Panorama demográfico da cobertura vacinal do calendário infantil na capital cearense entre 2019 e 2023

Abstract

Introduction: The decline in childhood vaccination coverage in Brazil has intensified in recent years, occurring against a backdrop of socio-spatial inequalities, the spread of misinformation, and the strengthening of the anti-vaccine movement. Objective: To assess factors associated with the decrease in vaccination coverage in the city of Fortaleza, Ceará, with an emphasis on understanding vaccine hesitancy. Methodological Approach: This is a descriptive and analytical cross-sectional study with a quantitative approach, conducted in four Primary Health Units (UAPS) selected based on contrasting sociodemographic criteria. The sample consisted of 2,341 children aged zero to four years with at least one delayed dose of the basic vaccination schedule between 2019 and 2023, identified through the municipal electronic medical records system. Statistical analysis included descriptive measures, Pearson’s chisquare tests, Student’s t-tests, and relative risk estimation. Results: The mean age was 2.5 years, with a predominance of mixed-race children (70.1%) and residents of low-HDI areas (82%). It was observed that 66.2% of children had delays in more than one vaccine, and 13.8% were delayed for all vaccines. Pentavalent and inactivated poliovirus (VIP) vaccines had the highest absence rates, followed by the first dose of yellow fever. Children over 24 months old had the most severe delays. A significant association was found between race and the number of delayed doses; white children had a higher proportion with three or more delayed doses, but mixed-race children, constituting the majority, accounted for the highest absolute number of delays. Discussion: Vaccine hesitancy in Fortaleza arises from overlapping structural, cultural, logistical, and informational factors. This entanglement amplifies the negative impact of each element in the 3Cs model (confidence, complacency, convenience) and explains why isolated actions, such as sporadic awareness campaigns, have limited effect. The "confidence" dimension was strongly affected by misinformation, while complacency and convenience were related to reduced risk perception and difficulties accessing services. Vaccines such as pentavalent, VIP, and yellow fever exhibited the highest delay rates. Final Considerations: Vaccine hesitancy in Fortaleza stems from multiple interconnected determinants, requiring intersectoral and integrated responses. Strengthening health communication, training PHC professionals, consolidating information systems, and expanding localized actions are essential strategies to reverse this trend and preserve the historical achievements of the National Immunization Program.