1.

0 Introduction

Animosity towards vaccination programme is widely considered as one of the major

problems that mainly suffers by most of the people around the world these days. It has become a
serious global health threat as many people choose not to vaccinate due to lack of confidence
with the programme itself. This phenomenon can be also known as vaccination hesitancy.
According to the World Health Organisation (2008), vaccination hesitancy can be defined as the
postpone in commendation or declination of vaccine despite accessible in vaccination services.
This global issue is in a heated discussion by everyone until it recently even listed as one of the
top ten global threats this year by the same organization.

Hesitation or refusal in vaccination has threatened many people's life and causes a serious
influence on public health development throughout the past few centuries. Vaccines reduce and
prevent around two to three million people in scarification that deals with illness annually, and
another 1.5 million people could be secured through having a vaccination (World Health
Organisation, 2018). There are many vaccine-preventable diseases such as measles and
diphtheria. However, many people do not really acknowledge the importance of acceptance in
vaccination by putting their life at risk, coming out with different reasons for not taking
vaccination on themselves and everyone around them.

Table 1: Top 10 Biggest Threats to Global Health in 2019

2.0 Factual reasons why vaccine hesitancy happened

2.1 Personal beliefs

People who delay or resist to vaccines for themselves or their kids are presenting a
growing challenge for countries seeking to shut the protection gap. Globally, one in five kids still
do not receive routine life-saving immunizations, and a numerable of 1.5 million kids still die
annually of diseases that will be prevented by vaccines that exist already (Jasarevic, 2010). One
among the foremost common reasons why parents don’t get insusceptible is owing to their
personal beliefs. The parents believe that if their kids contract a preventable unwellness, it will
be useful for the kid within the long run because it will facilitate build the child's system become
stronger as he or she grows into adulthood. This is often owing to parent trust that if their kid
contracts immunizing agent immunity is healthier for his or her kids than those immunities that
are nonheritable through vaccinations (Fredrickson, Davis, Arnould et al., 2014). For this reason,
the parent does not believe that vaccines are necessary to protect the health of their kids.
Moreover, the parent thinks if their kids have healthy diets and smart lifestyles, they're at
a lowest risk of getting preventable childhood diseases. They are beneath the idea that if they
were to contract one among the diseases that it'd be simply treatable (Harmsen, Mollema, Ruiter
et al, 2013). So, the parent decides to delay or not let their kids receive the vaccination.

2.2 Religious and cultural perspectives

Vaccination has already become the enormous achievements of public health in

nowadays. This help to build a community free of diseases. However, the vaccine hesitancy
problem happened widely, especially in western countries. Different religions have their own
real exception to vaccination or it just an excuse for parents to avoid vaccination. No matter what
religion, parents have proposed a series of reason by delaying vaccination and reason to reject
vaccination (McKee, 2016). Religious is the main reason for the parents to reject and avoid their
children to take the vaccination. In the Islamic view, the Quran and their traditional prohibited
the follower to use and eat the food like the pig (JD, 2013). Although the vaccine only uses for
the medical purpose there have some Muslim still worried about the requirement of halal.

2.3 Flu vaccine causes the side effect

As of November 30 2018, in American, there have been more than 93,179 reports of measles
vaccine reactions has threatened many people's life and causes serious death following measles
vaccinations made to influence on public health development. (n.d., 2018). Also, the article
stated that over 50% of those adverse events occurred in the children who three years old and
below.

The scientist had also done the research that the vaccine causes side effect such as measles,
mumps, and rubella vaccines-autism in children. Further research has found that vaccines cause
developmental disorders in the immune system, leading to nerve damage, associated with the
development of regressive autism in previously healthy children.

2.4 Lack of awareness and knowledge in vaccination

Another common reason that makes the vaccine hesitancy happen is the parents usually
request more knowledge and detail regarding the vaccinations. They desire to prepare well to
know all the information of vaccination by knowing the benefits and risk when they apply to
their child. They want to mentally prepare and have to take time to think about the side effect
and advantages that will give to their child. So, it might take time to make a decision as the
parents desire to learn more information detail about the vaccine. As the lack of knowledge to
the vaccination, the parents did not provide the vaccine to their child and it had caused vaccine
hesitancy.

