Rates of childhood vaccine refusal in Turkey during 2016-2017: Regional causes and solutions

Arch Pediatr. 2022 Nov;29(8):594-598. doi: 10.1016/j.arcped.2022.06.005. Epub 2022 Sep 25.


Objective: Vaccine hesitancy is a growing problem globally. This study aimed to detect the rates of vaccine refusal (VR) during childhood in each province and region of Turkey from 2016 to 2017 and to evaluate the experiences of Expanded Programme on Immunization (EPI) managers regarding childhood VR and opinions to solve and reduce vaccine hesitancy in Turkey.

Methods: VR was defined as the refusal to vaccinate for at least one vaccine in children aged 0-23 months. In this descriptive study, information on notified VR cases and recommended solutions from every province in Turkey was accessed by the local EPI manager for the period 2016-2017. The VR rates were calculated.

Results: From 80 provinces, 8977 VR cases were detected in 2016 (VR rate 3.5‰) and 14,779 cases in 2017 (VR rate 5.9‰; p<0.001). One quarter of Family Health Units reported at least one case of VR. The highest VR rate in children aged under 2 years was in East Marmara (8.4‰) in 2016, and the West Anatolia Region (10.9‰) and East Marmara region (10.9‰) in 2017. Concerns about the vaccine content, harmfulness, and fears about adverse effects were the most common reasons underlying VR. Educating healthcare workers about vaccines and interpersonal communication skills, increasing patient information with informative brochures, and preventing anti-vaccination publications in the media were the most frequent recommendations to solve VR.

Conclusions: In Turkey, VR cases continue to increase. Correct and adequate information, effective communication, and trust between healthcare workers and parents can help reduce VR.

Keywords: Communication; Family physician; Hesitancy; Parent; Vaccine refusal rates.

MeSH terms

  • Child
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Parents
  • Turkey
  • Vaccination
  • Vaccination Refusal
  • Vaccines*


  • Vaccines