Keywords: Vaccine hesitancy, parental concerns, childhood vaccination, Albania.

Background:

Vaccine hesitancy (VH) is an increasing global concern, contributing to vaccine-preventable disease outbreaks in the last decade. In Albania, childhood immunisation coverage decreased from 94% in 2008–2009 to 75% in 2017–2018. In 2023, the World Health Organization (WHO) reported suboptimal 83% coverage for the first dose of the MMR vaccine. Evidence on the sociodemographic determinants, parental beliefs, and sources of vaccine-related concerns in Albania remains limited.

Research questions:

This study aims to identify the most hesitated and refused childhood vaccines, and to assess frequently reported parental concerns, behaviours and attitudes toward vaccinating children aged 0–18 years across all Albanian regions.

Method:

A cross-sectional survey with 4,082 randomly selected parents and legal caregivers of children aged 0–18 years (response rate 90.2%). Data were collected using a validated, anonymous questionnaire administered at randomly selected primary healthcare centres across Albania. The questionnaire asked for sociodemographic information, and elicited information on vaccine-related behaviours, attitudes, and beliefs by using questions with ‘yes/no’ and multiple-choice answers, as well as Likert-scale questions.

Results:

Among mandatory vaccines, MMR showed the highest hesitancy (15.3%) and refusal (5.0%). Hesitancy for DTP (5.5%), Hepatitis B (5.5%), and Hib (5.3%) was lower, with refusal rates for Pentavalent, Rotavirus, and PCV around 3%. Overall, 27.3% self-reported VH and 17.6% reported vaccine refusal. Common concerns among hesitant and refusing parents were vaccine safety or side effects (56% and 59%), negative media influence (32% and 30%), second-hand accounts of adverse reactions (26% and 25%), and beliefs that vaccines were unnecessary (19% and 22%).

Conclusions:

Addressing VH in Albania requires a multifaceted strategy involving parental education, trust-building, responsible media communication, and strong healthcare support. Tailored approaches using trusted community and healthcare professionals are critical to increasing childhood vaccine uptake.

Points for discussion:

1. What parental attitudes and concerns are associated with childhood VH in your country?

2. What are the similarities and differences among related parental attitudes and concerns about childhood vaccination in your country?

3. What are some targeted interventions that you use to improve childhood VH in your country?