Davao Doctors College, Inc.

General Malvar St., Davao City

Nursing Program

A SURVEY ON VACCINE ACCEPTANCE

A Research Paper
Presented to the Nursing Clinical Instructors
of Davao Doctors College, Inc.

In Partial Fulfillment of the Requirements in

NRG206: Nursing Informatics

Submitted by:
Jun, Hannah Orzales
Languido, Karen May Magallon
Lorente, Edzel Mae Villanueva
Magallon, Jaidelo Adao
Millanes, Christian Dan Vinson
Mondala, Emma Maunla
Montas, Oscar Jr. Magbanua
Niebres, Michelle Anne Ugdang
Obenza, Roxan Ellana
Ontonga, Junaidah Diagoni

July 2021
Background of the Study

One of the critical steps to ending the spread of diseases or viruses is the

acceptance of vaccines by the public. According to the World Health Organization

(2021) vaccination is a simple, safe, and effective way of protecting people

against harmful diseases, before they come into contact with them. It uses your

body’s natural defenses to build resistance to specific infections and makes your

immune system stronger. Vaccines train your immune system to create

antibodies, just as it does when it’s exposed to a disease. However, because

vaccines contain only killed or weakened forms of germs like viruses or bacteria,

they do not cause the disease or put you at risk of its complications. With that

information, some people are still hesitant to receive vaccines due to a lack of

knowledge and misinformation about it. The intention of this survey is to measure

the vaccine acceptance among first-year nursing students of a specific section

enrolled in a Private Higher Education Institution in Davao City. This study was

based on another study that was done by (Sarathchandra et al., 2018) titled “A

survey instrument for measuring vaccine acceptance”. The data collection of this

study was also conducted through an online survey that was done for easy

access of the participants.

RESULTS AND DISCUSSIONS

1. What is the demographic profile of respondents in terms of age, sex, and

year level?

Table 1. Demographic Profile of the Respondents

Demographic Frequency (n=28) Percentage (%)
Profile
 Age

18 - 21 years old 26 92.86

22- 25 years old 2 7.14

Total 28 100

Sex

Male 8 28.57

Female 19 67.86

Prefer not to say 1 3.57

Total 28 100

Year Level

First Year 28 100

Total 28 100

Table 1 presents the demographic profile of the respondents in terms of age,

gender, and year level. Results show that the majority of the respondents were aged

between 18 to 21 years old (26 out of 28; 92.86%) and were first-year students (28 out

of 28; 100%). The majority of the respondents were also female (19 out of 28; 67.86%),

male (8 out of 28; 28.57%), and prefer not to say (1 out of 28; 3.57%).

2. What is the level of Vaccine Acceptance of the respondents in terms of

Perceived Safety of Vaccines, Perceived Effectiveness and Necessity of

Vaccines, Acceptance of the Selection and Scheduling of Vaccines, Positive

Values and Affect toward Vaccines, and Perceived Legitimacy of Authorities to

Require Vaccinations?

Table 2. VACCINE ACCEPTANCE SURVEY

Statements Mean Description
Perceived Safety of Vaccines

1. Vaccines are safe 5.39 Moderately Agree

2. Vaccines contain 3.39 Slightly Disagree

mercury in dangerous
amounts

3. Vaccines contain 3.46 Slightly Disagree

dangerous ingredients

4. Vaccines cause autism 2.96 Slightly Disagree

Categorical Mean 3.80 I'm not sure

Perceived Effectiveness and

Necessity of Vaccines

5. Some vaccines are 3.79 I'm not sure

unnecessary since they
target relatively harmless
diseases.

6. Diseases provide 3.39 Slightly Disagree

better immunity than
vaccines do.

7. Vaccines are effective at 5.36 Moderately Agree

preventing diseases.

8. Many of the illnesses 5.46 Moderately Agree

that vaccines prevent are
severe.

Categorical Mean 4.50 Slightly Agree

Acceptance of the Selection

and Scheduling of Vaccines

9. We give children the 5.32 Moderately Agree

right number of
vaccines.

10. The timing of the 5.14 Slightly Agree

current vaccination
schedule is appropriate.
 11. We give vaccines to 4.36 I’m not sure
children when they are too
young.

12. We give children too 3.57 Slightly Disagree

many vaccines.

