Factors influencing childhood Vaccine hesitancy in Albania. A cross-sectional study

Abstract Background According to the Albania Demographic and Health Survey 2017-2018, childhood vaccination rates in Albania have dropped from 94% in 2008-2009 to 75% in 2017-2018. The “Vaccine hesitancy” (VH) phenomenon has become a major concern. Methods This cross-sectional study surveyed 4,082 randomly selected Albanian parents and legal caregivers of children aged 0-18 years. Using a validated and ethically approved anonymous questionnaire, data were collected from participants at randomly selected primary health care centres across Albania. The questionnaire consisted of sociodemographic data and questions about participants’ behaviours, attitudes, and beliefs regarding vaccine safety and efficacy. Results 28% of respondents defined themselves as ‘'somewhat hesitant” and 6.8% as “very hesitant.” The vaccines that respondents hesitated the most were the MMR (15%) and COVID-19 (13%) vaccines. The most refused vaccines were COVID-19 (29%), MMR (5%) and Influenza (4.8%). The most significant reasons for vaccine hesitation and refusal were “Did not think the vaccine was safe/concerned about side effects” (58%), “Heard or read negative media” (32 %), and “Did not think vaccination was needed” (28%) p < 0.001. A large number of respondents reported that “It is better for children to get fewer vaccines at the same time” (44%), “I am concerned about serious adverse effects of vaccines” (55%) and “I wish children would receive vaccines when they are older” (44%). Participants in the central and southern regions of Albania reported a significantly higher likelihood of VH (OR 2.46) and (OR 1.92) compared to participants in the northern regions. Conclusions Improving childhood vaccination coverage in Albania requires providing parents with clear, evidence-based information about vaccines. Implementing the European Vaccine Action Plan 2015-2020 and addressing parental concerns through targeted public health efforts are key strategies to achieve improved vaccination coverage. Key messages • Although vaccines represent one of the most impactful public health achievements, Albanian parents continue to express concerns regarding their safety. • Vaccine hesitancy covers a wide range of attitudes, from refusal to intentional delays. Sharing trustworthy, evidence-based information is key to addressing these concerns.