2.5 Vaccine does not resolve the health issue

The reason why people keep having hesitate or refusal of having vaccine for their babies
and children are because they think the vaccines are not really work anyway (Haelle, 2018). The
truth is the majority of the success vaccinations are about 85% to 95%. The effectiveness of the
vaccines are depend on the variety they choose (Harris, 2018). And this also the biggest
misunderstanding among the parents nowadays (Halsey, 2018). Parents think that too many
vaccines will overpower their children’s immune system but not for protecting their babies. The
parents that born between year 1970 and '80 were vaccinated against for only 8 diseases. A baby
who accepted a fully vaccinations today, can fight for 14 diseases. Which means the children
nowadays are protected against to almost twice from many diseases compare to before (Stoudt,
2015).

Some parents will think the vaccines may contain toxin that might harmful for health.
According to the study, vaccines are actually water with antigens content, but they need some
additional composition to stabilize the vaccines or increase the vaccine's effectiveness
(Savoie,2018). Vaccine’s main purpose is making money for pharmaceutical companies and
doctors but main not for health purpose. Some parents said that the secondary effects from some
vaccines are even poorer than the real disease. According to the truth, a new vaccine would take
about 10 to 15 years and many experiment and studies to make. A new type of vaccine to will go
through all the four phases of process to ensure it is safe to use and effective. Vaccines must go
for the safety-and-effectiveness testing, before it can get approved and use for public. Every new
vaccine that use for any young ages is compulsory first tested in adults. If the vaccines that
injected into adults are no problem, then the vaccines can be inject for children and also babies.
Based on the article on 2018, every new vaccine product will go through the same process of
safety-effectiveness (Finello,2018).

3.0 Solutions by using Six Thinking Hats to overcome vaccine hesitancy

3.1 Clarify and correct parent belief of immunization

Healthcare providers can listen to parents concerns and clarify with parents about the
benefits of immunization by providing parents with practical vaccine detail affirmations,
academic resources, and trustworthy web sites. This can increase the parents understanding of
vaccine hesitancy and no the vaccine is safety and necessity from their children. In addition,
healthcare providers can also stress the number of lives saved by immunization as a positive
approach rather than focusing on the number of deaths from not immunizing (Kimmel & Wolfe,
2005). This can correct their own misconceptions and assumptions towards vaccine hesitancy.
 By wearing the white hat, healthcare providers need to conduct research and survey to
figure out the belief and concern parents about vaccine hesitancy. After that, they need to collect
and analyze the information from the research data (Freed, Clark, Butchart, et al., 2013). By
doing this, healthcare providers are enable to know the main concerns parents refused their
children vaccination, they can ready to prepare for having effective conversations with parents.

By wearing the yellow hat, parents understand vaccination is one of the most
cost-effective ways of avoiding disease (Novella, 2019). In addition, the parent will know that
they can protect their children from suffering vaccine. As a result, parents confident increase
towards vaccination and accept their children vaccination.

3.2 Correcting misconceptions of vaccination

By using the black hat, according to Latiff (2016), state that Muslim religious already
reduce the requirement of halal and allow them to take the vaccination, but that still has some
people worried that the vaccine contains pig's DNA. That had a lot of misinformation in the
Muslim community, most of them are Malays (Nordin, 2016). This is happening because that
have some religious teachers are spreading rumors about the vaccine contain a combination that
not allowed in Islamic jurisprudence (Musa, 2016). Therefore, the Muslim should know the truth
of the vaccine and not only listen to the rumors.

By using the white hat, in order to reduce the vaccine hesitancy, legislators got to develop
the rules that stipulate that so as for faculties to grant non secular exemptions, oldsters should
demonstrate “true and sincere non secular beliefs” that contradict the utilization of vaccinations
(Pelčić, 2016). Parents should change their mind to accept the vaccination, they may not only
trust the religious but they need to find the truth of the vaccination.