Categorical Mean 4.60 Slightly Agree

Positive Values and Affect

toward Vaccines

13. I'm morally opposed to 3.86 I'm not sure

vaccinating my child.

14. Vaccines conflict with 3.54 Slightly Disagree

my belief that children
should use natural
products and avoid toxins.

15. Vaccines are a major 5.04 Slightly Agree

advancement for
humanity.

16. Vaccines are 2.36 Moderately

disgusting to me. Disagree

Categorical Mean 3.70 I’m not sure

Perceived Legitimacy of
Authorities to Require
Vaccinations

17. The government 4.93 Slightly Agree

should not force children
to get vaccinated to
attend school.

18. My right to consent to 6.04 Moderately Agree

medical treatment means
that vaccinations should
always be voluntary.

19. To protect public 6.07 Moderately Agree

health, we should follow
government guidelines
about vaccines.
 20. It is legitimate for the 5.32 Moderately Agree
government to mandate
vaccinations.
Categorical Mean 5.59 Moderately Agree

Overall Mean 4.44 Slightly Agree

Legend: Strongly disagree (1.00-1.85), Moderately disagree (1.86-2.71), Slightly

disagree (2.72-3.57), I’m not sure (3.58-4.43), Slightly agree (4.44-5.29), Moderately
agree (5.30-6.15) and Strongly agree (6.16-7.00)

Table 2 presents the Vaccine Acceptance Survey of the respondents in terms of

the perceived safety of vaccines, perceived effectiveness and necessity of vaccines,

acceptance of the selection and scheduling of vaccines, positive values and affect

towards vaccines, and perceived legitimacy of authorities to require vaccinations.

In terms of the perceived safety of vaccines, results show that the respondents

moderately agree on item 1, “Vaccines are safe”. This item got the highest mean under

the perceived safety of vaccines of 5.39, which was qualitatively described as

moderately agree. This result suggests that the students agreed that the vaccines are

safe. Vaccines work by teaching and preparing the immune system to recognize and

fight viruses and germs. This result agrees with the findings of the World Health

Organization (2020) who stated that vaccines work by training and preparing the body’s

natural defenses which is the immune system to recognize and fight off viruses and

bacterias. In addition, this is also supported by the findings of Stanford Children’s

Organization (2021) who affirmed that vaccines are safe and fully tested before being

approved for use by the FDA. Moreover, the Healthy Children Organization (2021)
supported these results, stating in their study that vaccines can save lives and protect

against the spread of disease.

On the other hand, the result shows that respondents slightly disagree that

vaccines can cause autism. This item got the lowest mean under the perceived safety of

vaccines of 2.96, which was qualitatively described as slightly disagree. This result

suggested that the respondents slightly disagree that vaccines can cause autism. This

result agrees with the study of the US Centers for Disease Control and Prevention

(2020), which stated that Thimerosal, one ingredient of vaccines that have been

researched in particular, does not cause autism, according to research. In addition, this

is also supported by the findings of Dr. Joseph (2019) who affirmed that there is no

connection between vaccines and autism. Because autism is a neurological disorder

that makes communicating and connecting with other people more challenging.

Children’s development of illness is thought to be influenced by genetics, changes in

brain structure, and hazardous substances in the environment. Moreover, the History of

Vaccines Organization (2018) supported these results, stating in their study that the

majority of scientific and medical authorities believe there is no link between vaccines

and autism or other neurological disorders. Most autism researchers believe that there

are multiple causes of autism, including genetic and environmental factors, but that

vaccines are not one of them.

Overall, the categorical mean for the perceived safety of vaccines generated a

mean of 3.80, qualitatively described as I’m not sure. This result implies that the

respondents, in terms of the perceived safety of vaccines, were not sure. These results

disagree with the finding of the American Academy of Family Physicians (2021), which
stated that before a new vaccination is offered to the public, it undergoes intensive

laboratory testing to guarantee its safety and efficacy. It can take several years for

clinical studies to be completed and the vaccine to be licensed once human testing

begins. In addition, Michelle Roberts of BBC News (2021), disagrees with the finding

stating that before going on to human investigations, safety trials of vaccines begin in

the lab with tests and research on cells and animals. Moreover, the Vaccinate

Organization disagrees with the result, stating in their study that vaccines are subjected

to extensive safety testing before being licensed. Vaccination has been examined for at

least 15 to 20 years in tens of thousands of study participants, by thousands of

scientists, statisticians, and health care providers, before it is made available to the

public.

