Abstract
This qualitative study explored how “immunoculture”—local beliefs, faith, and traditions—shapes vaccine acceptance and hesitancy in Datu Saudi Ampatuan, Maguindanao del Sur. Thirty‑two co‑participants (16 parents and 16 religious leaders) from eight barangays joined key informant interviews and focus group discussions. Using reflexive thematic analysis, five themes emerged: (1) perceived benefits and trust in vaccines; (2) safety concerns and mistrust (e.g., fears of infertility or severe side effects); (3) religious determinism (vaccination seen in light of Allah’s will and halal concerns); (4) collective resistance and identity (elders’ narratives, “we lived without vaccines,” preference for hilot and herbs); and (5) access and practical barriers. Findings suggest culturally responsive policy: halal assurance, mosque‑based outreach, clear local‑language teaching, and visible endorsement by ustadz/imams. These steps can improve confidence in the National Immunization Program (NIP) while respecting community identity.
Introduction
Vaccine uptake is not only a medical issue; it is social, cultural, and religious. In Muslim‑majority, rural settings, perceptions of risk, halal compliance, and trust in messengers often determine whether families accept or refuse vaccines. Local Philippine work highlights how knowledge, attitudes, and trust in frontline health workers drive NIP outcomes, while global syntheses show religion can amplify hesitancy or, when engaged properly, enable acceptance (Bagasin et al., 2024; Tiwana & Smith, 2024). This study examined these dynamics in Datu Saudi Ampatuan to inform practical, culturally aligned strategies for improving vaccine uptake.
Methods
Design: qualitative, exploratory. Setting and participants: eight barangays in Datu Saudi Ampatuan. We purposively recruited 32 co‑participants: 16 parents/guardians and 16 religious leaders with relevant experience or influence on vaccine decisions.
Data collection: semi‑structured focus group discussions and key informant interviews conducted in local languages; sessions were recorded, translated, and transcribed.
Analysis: reflexive thematic analysis (Braun & Clarke) with manual and software‑supported coding; themes were reviewed with research assistants and checked for coherence. Ethical safeguards included informed consent, confidentiality, and the right to withdraw.
Results
Theme 1: Perceived benefits and trust. Many parents saw vaccines as protection that reduces illness and hospital costs, often influenced by midwives and barangay health workers. Some participants described “role‑modeling”—getting themselves vaccinated first to encourage their families.
Theme 2: Safety concerns and mistrust. Hesitancy was frequently tied to stories of infertility, paralysis, death, or “strong” side effects (e.g., fever, swelling). Rumors about pig‑derived ingredients or “poison” circulated widely, especially during COVID‑19. Even when people eventually accepted vaccination, fear often delayed action.
Theme 3: Religious determinism. Some co‑participants framed health as fully under Allah’s will, preferring Qur’anic healing, prayer, and herbal remedies. Doubts centered on halal status; acceptance often increased when trusted religious authorities (e.g., Darul Iftah, local ustadz) affirmed that vaccines are allowed and beneficial.
Theme 4: Collective resistance and identity. Elders’ narratives (“we grew up healthy without vaccines”) and communal norms maintained skepticism. Traditional practices—hilot (massage), and use of oregano, guava or soursop leaves—were seen as safer and more authentic. Questioning vaccination could symbolize loyalty to community and faith.
Theme 5: Access and practical barriers. Distance to health facilities, timing of visits, and inconsistent outreach in some sitios limited convenient access. Mobile or barangay‑based services and home visits were described as helpful when offered.
Discussion
Findings show hesitancy arises from the interaction of beliefs, information flows, and access—consistent with models that link coverage to both social narratives and structural factors (Anderson & Creanza, 2023). In this setting, religion functions as a decisive filter: halal concerns, divine sovereignty, and the authority of imams/ustadz shape acceptance. This aligns with a growing literature that urges active, respectful engagement with faith leaders and the use of faith‑consistent messages (Tiwana & Smith, 2024). Locally, trust in midwives and barangay leaders can be amplified by systematic, culturally attuned education, which earlier Filipino work associates with better NIP compliance (Bagasin et al., 2024).
Program implications.
Halal assurance and endorsement. Provide simple, visible halal statements for vaccines and invite Darul Iftah/ustadz to validate and relay them during Friday sermons and community talks.
Mosque‑ and barangay‑based services. Bring vaccination to familiar places (mosques, barangay halls, markets) with schedules announced in local language.
Trustworthy messengers and materials. Equip midwives, respected mothers, and imams with short, visual aids that address the specific rumors heard locally (infertility, “poison,” pig derivatives), and explain normal, mild side effects.
Respect traditional practices while bridging to care. Acknowledge hilot and herbal use; frame vaccination as complementary protection, not a replacement for faith or tradition.
Consistency and convenience. Maintain predictable outreach and consider home visits for far sitios.
Conclusion
In Datu Saudi Ampatuan, vaccine decisions are cultural decisions. Pairing halal assurance and religious‑leader endorsement with clear, locally delivered health teaching and easier access can move families from doubt to uptake—without asking them to set aside their identity or faith.
References
Anderson, K. A. M., & Creanza, N. (2023). Internal and external factors affecting vaccination coverage: Modeling the interactions between vaccine hesitancy, accessibility, and mandates. PLOS Global Public Health, 3(10), e0001186.
Bagasin, H. K., Quilang, A., Langcay, J., Umblas, J., Pamittan, L. F., & Cabatotan, J. B. (2024). Knowledge, attitudes, practices, and compliance toward the National Immunization Program. International Journal of Advances in Education, Social Sciences and Innovation, 3(1), 1–1.
Tiwana, M. H., & Smith, J. (2024). Faith and vaccination: A scoping review of the relationships between religious beliefs and vaccine hesitancy. BMC Public Health, 24, 1806.
DOI 10.5281/zenodo.17377100
