Vaccination rates are declining for two essential vaccines - the MMR (measles, mumps, rubella) vaccine and the pneumococcal vaccine, with identified causes including misinformation on social media, the elimination of school vaccinations and isolation in rural areas, according to the study 'Barriers to Vaccination in Rural Areas: Perspectives of Family Doctors and Community Nurses,' launched by the Save the Children Romania organisation on Thursday.

Thus, the analysis of vaccination coverage data for the period 2020-2024 highlights a worrying downward trend for two of the mandatory vaccines: the MMR (measles, mumps, rubella) vaccine and the conjugated pneumococcal vaccine.

'More and more parents are choosing not to vaccinate their children, which has led to a progressive decrease in vaccination coverage rates for MMR, especially for the second dose administered at age 5. While acceptance for the first dose is relatively good, the rate drops dramatically for the booster shot, reaching as low as 20% in some communities, whereas Romania has recorded 77.8% of all measles cases in the EU,' the study points out.

The study uses a qualitative approach, analysing the perspectives of community nurses and family doctors who oversee over 11,000 children in rural areas. The sample is convenience-based and comes from rural areas in nine counties (Arges, Bihor, Brasov, Constanta, Dolj, Hunedoara, Olt, Sibiu and Timis).

'Particularly concerning is the disproportionate impact on children under one year of age, with three of the measles-related deaths recorded among children aged between 7 and 8 months, who were not yet eligible for vaccination,' the study also mentions.

The document identified four main types of barriers to vaccination from the perspective of family doctors and community nurses:
- Attitudinal and behavioral barriers include post-COVID-19 reluctance, outright refusal in some communities, and fear of adverse reactions;
- Socio-cultural barriers are represented by cultural, linguistic and religious aspects, as well as the high mobility of families;
- Informational barriers include the negative impact of the media, misinformation on social media, and myths about vaccination, which are major obstacles.

Additionally, there are systemic barriers, such as excessive bureaucracy, lack of material resources, the elimination of school vaccinations and lack of transportation.

The analysis of the interviews shows that the relationship between family doctors and parents is complex and varies significantly. Many doctors report avoidance behaviours from parents, who consistently postpone vaccinations and refuse to formally acknowledge their decision in writing.

In addition, in their interactions with parents, doctors notice that the fear of adverse reactions and the lack of perception regarding the seriousness of vaccine-preventable diseases represent significant obstacles in convincing parents to vaccinate their children.

To increase vaccination rates, doctors identify multiple and interconnected needs. At the national level, they call for stricter legislation regarding vaccination and more intensive media campaigns for information and education. At the local and operational level, the main needs include: expanding the community healthcare network, reducing bureaucracy in vaccination reporting, ensuring transportation for patients to clinics, and better involvement of minority representatives. A frequently mentioned specific need is the reintroduction of school vaccinations, which in the past ensured better vaccination coverage rates. Doctors also emphasise the importance of developing their own communication skills through participation in specialised courses.

Executive President of Save the Children Romania Gabriela Alexandrescu underscores the importance of integrated social policies that ensure access to education and healthcare services for children and parents.

'When we talk about vulnerable socio-economic groups, we must develop programmes through which they can benefit from easy access to vaccination,' Alexandrescu is quoted in a press release as saying.

The study was conducted by the Public Health Department of Babes-Bolyai University, as part of the 'Mother and Child Health' programme, implemented by Save the Children Romania, and was funded by MSD Romania. AGERPRES (RO - writing by: Roberto Stan; En - writing by: Adina Panaitescu)