Parental factors that contribute to vaccine hesitancy in the Philippines
| Themes | Illuminating quote |
| Individual barriers | |
| Fears associated with vaccination (especially new vaccines and in the light of Dengvaxia vaccine scare) | “When my child experienced fever after vaccination I felt guilty for why I submitted my child for vaccination(…)because I am not used to my child getting sick(…)I felt fearful and confused too.” (Mother of 2, age 25) |
| “Our second child was injected by Dengvaxia when at school, that was what we worried about. We learned from the television that many have died from Dengvaxia. This is the reason why we do not want our child to be vaccinated again(…)even the youngest one because we are worried for our child’s safety.” (Father of 3, age 30) | |
| “(…)I felt nervous with the new vaccines, but with the old vaccines until measles, I am fine as I do not have any bad experience.” (Mother of 4, age 38) | |
| Perceived lack of information | “Health workers will visit our houses, informing us to bring the child at the health center for vaccination…no other information but name of vaccine and doses only… no information on advantages or disadvantages…or the side effects to be expected.” (Mother of 7, age 46) |
| Religious or cultural edicts dissuade vaccination | “Our belief is that we are made by God naturally, so it is also a need that what enters our body is also natural- not the chemicals that once ingested(…)will have side effects in the body.” (Mother of 10, age 46) |
| Vaccines viewed as non-essential | “It is not needed. My baby is already healthy and active.” (Mother of 3, age 25) |
| “It is (hindi uso) not trendy and, that we turned okey even without injections.” (Mother of 5, age 28) | |
| Competing time demands | “I was washing clothes during the day my child was scheduled for vaccination, and I remember it night time already(…)My husband was working and I was left alone at the house(…)I need to go to the market for our food(…).” (Mother of 6, age 33) |
| Interpersonal and community barriers | |
| Household head, opinion leader and neighbours’ opposition to vaccines | “My husband does not want my children to be vaccinated because they might get sick(…)and I will obey my husband’s decision because I don’t want to fight with him over our children’s health.” (Mother of 2, age 25) |
| “(…)my father got mad when I let my child be vaccinated with polio vaccine, the child has developed fever and was crying overnight, he told me not to let my child be vaccinated again(…)my father knew what is right(…).” (Mother of 2, age 29) | |
| “My neighbors told me that vaccine is not good for my children because they will get infected with the disease, which also I believed, thus I am also hesitant for my children to be vaccinated.” (Mother of 2, age 25) | |
| Health system barriers | |
| Lack of trust in HCWs | “(…)it’s hard to open up, when you have concerns in mind, and you want to clarify. The way she (healthcare worker) talks is different, very straightforward, she can hurt someone’s feelings, it’s like an insult(…)When you have follow-up questions, she shouts(…)with limited patience.” (Mother of 5, age 35) |
| Appointment scheduling and waiting time challenges | “It was difficult(…)health center is full of children(…)sometimes the healthcare worker is not yet there(…)sometimes we are asked to return because the vaccinator is not yet available(…)busy attending to childbirth(…). So, I decided not to go back because it was really far(…)and that same thing will happen.” (Mother of 5, age 31) |
| Multidose vaccine vials | Sometimes when we are scheduled for vaccination, there was no available open vaccine vial(…)they will need to reschedule us so that for the next vaccine vial that will be opened, there are also other children who will be vaccinated.” (Mother of 2, age 23) |
| School-based approaches make it harder to know who is accountable | “I did not allow my children to be vaccinated in school because if there are problems, like side effects, I do not know whom to approach, at least when it was given by the health center, I know them well and I can approach them in case there are problems.” (Mother of 3, age 40) |
| Superstructural barriers | |
| Natural calamities and associated repercussions | “It was difficult to walk going to the health center(…)sometimes it was raining, sometimes too hot and we had no umbrella(…)no transportation also, your option is to walk only(…)then there are roads that are elevated.” (Mother of 5, age 31) |
| Fear of COVID-19 and associated community lockdowns | “I do not want to risk bringing my baby to the health center because of COVID-19(…)they told me that I need to put a mask to my baby, how is that even possible? My baby is not used to wearing a mask(…)she can’t breathe” (Mother of 3, age 34) |
HCWs, healthcare workers.