In terms of perceived effectiveness and necessity of vaccines, results show that

the respondents moderately agree on item 8, “Many of the illnesses that vaccines

prevent are severe”. This item got the highest mean under the perceived effectiveness

and necessity of vaccines of 5.46, which was qualitatively described as moderately

agree. This result suggests that the students agreed that vaccines protect against a

wide range of illnesses, many of which are life-threatening. These deadly diseases are

chickenpox, diphtheria, flu, hepatitis A, hepatitis B, Hib, HPV, measles, meningococcal,

mumps, pneumococcal, polio, rotavirus, rubella, shingles, tetanus, and whooping

cough. This result agrees with the findings of the US Centers for Disease Control and

Prevention (2016) who stated vaccines are available for MMR, hepatitis A and B,

tetanus, and other deadly diseases. Over the years, these vaccines have saved millions

of lives and avoided countless incidences of diseases over the years. In addition, this is
also supported by the findings of the US Centers for Disease Control and Prevention

(2018) who affirmed that vaccines are necessary for all of us throughout our lives to

help protect us from dangerous diseases. Every year, tens of thousands of people in the

United States become ill from diseases that may be prevented with vaccines; some are

hospitalized, and some even die. Moreover, Vaccinate Your Family Organization (2021)

supported these results, mentioned in their study that diseases that vaccines protect

against are chickenpox, COVID-19, Diphtheria, Hib, Hepatitis A and B, HPV, influenza,

measles meningococcal disease, mumps, pneumococcal disease, polio, and some

other deadly diseases.

On the other hand, the result shows that respondents slightly disagreed on

whether diseases provide better immunity than vaccines do. This item got the lowest

mean under the perceived effectiveness and necessity of vaccines of 3.39, which was

qualitatively described as slightly disagree. This result suggested that the respondents

slightly disagree whether vaccines do not provide the same level of immunity, unlike

diseases. This result disagrees with the findings of Klein (2021) a virologist who stated

that you have some protection if you’ve been infected. However, that immunity has its

limits. The most significant limitation is that it does not last as long as we would like.

Vaccination has been shown in studies to provide significant benefits to persons who

have been infected. It provides them with a powerful and long-lasting immune boost. In

addition, this disagrees with the findings of Hickman (2020), who affirmed that your

immune system goes through this process of recognizing the virus and subsequently

producing effective antibodies when you generate antibodies through natural infection.

On the other hand, vaccination is a method for your body to develop protective immunity
without first becoming ill. Moreover, Bai (2021) disagreed with these results, stating in

his study that the response of natural immunity and immunity from vaccines may be

similar whether that first encounter is from infection with the virus or from the first dose

of the vaccine. He also suggests getting the second dose of a vaccine so that the

immune response is bigger, better, and lasts longer than merely becoming infected.

Overall, the categorical mean for perceived effectiveness and necessity of

vaccines generated a mean of 4.50, qualitatively described as slightly agree. This result

implies that the respondents in terms of perceived effectiveness and necessity of

vaccines were slightly agreed. These results disagree with the finding of Baldoli,

Michon, Verdon, & Fournier (2020) who stated in their study that among 542 health care

students, 530 or 97.8% students perceived vaccines as effective and secure. In

addition, this is also disagreed by the findings of the study of Mizuta, Succi, G., Montalli,

& Succi, R.C. (2019) who affirmed that adequate immunization is the best way to

protect yourself against infectious diseases. Moreover, Family Doctors Organization

(2021) disagrees with these results, stating in their study that vaccinations are an

essential aspect of both personal and public health. Vaccines are important because

they help to prevent the spread of diseases that are contagious, hazardous, and deadly.

In terms of acceptance of the selection and scheduling of vaccines, results show

that the respondents moderately agreed on item 9, “We give children the right number

of vaccines”. This item got the highest mean under the acceptance of the selection and

scheduling of vaccines of 5.32, which was qualitatively described as moderately agree.

