Perceptions of childhood immunization in São Paulo: a quantitative-qualitative cross-sectional study
Keywords:
Vaccination, Immunization, Vaccine refusal, Child, COVID-19, Vaccine-preventable diseases, Vaccination coverage, Anti-vaccine movementAbstract
BACKGROUND: Vaccination hesitation spans from historical diseases such as smallpox to the current challenges with the coronavirus disease (COVID-19). In Brazil, vaccination faces obstacles related to trust and convenience. Despite the National Immunization Program, fear of adverse effects as well as misinformation challenge confidence in vaccines, and anti-vaccine movements have gained momentum.
OBJECTIVES: This study investigated childhood vaccine refusal, including COVID-19 vaccines, by comparing the reasons for and sociodemographic differences between vaccinated individuals and those who hesitated or refused immunization.
DESIGN AND SETTING: A cross-sectional study was conducted in São Paulo, Brazil, using questionnaires administered during pediatric consultations between January and April 2023.
METHODS: This study investigated vaccine hesitancy and the attitudes of parents and caregivers of children (0–12 years) towards vaccines. The questionnaire was administered during routine pediatric consultations at three different locations, each with 50 participants for a total of 150 participants, to avoid selection bias. RESULTS: Marked differences were evident among caregivers in terms of sex, race, income, education, and religion, which influenced their attitudes toward vaccination. There was an increase in the refusal of seasonal vaccinations and a significant distrust of the efficacy of the COVID-19 vaccine (52%), with concerns about its side effects. Although most patients did not stop vaccination, significant delays occurred, especially in the clinical setting (58%).
CONCLUSIONS: This study emphasizes the importance of childhood health decisions, indicating the need to build trust in vaccines, tailor health policies, and investigate the causes of distrust to promote childhood immunizations.
Downloads
References
World Health Organization. Ten Threats to Global Health in 2019. Geneva: WHO; 2019. Available from: https://www.who.int./. Accessed in 2024 (Jun. 14).
Bianco A, Mascaro V, Zucco R, Pavia M. Parent perspectives on childhood vaccination: How to deal with vaccine hesitancy and refusal?
Vaccine. 2019;37(7):984-90. PMID: 30655175. https://doi.org/10.1016/j. vaccine.2018.12.062.
Brown AL, Sperandio M, Turssi CP, et al. Vaccine confidence and hesitancy in Brazil. Cad Saude Publica. 2018;34(9):e00011618. PMID: 30281705. https://doi.org/10.1590/0102-311x00011618.
Figueiredo GL, Pina JC, Tonete VL, Lima RA, Mello DF. Experiences of families in the immunization of Brazilian children under two years old. Rev Lat Am Enferm. 2011;19(3):598-605. https://doi.org/10.1590/ s0104-11692011000300020.
Barbieri CL, Couto MT, Aith FM. Culture versus the law in the decision not to vaccinate children: meanings assigned by middle-class couples in São Paulo, Brazil. Cad Saude Publica. 2017;33(2):e00173315. PMID: 28300971. https://doi.org/10.15900102-311x001733/15.
Monteiro PV, Miranda KC, Pereira ML, editors. Immunization manual and vaccination room: vaccination in the context of the National Immunization Program. Fortaleza: IMAC Editora; 2021. https://doi. org/10.22491/manual-imunizacoes.
Secretariat of Primary Health Care. PNI: understand how one of the largest vaccination programs in the world works. Brasília-DF, May 8, 2022. Available from: https://aps.saude.gov.br/noticia/18379. Accessed in 2024 (Jan. 17).
Menezes MS, Maia IB. The family’s involvement in the care process of hospitalized children. Serv Soc Saude. 2020;19:e020005. https://doi. org/10.20396/sss.v19i0.8661082.
Ryan J, Malinga T. Interventions for vaccine hesitancy. Curr Opin Immunol. 2021;71:89-91. PMID: 34271335. https://doi.org/10.1016/j. coi.2021.05.003.
Bianco A, Mascaro V, Zucco R, Pavia M. Parent perspectives on childhood vaccination: How to deal with vaccine hesitancy and refusal? Vaccine.
;37(7):984-990. PMID: 30655175. https://doi.org/10.1016/j. vaccine.2018.12.062.
Lalot F, Abrams D, Heering MS, Babaian J, Ozkececi H, Peitz L, Davies Hayon K, Broadwood J. Distrustful Complacency and the COVID-19 Vaccine: How Concern and Political Trust Interact to Affect Vaccine Hesitancy. Polit Psychol. 2022:10.1111/pops.12871. PMID: 36718283; https://doi.org/10.1111/pops.12871.
Bargain O, Aminjonov U. Trust and compliance to public health policies in times of COVID-19. J Public Econ. 2020;192:104316. PMID: 33162621. https://doi.org/10.1016/j.jpubeco.2020.104316.
Hansen BT, Labberton AS, Kour P, Kraft KB. Coverage of primary and booster vaccination against COVID-19 by socioeconomic level: A nationwide crosssectional registry study. Hum Vaccin Immunother. 2023;19(1)2188857. PMID: 36941785; https://doi.org/10.1080/21645515.2023.2188857.
Yao Y, Wu YS, Weng X, et al. Socio-economic disparities in exposure to and endorsement of COVID-19 vaccine misinformation and the associations with vaccine hesitancy and vaccination. Public Health. 2023;223:217-22. PMID: 37677851; https://doi.org/10.1016/j.puhe.2023.08.005.
Fujita DM, Nali LHS, Sartori GP, et al. Fake news and covid-19: a concern due to the low vaccine coverage in Brazil. Saude Soc. 2022;31(1):e210298. https://doi.org/10.1590/S0104-12902022210298.
Santos KCO, Junqueira-Marinho MF, Reis AT, et al. Social Representations of Hesitant Brazilians about Vaccination against COVID-19. Int J Environ Res Public Health. 2023;20(13):6204. PMID: 37444052; https://doi. org/10.3390/ijerph20136204.
Ojong N, Agbe E. “This is most likely not the correct vaccine”: Analyzing COVID-19’s viral spread and vaccine anxieties in Ghana, Cameroon, and Malawi. Soc Sci Med. 2023;329:116001. PMID: 37327597; https://doi. org/10.1016/j.socscimed.2023.116001.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 São Paulo Medical Journal
This work is licensed under a Creative Commons Attribution 4.0 International License.
