Abstract
Background: Vaccine hesitancy, defined by the World Health Organization as the delay or refusal of vaccination despite the availability of services, has become a major challenge for global public health. This phenomenon threatens the vaccine coverage required to maintain herd immunity, which is essential to protect unvaccinated or immunologically vulnerable individuals. Vaccine hesitancy directly impacts pediatric and public health indicators.
Approach: This study examines childhood vaccine hesitancy and the interventions of Medical Councils in collaboration with the community, aiming to understand the underlying dilemmas and propose ethical strategies to mitigate them. Scientific literature, relevant legislation, and ethical guidelines—particularly those established by the Brazilian Federal Council of Medicine—were reviewed. In the state of Paraíba, which has 1.5 million children according to the latest census, we analyzed vaccination coverage indicators from the past five years and assessed family perceptions of childhood immunization through a qualitative study.
Results: Vaccination coverage in Paraíba declined from an average of 78% to 47% over the past five years. The dissemination of misinformation about vaccines, amplified by social media, was found to be a key driver of hesitancy. Additionally, mistrust in governmental institutions and the pharmaceutical industry negatively influenced vaccine acceptance. A lack of perceived risk of diseases that were historically preventable by vaccines also contributed to hesitancy. Consequences identified include the resurgence of diseases, increased infant morbidity and mortality, and strain on healthcare systems.
From a bioethical perspective, although parents have the right to make decisions regarding their children's health, this autonomy is not absolute and must be balanced with the child's and community's well-being. Healthcare professionals have a duty to promote good, prevent harm, and encourage vaccination as a means to protect both the child and others. Equity in access and distribution of vaccines is essential to ensure equal protection opportunities for all.
Implications: Physicians and medical organizations must provide continuous ethical guidance and evidence-based information, acting with legal and moral responsibility. Recommending against vaccination without scientific justification may result in legal and ethical consequences and undermine trust in medicine. To address childhood vaccine hesitancy, this study employed a multidisciplinary approach that included a continuing education program and effective communication strategies. Clear and accessible informational campaigns were developed to clarify doubts and correct misconceptions. Engaging community and religious leaders to promote vaccine acceptance proved important. We also called on governments to implement policies that encourage vaccination and facilitate access to immunization services. Rebuilding trust will depend on transparent and consistent communication from health authorities. Preliminary data suggest an improvement in vaccination indicators this year, with coverage increasing to 67%. Ongoing research is necessary to monitor vaccine hesitancy trends and assess the effectiveness of interventions.