This result suggests that the students agreed that we are giving the right number of

vaccines to children, mostly attributed to the fact that vaccines have been shown to
prevent and reduce the prevalence of vaccine-targeted diseases. According to the U.S.

Centers for Disease Control and Prevention (2021), that from birth to 18 years of age,

children are recommended to be given approximately 14 vaccines with some requiring

multiple doses at specific ages and times. If we calculate the total doses that children

receive for each vaccine from birth to 18 years old, we get 48 shots (Vaccine

Information, 2021). This result agrees with the study of the U.S. Centers for Disease

Control and Prevention (2018) that the number of vaccines administered to a child is

correlated to the susceptibility of the recipient to the disease and the amount of time for

the immune system to develop and maintain immunity against the disease.

On the other hand, the results show that the respondents are not sure about item

12, “We give children too many vaccines”. This item got the lowest mean with 3.57,

which was qualitatively described as slightly disagreed. This result suggested that the

students slightly disagree that we give too many vaccines to children which can be

related to the public trust towards the government’s efforts on vaccinations and

immunizations. This result agrees with the findings of Daley, et al. (2018) in which their

study stated that there was no significant difference in estimated cumulative vaccine

antigen exposure through the first 23 months of life among children from 24 to 47

months of age with or without vaccination visits. From this data, we can conclude that

vaccines don’t weaken the immune system of a child regardless of the amount of

antigen exposure from an early age. In fact, according to the U.S. Centers for Disease

Control and Prevention (2020), that getting multiple vaccines at the same time does not

cause any chronic health problems. They also stated in the same article that a variety of

studies have been conducted to examine the effects of administering various vaccine
combinations, and when a new vaccine is approved, it is evaluated alongside the

vaccines previously recommended for a given age group.

Overall, the categorical mean for the acceptance of the selection and scheduling

of vaccines generated a mean of 4.60, qualitatively described as slightly agree. This

implies that the respondents slightly agree with the selection and scheduling of vaccines

because the fact that adhering to schedules and the vaccines are given, contributed to

the decline in cases of common and serious vaccine-preventable diseases like

diphtheria, Haemophilus influenzae serotype b infection, hepatitis B, measles,

meningitis, mumps, pertussis, poliomyelitis, rubella, tetanus, tuberculosis, and yellow

fever. These results agree with the findings of Muathe, Kamau, and Rajula (2020),

which stated that only 54.9% adhered to the immunization schedules mostly consisting

of educated and married couples. However, this result disagrees with the study of

Kurosky, Davis, and Krishnarajah (2017), which stated that vaccination at age-

appropriate intervals compliance rates remained low which was partly related to a

complicated vaccination schedule. Moreover, according to Hadjipanayis (2019),

adherence to schedule, acceptance of the vaccines, and wide vaccination coverage are

critical for providing the community with the maximum effectiveness against vaccine-

preventable diseases.

In terms of positive values and affect towards vaccines, the result shows that the

respondents slightly agree on item 15, “ Vaccines are a major advancement for

humanity.” This item got the highest mean under positive values and affect towards

vaccines of 5.04, which was qualitatively described as slightly agree. This result

suggests that students agreed that vaccines are a major advancement of humanity.
Vaccines have made a fundamental, cost-effective contribution to the prolongation of

expectancy and quality of life. This result agrees with the World Health Organization

(2021) findings that vaccines reduce the risks of acquiring a disease by working with

your body’s natural defenses to build protection. Vaccination is an effective way of

safeguarding an individual’s health against harmful viruses before contacting them. In

addition, this is also supported by the study of the Centers for Disease Control and

Prevention (2016), who affirmed that vaccines have prevented numerous disease cases

and saved millions of lives through the years. Moreover, the Public Health Organization

(2021) supported these results by stating in their study that vaccines protect the entire

population, so once enough people are immunized, there is a low possibility for an

outbreak of disease.

On the other hand, the result shows the respondent moderately disagrees that

vaccines are disgusting. This item got the lowest mean under the positive values and

affect towards vaccines of 2.36, which was qualitatively described as moderately

disagree. This result suggested that the respondent moderately disagrees that vaccines

are disgusting. This result agrees with the study of (Anderson et al.,2018) vaccines

become an instrument and contribute to worldwide reductions in morbidity and mortality

by diminishing the incidence of serious infectious diseases. In addition, this is also

supported by the World Health Organization (2021) vaccines have securely reduced the

scourge of conditions and are considered the greatest advances in global health.

