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

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.