VACCINATION HESITATION IN THE METROPOLITAN REGION OF BAIXADA SANTISTA AND ITS INFLUENCE ON THE VACCINATION OF CHILDREN UP TO TWO YEARS OF AGE

Abstract

Low vaccination coverage has raised concerns in health systems worldwide due to the risk of reemerging diseases that have already been eliminated. One of the main factors contributing to this low coverage is vaccine hesitancy, defined as the delay or refusal to accept recommended vaccines, even when they are available in the healthcare system. In this context, the objective of this study was to analyze vaccine hesitancy in the Baixada Santista Metropolitan Region and its influence on the vaccination of children under two years of age. This cross-sectional epidemiological study was conducted through a household survey on infant vaccination coverage (0 to 2 years) in the municipalities of the Baixada Santista Metropolitan Region. The probabilistic sample included 831 participants, with a significance level of 5% and a power of 80%, and the survey was conducted from November 2020 to April 2022. The analysis used association tests and the Likert scale to measure the degree of vaccine hesitancy. The results indicate that 74% of respondents were mothers, with the majority having completed high school or some college education (54%), aged between 30 and 39 years (44.5%), and 53.5% working outside the home. The children were mostly white (56.2%) and were primarily taken by their mothers to be vaccinated (77.3%), with Basic Health Units (UBS) being the main vaccination site (92.4%). Additionally, 16.8% of respondents stated that the COVID-19 pandemic influenced their decision not to vaccinate. The analysis showed a significant association (p<0.05) between vaccine hesitancy and geographic areas within the region. The Northern Area had the highest percentage of vaccine hesitancy, although it was significant across all areas. Bonferroni multiple comparisons and Kruskal-Wallis tests revealed differences between the regions in terms of vaccine hesitancy. Based on Ayres' concept of vulnerability, which considers the interaction between individual, social, and programmatic factors, the study highlights that vaccine hesitancy in the region is multifaceted. Factors associated with the 5Cs (Confidence, Complacency, Convenience, Calculation, and Collective Responsibility) were identified in all areas. Therefore, addressing vaccine hesitancy requires territorially adapted strategies that take regional and cultural specificities into account to promote greater acceptance of vaccines.

DOI: https://doi.org/10.56238/sevened2025.021-050