Moreover, the Department of Health (2021) supported this result by stating vaccines

imitate the virus or bacteria that cause disease and stimulates the body’s creation of
antibodies. These antibodies protect the infected person with the actual disease-

causing virus or bacteria.

The overall categorical mean for positive values and affect towards vaccines

generated a mean of 3.70 qualitatively described as I’m not sure. This result implies that

the respondents were not sure about positive values and affect towards vaccines. This

result correlates with the study of (Handy et al., 2017) vaccine acceptance is a critical

component of sustainable immunization programs, yet rates of vaccine hesitancy are

rising. In addition, (Smith et al., 2020) stated that the degree to which the public

incorporates misinformation depends on contextual factors such as trust in government

and associated institutions. If levels of trust are low and people cannot access reliable

information on vaccines, ‘misinformation narratives rush in to fill the vacuum. Moreover,

(Thornloe et al., 2020) stated in their study that public health communications ‘play a

key role in informing the public on managing risks during public health pandemics.

In terms of the perceived legitimacy of authorities to require vaccinations, the

results show that the respondents moderately agree on item 19, “To protect public

health, we should follow government guidelines about vaccines”. This item got the

highest mean under the perceived legitimacy of authorities to require vaccinations with

6.07, which was qualitatively described as moderately agreed. This result suggests that

the students moderately agree that we need to follow government guidelines about

vaccines to protect the community. This agrees with the findings of the Philippine

Department of Health (2021), which states that one of the reasons for the outbreak of

measles last January 1 to February 9, 2021, was because of vaccine hesitancy that

caused a total of 4,302 measles cases, with 70 deaths. Vaccine hesitancy refers to the
delay in acceptance or total refusal of receiving vaccines despite its availability and

guidelines of the government, which can lead to endangering the community. According

to the U.S. Department of Health and Human Services (2021), vaccines protect the

community by the concept called herd immunity, which is defined as when a large

portion of a community becomes immune to a disease, lowering the chances of disease

from spreading (Mayo Clinic, 2021). It was also mentioned in the same article that even

unvaccinated people will have some protection from getting sick if herd immunity is

achieved and that there's less chance of an outbreak because it’s harder for the disease

to spread.

On the other hand, the results show that the respondents slightly agree on item

17, “The government should not force children to get vaccinated to attend school”. This

item got the lowest mean of 4.93, which was qualitatively described as slightly agree.

This result suggests that the students slightly agree that the government should not

force children to get vaccinated in order to attend school. This is related to the violation

of their autonomy to choose what to do with their body and overall health. According to

McMillan (2021), the legal status of requiring immunization for particular activities, both

public and private, differs greatly between countries. Vaccination policies in several

countries are considered "mandatory" to the point where children without specific

vaccines are unable to attend school and/or their parents face fines or even

incarceration. This result agrees with the study of Grzybowski, Patryn, Sak, and Zagaja

(2017), that in the year 2015, through the Bill SB 277, three states, namely California,

West Virginia, and Mississippi, have already prohibited the exemptions from

immunization based on philosophical and/or religious beliefs. With respect to their

autonomy, the new law prohibits children from being admitted to private and public

nurseries, primary and secondary schools (and other public social institutions) unless

they have had all of their vaccinations according to the prescribed schedule. This does

not apply to children who are exempted due to a medical condition or who are

homeschooled. When implemented, this option restricts the availability of public and

private education while allowing parents the right to choose.

Overall, the categorical mean for the perceived legitimacy of authorities to require

vaccinations generated a mean of 5.59, qualitatively described as moderately agree.

This implies that the respondents moderately agree with the legitimacy of authorities to

require vaccinations. According to the United Nations Inter-agency Group for Child

Mortality Estimation (2020), in the year 2019, the total number of under-five mortality

rates dropped from 28.04 (2018) to 27.28 (2019). While this is still a relatively small

difference, the Philippine government has aimed to end preventable deaths of newborns

and children under the age of five by 2030, with all nations aiming to reduce neonatal

mortality to 12 per 1,000 live births and under-5 mortality to 25 per 1,000 live births as

part of the United Nations Sustainable Development Goals, specifically, Goal 3 (Good

Health and Well-Being), stated in the Philippine Statistics Authority article (2021).

