VACCINE HESITANCY AND ITS ROLE IN THE RESURGENCE OF VACCINE-PREVENTABLE DISEASES: INSIGHTS FROM FOUR MALAYSIAN STATES BORDERING THAILAND (2019–2023)
DOI:
https://doi.org/10.37268/mjphm/vol.25/no.3/art.3342Keywords:
Keyword: Vaccine Hesitancy, Vaccine preventable diseases, NIP, Malaysia, resurgenceAbstract
Vaccine hesitancy, a major global health threat, is especially concerning in Malaysia’s border states with Thailand due to cross-border mobility, shared socio-cultural and religious beliefs, and widespread misinformation that undermine immunization efforts. This study aimed to assess the prevalence of vaccine hesitancy, VPD outbreaks that related to it, and factors associated with total vaccine refusal (refused vaccine and subsequence follow up) in Kedah, Perlis, Perak, and Kelantan between 2019 and 2023. A retrospective cross-sectional study design was employed using secondary data from the Vaccine Hesitancy Registry and the Ministry of Health’s eNotifikasi system. The study included 2,740 documented cases of parental refusal for children aged 0–2 years (2019-2023) and all VPD cases reported in 2023. Descriptive analyses summarized prevalence of vaccine hesitancy, VPD outbreaks that related to it, sociodemographic characteristics, and reasons for refusal, while multiple logistic regression identified predictors of total refusal. Vaccine hesitancy prevalence ranged from 0.25% to 1.12%, with marked increases in Kedah (1.08%) and Perlis (1.12%) in 2023. Most hesitant parents were young, Malay, Muslim mothers, with 36.6% holding tertiary education. Religious concerns (non-halal ingredients), fear of adverse events, and social influences were the most cited reasons. In 2023, Kedah recorded 65 VPD cases linked to hesitancy, while outbreaks in Perak and Kelantan were similarly associated. Multivariate analysis revealed unemployment (AOR 2.53,95%CI: 1.43-4.49;p=0.002), low education (AOR 1.89,95%CI:1.27-2.82;p=0.002), halal concerns (AOR 1.61, 95%CI:1.38-1.96;p=0.031), reliance on homeopathy (AOR 1.64,95%CI:1.09-2.47;p value=0.019), and fear of adverse events (AOR 1.78,95%CI:1.61-1.92;p value= 0.017) as significant predictors of total refusal. Vaccine hesitancy in Malaysia’s border states is shaped by cultural, religious, and socioeconomic factors, directly contributing to VPD outbreaks. Targeted interventions such as religious engagement, transparent risk communication, and binational Malaysia–Thailand cooperation are urgently needed to strengthen vaccine confidence and prevent further resurgence.
References
Ichsan MuhN, Ukratalo AM. Basic Immunization Education for Parents in Rutong Village, Ambon City, as an Effort to Reduce Infectious Disease Incidence in Children. Indones J Community Serv Empower. 2025 July 6;1(1):18–21.
Alanazi FTH, Alharbi BN, Aljuaid TH, Alammar FA, Almarzouq YF, Albalawi I, et al. The impact of vaccinations on disease prevention: A comprehensive analysis of their role in enhancing global public health and reducing morbidity and mortality rates. Int J Health Sci. 2024 Jan 15;8(S1):1885–907.
Keja K, Chan C, Hayden G, Henderson RH. Expanded programme on immunization. World Health Stat Q Rapp Trimest Stat Sanit Mond. 1988;41(2):59–63.
Okesanya O, Olatunji G, Olaleke N, Mercy M, Ilesanmi A, Kayode H, et al. Advancing Immunization in Africa: Overcoming Challenges to Achieve the 2030 Global Immunization Targets. Adolesc Health Med Ther. 2024 Oct;Volume 15:83–91.
Decouttere C, De Boeck K, Vandaele N. Advancing sustainable development goals through immunization: a literature review. Glob Health. 2021 Aug 26;17(1):95.
