Reasons for Childhood Vaccine Refusal: A Cross-Sectional Study in South-Eastern Türkiye

Abstract

Highlights What are the main findings? Among 4118 documented childhood vaccine refusals in a south-eastern Turkish province, parents most often cited media and community reports questioning vaccine safety (71.3%), and reported a mean of 3.6 reasons each rather than a single concern. The reasons parents gave differed by socioeconomic position: doubts about vaccine safety were more common in lower-income and less-educated families, whereas the belief that vaccination is unnecessary was more common in higher-income families. Concern about side effects was common at every educational level, including among university graduates, indicating that refusal was not limited to less-educated parents. What are the implications of the main findings? Because refusal rested on a cluster of mutually reinforcing beliefs, communication efforts that correct a single misconception are unlikely to be sufficient on their own. Messages should be tailored to each group: building trust and countering misinformation where confidence is low, and restoring awareness of disease risk where families see vaccination as unnecessary. Routine primary care visits remain the key opportunity to address parental concerns directly, supporting investment in the communication skills of family physicians and nurses. Abstract Background/Objectives: Vaccine hesitancy has intensified worldwide, and measles and pertussis have resurged across the WHO European Region. In Türkiye, a regulation introduced in May 2024 made documentation of every parental refusal mandatory, rendering 2025 the first calendar year for which provincial refusal data can be considered systematically ascertained. Methods: We conducted a retrospective, registry-based cross-sectional study of all vaccine refusal notifications submitted to the Batman Provincial Health Directorate between 1 January and 31 December 2025, covering all six districts of the province. Sociodemographic data were extracted from the notification database, and reasons for refusal were obtained using a structured questionnaire administered by primary healthcare personnel. Parents could endorse more than one reason. Results: A total of 4118 notifications were analysed. Mothers completed 62.4% of notifications; 44.2% of parents had primary education only and 58.3% belonged to low-income households. The diphtheria–tetanus–acellular pertussis–inactivated poliovirus–Haemophilus influenzae type b (DTaP-IPV-Hib) combination vaccine (28.4%) and measles–mumps–rubella (MMR) vaccine (22.1%) were the most frequently refused vaccines. Exposure to media or community reports was the most frequently endorsed reason (71.3%), followed by concern about adverse effects (68.9%) and doubts about vaccine safety (65.4%). Parents endorsed a mean of 3.6 reasons each. Doubts about safety predominated in lower socioeconomic strata, whereas the perception that vaccination is unnecessary predominated in higher strata. Conclusions: Refusal in this setting rests on a cluster of mutually reinforcing beliefs rather than a single misconception, and the concerns reported differ systematically by socioeconomic position. Differentiated rather than uniform communication strategies are required.