In terms of overall mean, our results show that the respondents slightly agree

with our study about vaccine acceptance, with a generated mean of 4.44, which is

qualitatively described as slightly agree. This is mainly due to the fact that most of the

public views about the vaccine have been eroded with politics and vaccine

misinformation. This agrees with the study of Kreps et al. (2020), who stated in their

study that vaccine-related attributes and political factors were related to preferences in
choosing a vaccine. It was also stated in the same study that health attitudes and

practices, political affiliation, and demographic characteristics were related to

willingness to receive a vaccination. Health attitudes and practices and vaccine

acceptance were also discussed to be correlated with the free-riding behavior of

vaccination (Ibuka, Li, Vietri, Chapman & Galvani, 2014). Free-riding behavior refers to

the ability of each individual’s decision to base on other people’s decisions. This is also

supported by the study of Hacquin, Altay, Araujo, Chevalier & Mercier (2020), who

stated that subjective and objective factors are affiliated with vaccine acceptance,

stating that those factors affected and influenced the decision making of the participants

towards vaccination.

The increasing number of factors affecting vaccine acceptance was always

viewed to be a major barrier in vaccine deployment and proliferation. Political

polarization should be excluded in the decision-making process of vaccine acceptance,

rather, focus on understanding and increasing trust for the healthcare professionals and

scientists in the field. Indeed, this pattern shows that public health communication

strategies should stress the credibility of scientists, medical experts, and public health

officials to enhance vaccine acceptance among the public.

 References

Anderson, E. J., Daugherty, M. A., Pickering, L. K., Orenstein, W. A., & Yogev, R.

(2018). Protecting the Community Through Child Vaccination. Clinical Infectious

Diseases, 67(3), 464–471. https://doi.org/10.1093/cid/ciy142

Baldolli, A., Michon, J., Verdon, R., & Fournier, A. (2020). Vaccination perception

and coverage among healthcare students in France in 2019. BMC Medical

Education, 20(1). https://doi.org/10.1186/s12909-020-02426-5

Bateman, W., Deo, R., Nocco, L., & Constable, M. (2020). COVID-19

Vaccination: Reducing vaccine hesitancy Review & Recommendations Reducing

vaccine hesitancy. https://www.bsphn.org.uk/_data/site/54/pg/675/COVID-19-

Vaccination-Reducing-Vaccine-Hesitancy.pdf

Ben-Joseph, E. P. (2019). Is There a Connection Between Vaccines and

Autism? (for Parents) - KidsHealth. Kidshealth.org.

https://kidshealth.org/en/parents/autism-studies.html

CDC. (2020, January 14). Things You Need to Know about Vaccines. Centers for

Disease Control and Prevention. https://www.cdc.gov/vaccines/vac-

gen/vaxwithme.html

CDC/NCIRD. (2018). Understanding How Vaccines Work.

https://www.cdc.gov/vaccines/hcp/conversations/downloads/vacsafe-understand-

color-office.pdf

Centers for Disease Control and Prevention. (2019). Birth-18 Years

Immunization Schedule. Centers for Disease Control and Prevention.

https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html

Centers for Disease Control and Prevention. (2020, August 25). Vaccines Do Not

Cause Autism Concerns. Centers for Disease Control and Prevention.

https://www.cdc.gov/vaccinesafety/concerns/autism.html

Department of Health. (2021). FAQs: Vaccines | Department of Health website.

Doh.gov.ph. https://doh.gov.ph/faqs/vaccines

DOH IDENTIFIES VACCINE HESITANCY AS ONE OF THE REASONS FOR

MEASLES OUTBREAK | Department of Health website. (2018). Doh.gov.ph.

https://doh.gov.ph/node/16721
Easy-to-read Immunization Schedule by Vaccine for Ages Birth-6 Years. (2019).

