers, | |
Mediterranean | ||
Belief that vaccine changes genetic code or causes infertility Serious acute adverse reactions Vaccines do not work Vaccine-preventable diseases have disappeared Anti-vaccine publications in social media | Preparing cards, brochures, magazines and books about the vaccines and their contents for public use | |
Aegean | ||
Belief that vaccine changes genetic code or causes infertility Vaccine additives considered not appropriate to religion Specific religious life (sect) Some HCWs’ misinformation about vaccines Distrust to health workers or government health authorities Anti-vaccine publications in social media | Working with sociologists and social workers to determine a solution within the framework of regional features Preparing cards, brochures, magazines and books about the vaccines and their contents for public use Blocking access to anti-vaccine websites Legal regulations | |