Vaccination Refusal in Children under 2 Years of Age in Malaysia 2016-2019

Aims: This study will explore the incidence rate of childhood vaccination refusal in Malaysia as well as the reasons for this refusal over a four-year period (2016–2019). Given the complexities and dynamic nature of vaccine refusal, this research is essential for defining the target group, identifying the vaccine types they commonly refuse, and comprehending their vaccination concerns.

Study Design: This is a retrospective review study.

Methodology: This study used a nationally representative secondary data set from the Malaysian Ministry of Health's Family Health Division for the years 2016 to 2019. We included vaccination refusals involving children younger than 24 months of age. Data was extracted from the mothers’ immunization refusal form includes information of the ethnicity, citizenship, religion, occupation, the type of vaccine they refused, and the reason for their refusal. The annual incidence rates of childhood vaccination refusal, the types of vaccines and the refusal reason were summarized by percentage, with 95% confidence intervals.

Results: There was a decline in incidence rates of vaccination refusal from 3.2 in 2016 to 2.3 in 2019 (P<0.001). The refusal rate is highest in the states of Terengganu (15.9%), Kedah (14.1%), and Perak (12.2%). Of the 4052 mothers who refused to vaccinate their children, the majority were Muslims (99.0%) who had secondary education (53.7%) and were housewives (65.3%). Furthermore, most mothers refused to vaccinate their children due to religious beliefs (37.5–39.0%), safety concerns (26.3–34.0%), or belief in complementary and alternative medicine (11.4–15.8%). The reasons of refusal are associated with the mothers’ religion, socioeconomic class, and education level (P<0.001). Muslims have refused vaccinations due to religious beliefs, as they were concerned about the vaccine's halal status. Meanwhile, mothers from a higher socioeconomic class and with a higher educational level were apprehensive about the vaccine's safety.

Conclusion: Consolidated strategies are required to increase vaccination uptake, combined with a concerted effort to comprehend, analyse, and overcome vaccine refusal.