Centers for Disease Control and Prevention.

https://www.cdc.gov/vaccines/schedules/easy-to-read/child-easyread.html

Glanz, J. M., Newcomer, S. R., Daley, M. F., DeStefano, F., Groom, H. C.,

Jackson, M. L., Lewin, B. J., McCarthy, N. L., McClure, D. L., Narwaney, K. J.,

Nordin, J. D., & Zerbo, O. (2018). Association Between Estimated Cumulative

Vaccine Antigen Exposure Through the First 23 Months of Life and Non–

Vaccine-Targeted Infections From 24 Through 47 Months of Age. JAMA, 319(9),

906. https://doi.org/10.1001/jama.2018.0708

Grzybowski, A., Patryn, R. K., Sak, J., & Zagaja, A. (2017). Vaccination refusal.

Autonomy and permitted coercion. Pathogens and Global Health, 111(4), 200–

205. https://doi.org/10.1080/20477724.2017.1322261

Hacquin, A.-S., Altay, S., Araujo, E., Chevallier, C., & Mercier, H. (2021). Sharp

rise in vaccine hesitancy in a large and representative sample of the French

population: reasons for vaccine hesitancy. Psyarxiv.com.

https://psyarxiv.com/r8h6z/

Hadjipanayis, A. (2019). Compliance with vaccination schedules. Human

Vaccines & Immunotherapeutics, 15(4), 1003–1004.

https://doi.org/10.1080/21645515.2018.1556078

Handy, L. K., Maroudi, S., Powell, M., Nfila, B., Moser, C., Japa, I., Monyatsi, N.,

Tzortzi, E., Kouzeli, I., Luberti, A., Theodoridou, M., Offit, P., Steenhoff, A., Shea,

J. A., & Feemster, K. A. (2017). The impact of access to immunization

information on vaccine acceptance in three countries. PLOS ONE, 12(8),

e0180759. https://doi.org/10.1371/journal.pone.0180759

Hickman, R. J. (2020, December 24). What’s the Difference Between Antibodies

From Infection and Vaccines? Verywell Health.

https://www.verywellhealth.com/antibodies-from-vaccines-and-from-natural-

infection-5092564

Ibuka, Y., Li, M., Vietri, J., Chapman, G. B., & Galvani, A. P. (2014). Free-Riding

Behavior in Vaccination Decisions: An Experimental Study. PLoS ONE, 9(1),

e87164. https://doi.org/10.1371/journal.pone.0087164

Infant and Child Vaccines - Vaccines You Need - When Do Infants and Children

Need Vaccines? (2019). Vaccineinformation.org.

https://vaccineinformation.org/infants-children/schedules.asp

Information, N. C. for B., Pike, U. S. N. L. of M. 8600 R., MD, B., & Usa, 20894.

(2008). Immunization and other public health measures. In

www.ncbi.nlm.nih.gov. World Health Organization.

https://www.ncbi.nlm.nih.gov/books/NBK143735/

Kreps, S., Prasad, S., & Brownstein, J. (2020, October 20). Validate User.

Jamanetwork.com.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2771872

Kurosky, S. K., Davis, K. L., & Krishnarajah, G. (2017). Effect of combination

vaccines on completion and compliance of childhood vaccinations in the United

States. Human Vaccines & Immunotherapeutics, 13(11), 2494–2502.

https://doi.org/10.1080/21645515.2017.1362515
Mayo Clinic. (2020, December 15). Herd immunity and COVID-19 (coronavirus):

What you need to know. Mayo Clinic. https://www.mayoclinic.org/diseases-

conditions/coronavirus/in-depth/herd-immunity-and-coronavirus/art-20486808

McMillan, A. (2021, March 19). Mandatory vaccination: legal, justified, effective?

Www.ibanet.org. https://www.ibanet.org/article/70e1f93e-a23b-4f1a-a596-

aeef84750241

Mizuta, A. H., Succi, G. de M., Montalli, V. A. M., Succi, R. C. de M., Mizuta, A.

H., Succi, G. de M., Montalli, V. A. M., & Succi, R. C. de M. (2019).

