Understanding the influence of religious and safety concerns on childhood measles and pertussis vaccination: a study conducted in Aceh, Indonesia, 2022

Abstract

Background: Aceh, the westernmost province in Indonesia, was granted autonomous status, allowing the area to officially practice Sharia law, making the region religiously conservative. The province has the lowest measles vaccination rates in the country, with only 54% coverage. This study aims to quantify the contribution of concerns or structural barriers on non-vaccination. Methods: In a 2022 cross-sectional population-based study, 899 parents reported religious vaccine concerns, concerns about side effects, and whether they encountered structural barriers. The degree to which religious concerns impact the first dose of measles-rubella (MR1) and pentavalent (Penta1) vaccination was quantified through population-attributable fractions (PAF). Results: Among respondents, 62% reported their child had received MR1 and 63% Penta1. In total, 60% of parents expressed religious concerns about vaccination and 75% about vaccine side effects. The PAF for MR1 non-vaccination was 36% (95% CI: 21%, 52%) for religious concerns and 35% (95% CI: 16%, 51%) for concerns about side effects. For Penta1, the PAF was 42% (95% CI: 24%, 59%) for concerns about side effects and 28% (95% CI: 13%, 44%) for religious concerns. Structural barriers like stockouts, cost, or inconvenient clinic hours were less frequently cited and contributed minimally to non-vaccination. Conclusions: While concerns can overlap, evidence suggests that religious concerns are distinct and influence vaccination rates more than structural barriers. Understanding barriers to vaccination is a precursor to developing tailored interventions, like encouraging religious leaders to act as a trusted source of vaccine guidelines or promoting the use of a halal vaccine, that can mitigate hesitancy.