WHO. Global Vaccine Action Plan [Internet]. 2024 [cited 2025 Aug 17]. Available from: https://www.who.int/teams/immunization-vaccines-and-biologicals/strategies/global-vaccine-action-plan
Kamaruzaman NK, Rizzi M, Attwell K. A comprehensive review of the childhood vaccination landscape in Malaysia. Epidemiol Infect. 2025;153:e41.
Otaigbe I. A narrative review of strategies to improve childhood vaccination coverage in Low- and Middle-Income Countries: Improvement of Childhood Vaccination Coverage. Babcock Univ Med J. 2023 Dec 31;6(2):202–14.
Lim KK, Chan YY, Noor Ani A, Rohani J, Siti Norfadhilah ZA, Santhi MR. Complete immunization coverage and its determinants among children in Malaysia: findings from the National Health and Morbidity Survey (NHMS) 2016. Public Health. 2017 Dec;153:52–7.
Nozaki I, Hachiya M, Kitamura T. Factors influencing basic vaccination coverage in Myanmar: secondary analysis of 2015 Myanmar demographic and health survey data. BMC Public Health. 2019 Dec;19(1):242.
Hergott M, Andreski M, Rovers J. Vaccine hesitancy among health paraprofessionals: A mixed methods study. Nusair M, editor. PLOS ONE. 2025 Jan 7;20(1):e0312708.
Shah GH, Nguyen TH. Vaccine Hesitancy Through a Global Lens: Cross-Cultural Evidence from a Special Issue. Vaccines. 2025 May 16;13(5):529.
Hilário AP, Augusto FR, Mendonça J. Working on a Sensitive Topic. In: The Routledge Handbook of Field Research [Internet]. 1st ed. London: Routledge; 2025 [cited 2025 Aug 17]. p. 314–21. Available from: https://www.taylorfrancis.com/books/9781003404903/chapters/10.4324/9781003404903-44
Mendonça J, Hilário AP. Touching the cornerstone: An illustrative example of the effects of stigma and discrimination on vaccine-hesitant parents. Public Health Pract. 2023 Dec;6:100438.
Cooper S, Wiysonge CS. Towards a More Critical Public Health Understanding of Vaccine Hesitancy: Key Insights from a Decade of Research. Vaccines. 2023 June 26;11(7):1155.
Musa AF, Soni T, Cheong XP, Nordin RB. Vaccine hesitancy among parents in Kuala Lumpur: a single center study. F1000Research. 2019 Sept 18;8:1653.
Mohd Azizi FS, Kew Y, Moy FM. Vaccine hesitancy among parents in a multi-ethnic country, Malaysia. Vaccine. 2017 May;35(22):2955–61.
Othman NH, Rajendram S, Singh HKB. Vaccine Hesitancy in Childhood Immunization in the Malaysian Context. J Pharm Bioallied Sci. 2024 Oct;16(4):121–5.
Sutan R, Batarfi SA, Ismail H, Bin-Ghouth AS. Vaccine hesitancy from parents and healthcare providers perspectives in Hadhramout Governorate, Yemen: a mixed-method study protocol. BMJ Open. 2022 Feb;12(2):e055841.
MacDonald NE. Vaccine hesitancy: Definition, scope and determinants. Vaccine. 2015 Aug;33(34):4161–4.
Dubé E, MacDonald NE. How can a global pandemic affect vaccine hesitancy? Expert Rev Vaccines. 2020 Oct 2;19(10):899–901.
Ullah AA, Chattoraj D. COVID-19 Pandemic and the Migrant Population in Southeast Asia: Vaccine, Diplomacy and Disparity [Internet]. WORLD SCIENTIFIC; 2022 [cited 2025 Aug 18]. (World Scientific Series on International Relations and Comparative Politics in Southeast Asia; vol. 02). Available from: https://www.worldscientific.com/worldscibooks/10.1142/12761
Kurpas D, Stefanicka–Wojtas D, Soll–Morka A, Lomper K, Uchmanowicz B, Blahova B, et al. Vaccine Hesitancy and Immunization Patterns in Central and Eastern Europe: Sociocultural, Economic, Political, and Digital Influences Across Seven Countries. Risk Manag Healthc Policy. 2025 June;Volume 18:1911–34.