PERCEPÇÕES ACERCA DA IMPORTÂNCIA DAS VACINAS E DA RECUSA

VACINAL NUMA ESCOLA DE MEDICINA. Revista Paulista de Pediatria, 37(1),

34–40. https://doi.org/10.1590/1984-0462/;2019;37;1;00008

Muathe, E. C., Kamau, M., & Rajula, E. (2020, August 11). Exploring Strategies

to Improve Adherence to Immunization Schedule: A Study among Children

Attending Maternal and Child Health Clinic at Kenyatta National Hospital,

Nairobi, Kenya. International Journal of Pediatrics.

https://www.hindawi.com/journals/ijpedi/2020/4730205/

Multiple Vaccines and the Immune System. (2019). Centers for Disease Control

and Prevention. https://www.cdc.gov/vaccinesafety/concerns/multiple-vaccines-

immunity.html

Offit, P. (2021, June 2). Vaccines & Diseases. Vaccinate Your Family.

https://vaccinateyourfamily.org/vaccines-diseases/
Paterson, P., Meurice, F., Stanberry, L. R., Glismann, S., Rosenthal, S. L., &

Larson, H. J. (2016). Vaccine hesitancy and healthcare providers. Vaccine,

34(52), 6700–6706. https://doi.org/10.1016/j.vaccine.2016.10.042

Philippine Statistics Authority | Republic of the Philippines. (2021). Psa.gov.ph.

https://psa.gov.ph/sdg/Philippines/baselinedata/3%20Good%20Health%20and

%20Well-being

Policy (OIDP), O. of I. D. and H. (2021, April 26). Vaccines Protect Your

Community. HHS.gov.

https://www.hhs.gov/immunization/basics/work/protection/index.html

Recommended Vaccinations by Age. (2019). CDC.

https://www.cdc.gov/vaccines/vpd/vaccines-diseases.html

Recommended Vaccinations by Age | CDC. (2020, July 21). Www.cdc.gov.

https://www.cdc.gov/vaccines/vpd/vaccines-diseases.html#recommended

Roberts, M. (2020, November 24). Covid vaccines: Who decides if they are safe?

BBC News. https://www.bbc.com/news/health-55056016

Shu, J. (2019). Vaccine Safety: The Facts. HealthyChildren.org.

https://www.healthychildren.org/english/safety-

prevention/immunizations/pages/vaccine-safety-the-facts.aspx

Simpson, B. W., & Health, J. B. S. of P. (2021, May 28). Why COVID-19

Vaccines Offer Better Protection Than Infection. Johns Hopkins Bloomberg

School of Public Health. https://www.jhsph.edu/covid-19/articles/why-covid-19-

vaccines-offer-better-protection-than-infection.html
Smith, M. (2019, December). Effectiveness and Safety of Childhood Vaccination

- Pediatrics. MSD Manual Professional Edition.

https://www.msdmanuals.com/professional/pediatrics/childhood-

vaccination/effectiveness-and-safety-of-childhood-vaccination#v6524142

Staff Writers. (2011). How Vaccines Work | PublicHealth.org. PublicHealth.org;

PublicHealth.org. https://www.publichealth.org/public-awareness/understanding-

vaccines/vaccines-work/

Stewart, A. (2020). Vaccines Are Safe, Effective and Save Lives. Www.aafp.org.

https://www.aafp.org/news/media-center/kits/vaccines-are-safe-effective-and-

save-lives.html

Thorneloe, R., Wilcockson, H. E., Lamb, M., Jordan, C. H., & Arden, M. (2020).

Willingness to receive a COVID-19 vaccine among adults at high-risk of COVID-

19: a UK-wide survey. Willingness to Receive a COVID-19 Vaccine among

Adults at High-Risk of COVID-19: A UK-Wide Survey.

https://doi.org/10.31234/osf.io/fs9wk

Vaccines and the diseases they prevent. (n.d.). Www.unicef.org.

https://www.unicef.org/parenting/health/vaccines-and-diseases-they-prevent

Welch, M. (2021). default - Stanford Children’s Health. Stanfordchildrens.org.

https://www.stanfordchildrens.org/en/topic/default?id=what-every-parent-should-

know-about-immunizations-1-1750

World Health Organization. (2020, December 31). Vaccines and immunization:

What is vaccination? Www.who.int. https://www.who.int/news-room/q-a-

detail/vaccines-and-immunization-what-is-vaccination
World Health Organization. (2020, October 19). Vaccines and immunization:

Myths and misconceptions. www.who.int. https://www.who.int/news-room/q-a-

detail/vaccines-and-immunization-myths-and-misconceptions