Barriers to Vaccine Uptake and Proactive Strategies: A Mixed-method Study of MMR2 Coverage in Narathiwat Province, 2023

Abstract

Measles remains a public health concern in Thailand’s southern border provinces due to persistent vaccine hesitancy despite national elimination efforts. Narathiwat Province continues to report a high incidence of measles, reflecting challenges in vaccine accessibility, cultural acceptance, and operational barriers. This study aimed to identify factors associated with the uptake of the second dose of measles-mumps-rubella (MMR2) vaccine and to explore parental vaccine hesitancy in Narathiwat Province using a mixed-methods approach. The quantitative study utilized secondary data from a 2023 performance survey of 114 childhood state vaccination service units, assessing key operational factors such as target area identification, vaccine uptake rechecks, and supervisor encouragement. Logistic regression identified factors associated with achieving ≥95% MMR2 coverage. The qualitative study explored vaccine hesitancy among 19 mothers in low-coverage districts, identifying concerns about post-vaccination side effects, religious permissibility, and trust in vaccination services. Results indicated that service units with >60 target children had significantly higher odds of failing to achieve ≥95% MMR2 coverage (adjusted OR 6.98, 95% CI 1.46–33.23). Vaccine uptake rechecks and target area clearance were associated with improved coverage but did not reach statistical significance. Common reasons for vaccine hesitancy included fear of side effects, particularly fever, and religious concerns. To enhance coverage, mobile vaccination clinics and door-to-door strategies should be expanded, alongside strengthened public health communication addressing parental concerns. Collaboration with local religious authorities is crucial in fostering trust. Addressing both logistical and cultural barriers is essential for improving vaccine acceptance in high-burden areas like Narathiwat Province.