Fliou F. Vaccinations and Misinformation. In: Marciano A, Ramello GB, editors. Encyclopedia of Law and Economics [Internet]. New York, NY: Springer New York; 2025 [cited 2025 Aug 18]. p. 1–10. Available from: https://link.springer.com/10.1007/978-1-4614-7883-6_829-1
Youssef A, Ulloa L. Ethical and Legal Debates on Vaccine Infodemics. Cureus [Internet]. 2024 Jan 19 [cited 2025 Aug 18]; Available from: https://www.cureus.com/articles/209029-ethical-and-legal-debates-on-vaccine-infodemics
Kreps GL, Chen X, Li M. Editors’ Introduction: Understanding and Addressing Vaccine Hesitancy. Vaccines. 2025 June 6;13(6):613.
Nuwarda RF, Ramzan I, Weekes L, Kayser V. Vaccine Hesitancy: Contemporary Issues and Historical Background. Vaccines. 2022 Sept 22;10(10):1595.
Wong LP, Wong PF, AbuBakar S. Vaccine hesitancy and the resurgence of vaccine preventable diseases: the way forward for Malaysia, a Southeast Asian country. Hum Vaccines Immunother. 2020 July 2;16(7):1511–20.
Al-Eitan LN, Almahdawi DL, Abu Khiarah RA, Alghamdi MA. Bridging Gaps in Vaccine Access and Equity: A Middle Eastern Perspective. Vaccines. 2025 July 29;13(8):806.
Ali HA, Hartner AM, Echeverria-Londono S, Roth J, Li X, Abbas K, et al. Vaccine equity in low and middle income countries: a systematic review and meta-analysis. Int J Equity Health. 2022 June 11;21(1):82.
WHO. Vaccine hesitancy: A growing challenge for immunization programmes [Internet]. 2015 [cited 2025 Aug 18]. Available from: https://www.who.int/news/item/18-08-2015-vaccine-hesitancy-a-growing-challenge-for-immunization-programmes
WHO. Western Pacific countries at risk of measles outbreaks due to immunization and surveillance gaps [Internet]. 2024 [cited 2025 Aug 18]. Available from: https://www.who.int/westernpacific/news/item/01-03-2024-western-pacific-countries-at-risk-of-measles-outbreaks-due-to-immunization-and-surveillance-gaps
Tiwana MH, Smith J. Faith and vaccination: a scoping review of the relationships between religious beliefs and vaccine hesitancy. BMC Public Health. 2024 July 6;24(1):1806.
Al-Regaiey KA, Alshamry WS, Alqarni RA, Albarrak MK, Alghoraiby RM, Alkadi DY, et al. Influence of social media on parents’ attitudes towards vaccine administration. Hum Vaccines Immunother. 2022 Jan 31;18(1):1872340.
McKinley CJ, Limbu Y. Promoter or barrier? Assessing how social media predicts Covid-19 vaccine acceptance and hesitancy: A systematic review of primary series and booster vaccine investigations. Soc Sci Med. 2024 Jan;340:116378.
Smith SE, Sivertsen N, Lines L, De Bellis A. Exploring social media influences on vaccine decision-making in parents: a netnography. Ther Adv Vaccines Immunother. 2024 Jan;12:25151355241249607.
Sirithammaphan U, Chaisang U, Pongrattanamarn K. Barriers to measles mumps rubella vaccine acceptance in the three southern border provinces of Thailand. Clin Exp Vaccine Res. 2023;12(4):298.
Jinarong T, Chootong R, Vichitkunakorn P, Songwathana P. Muslim parents’ beliefs and factors influencing complete immunization of children aged 0–5 years in a Thai rural community: a qualitative study. BMC Public Health. 2023 July 13;23(1):1348.
Takkinsatian P, Wannaphahoon K, Upapan P, Senawong S, Prommalikit O. Measles seroprevalence in Thailand: are adolescents and young adults at risk of measles? Singapore Med J. 2024 June 1;65(6):340–7.
WHO. Summary WHO SAGE conclusions and recommendations on Vaccine Hesitancy. 2015.
