Measles vaccine hesitancy among mothers in Yerevan, Armenia: A qualitative study

Measles is a highly contagious disease with significant morbidity and mortality, particularly among children under five. Despite the availability of an effective vaccine, in 2022, 22 million children worldwide missed their first dose and 11 million missed their second. This study aimed to explore the reasons for measles vaccine refusal and delay among mothers of young children in Yerevan, Armenia, using the constructs from the Health Belief Model and the Theory of Planned Behavior. Eight mothers of children aged 13-36 months were recruited through convenience and snowball sampling. In-depth interviews examined their beliefs about measles and vaccination, perceived social norms, and sources of information. A thematic analysis was conducted. Although participants generally understood measles' severity and transmissibility, many believed their children's natural immunity was sufficient protection. Concerns about vaccine safety and effectiveness were common. Despite reporting no structural barriers and expressing trust in individual healthcare providers, participants exhibited a broader mistrust of health institutions. Social media was a key source of anti-vaccine messaging, while family norms strongly influenced vaccination decisions. The study revealed that vaccine hesitancy among participants was primarily driven by a strong belief in natural immunity, mistrust in health institutions, and the influence of misinformation on social media. To improve vaccine uptake in Armenia and similar contexts, it is essential to rebuild public trust in health authorities and actively counter false information, particularly on social media platforms.