3.3 Development in vaccine research

The government has established a strict vaccine approval regulatory production

mechanism. Currently, vaccine regulation is the most stringent in all pharmaceutical industries,
ensuring the safety of vaccines. Vaccine regulation is the responsibility of the Food and Drug
Administration (FDA). From the perspective of regulatory procedures, it is broadly divided into
trials, approvals, production, use, and feedback on vaccine use. It is monitored by medical
experts and professional analysts from the Food and Drug ministration and the Centers for
Disease Control and Prevention.

By using the black hat, the government needs to spend high cost in developing vaccine
research by building a professional laboratory. For example, production lines with professional
equipment. The production process needs to have a high quality of management technology and
high-tech workers, as well as professor, supervisors, managers. In addition, the laboratory need
established in suburban area and research vaccine will cause air pollution.

By using the red hat, individuals felt the government must not development laboratory
analysis of the immunogen this cause several pollutions like pollution. Individuals felt pollution
conjointly enhances its negative and harmful effects on the health of living beings. pollution is
inflicting heating to extend owing to increasing atmospherical temperature thanks to the
increasing level of greenhouse gases. Such greenhouse gases once more inflicting the
atmospheric phenomenon and forcing ocean levels to extend, glaciers to soften, whether or not to
vary fatal diseases and death to occur. The increasing level of harmful gases within the
atmosphere is inflicting the prevalence of air pollution and depleting the layer.

By using the yellow hat, the benefits of government development laboratory research of
the vaccine are to improve people's employment opportunities, medical standards. Development
professional laboratory needs high-tech worker such as professor from the international stage.
Second is to improve medical treatment this will decrease vaccine causes side effects such as
nerve injury and endocrine disorders.

3.4 Organize mass vaccination campaign for community

By using the blue hat, the concerned department like the World Health Organization or
clinic may organize a campaign to give a speech to the public. The counselor may explain the
superstition to the parents patiently and nicely by providing them the correct information
regarding vaccination. The parents will feel confident and will disburden to the vaccine.
 By using the green hat, the organization may use the creative way to attract the people.
For example, the organization may show some short clip to the public that shows the advantages
of vaccine and the disadvantage of vaccination hesitancy in order to help them to realize the
benefit of accepting the vaccine. Create related gameplay in the campaign to raise their
awareness for making it fun and it also helps provide the knowledge and awareness about
vaccination to the audience.

3.5 Communicate strategies

By using the white hat, the staff of the clinic or hospital should be taught precisely with
the correct information regarding vaccination so that they could always provide correct health
information to the patients, especially the common medical knowledge which is easy to
misunderstand. For the vaccine hesitancy situation, the medical staff should tell the parents about
the fact of the vaccination, which contain no toxin substances in the vaccine, and it is more
protective for the babies. There is a strict examined process to pass through before vaccines get
approved to inject on people, which means the safety of vaccines is the guarantee, and so on.

By using the green hat, the medical staff or related parties can make some creative
and colorful poster and post them at the medical center, pharmacies, or even the road
street, in order to promote the correct medical knowledge and untie people’s
misunderstanding. The medical staff might also plan to organize a campaign that can
provide true information about the vaccines. At the same time, the organizer should also
allow a Q&A session to make the people get to know deeper about the information that
the speaker delivered regarding the knowledge of vaccination.
4.0 Decision Making

In a nutshell, there are many different factors that may cause vaccine hesitancy to
become a more serious threat nowadays. People should fully pay notice on the issue and try to
perform duties together as a team in order to change the mindset of those people who are refused
to accept the vaccination. It is important for everyone to achieve the goal together as it is not
only the duty of the government to resolve the issue. Moreover, The validity is usually restricted
to the time and context of the applying, and for this factor analysis within the field of vaccines
continues to be in want of great investments, each in terms of human resources and economic
factor. Streamlining resources through a continuing method of study and sharing of results (and
unsuccessful attempts) obtained is crucial, and can contribute to making a cooperative network, a
shared method for the answer to the matter of immunizing vaccine hesitancy (Petrelli, Contratti,
Tanzi, & Grappasonni, 2018).