Attitudes and Perspectives to Influenza Vaccination in Thailand Among the Population: A literature review
Article Sidebar
Main Article Content
Abstract
Vaccine hesitancy continues to pose a major barrier to reducing the burden of influenza in Thailand, despite the proven safety and availability of vaccines. Although government vaccination programs have expanded over the past decade, national coverage remains far below the World Health Organization (WHO) target, especially among high-risk populations. This literature review aims to synthesize existing evidence on attitudes, perceptions, and factors influencing influenza vaccination acceptance in Thailand, as well as to identify persistent barriers and knowledge gaps. A systematic search of PubMed and relevant public health databases was conducted for English-language studies published between January 2010 and August 2025. Eligible studies included those focusing on influenza vaccination, awareness, or hesitancy among the Thai population. Findings were narratively analyzed according to three main domains: epidemiological situation, public attitudes, and policy or accessibility challenges. The review revealed that vaccine hesitancy in Thailand is shaped by multiple, interrelated factors. Cultural beliefs, misinformation-particularly via social media and limited access to accurate information significantly contribute to low vaccine confidence, especially in rural areas. Insufficient communication from healthcare providers, inadequate training, and socioeconomic barriers such as low income and education levels further limit vaccine uptake. Despite government support and free vaccination programs, coverage remains below 35.0% among older adults and under 5.0% among children. Moreover, there is a notable lack of research examining how financial status, education, and healthcare access interact to influence vaccine decisions within Thailand. Understanding the multifactorial drivers of vaccine acceptance is critical for developing effective, culturally sensitive strategies to improve influenza vaccination rates in Thailand. Addressing misinformation, strengthening healthcare communication, and reducing geographic and socioeconomic inequities will be essential to enhancing public trust and achieving national immunization goals.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
บทความที่พิมพ์ในวารสารสถาบันป้องกันควบคุมโรคเขตเมือง ถือว่าเป็นผลงานวิชาการ งานวิจัยและวิเคราะห์ ตลอดจนเป็นความเห็นส่วนตัวของผู้เขียนเอง ไม่ใช่ความเห็นของสถาบันป้องกันควบคุมโรคเขตเมือง หรือคณะบรรณาธิการแต่ประการใด ผู้เขียนจำต้องรับผิดชอบต่อบทความของตน
References
World Health Organization. [Internet]. Geneva: Who.int. World Health Organization: WHO; c2025. Influenza (seasonal); 2025 [cited 2025 Feb 28]; [about 1 screen]. Available from: https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal)
Fraaij PLA, Heikkinen T. Seasonal influenza: The burden of disease in children. Vaccine. 2011;29(43):7524-8.
Willis GA, Preen DB, Richmond PC, Jacoby P, Effler PV, Smith DW, et al. The impact of influenza infection on young children, their family and the health care system. Influenza Other Respir Viruses. 2019 Jan;13(1):18-27. doi: 10.1111/irv.12604.
Centers for Disease Control and Prevention [Internet]. Georgia: Centers for Disease Control and Prevention; c2018. People at Increased Risk for Flu Complications; 2018 [cited 2025 Jun 11]; [about 1 screen]. Available from: https://www.cdc.gov/flu/highrisk/index.htm.
Centers for Disease Control and Prevention [Internet]. Georgia: Centers for Disease Control and Prevention; c2024. Influenza Activity in the United States during the 2022–2023 Season and Composition of the 2023–2024 Influenza Vaccine; 2024. [cited 2025 Jun 28]; [about 1 screen]. Available from: https://www.cdc.gov/flu/whats-new/22-23-summary-technical-report.html
Czaja CA, Miller L, Alden N, Wald HL, Cummings CN, Rolfes MA, et al. Age-Related Differences in Hospitalization Rates, Clinical Presentation, and Outcomes Among Older Adults Hospitalized With Influenza-U.S. Influenza Hospitalization Surveillance Network (FluSurv-NET). Open Forum Infect Dis. 2019 Jul 1;6(7):ofz225. doi: 10.1093/ofid/ofz225.
Hernandez-Vargas EA, Wilk E, Canini L, Toapanta FR, Binder SC, Uvarovskii A, et al. Effects of aging on influenza virus infection dynamics. J Virol. 2014 Apr;88(8):4123-31. doi: 10.1128/JVI.03644-13.
World Health Organization [Internet]. Geneva: World Health Organization: WHO; c2022. Vaccines against influenza: WHO position paper – May 2022; 2022. [cited 2025 May 13]; [about 1 screen]. Available from: https://www.who.int/publications/i/item/who-wer9719
Owusu JT, Prapasiri P, Ditsungnoen D, Leetongin G, Yoocharoen P, Rattanayot J, et al. Seasonal influenza vaccine coverage among high-risk populations in Thailand, 2010-2012. Vaccine. 2015 Jan 29;33(5):742-7. doi: 10.1016/j.vaccine.2014.10.029.
Sairuk R, Nishino K, Inthaphatha S, Hamajima N, Yamamoto E. Comparison of the influenza vaccination coverage among high-risk people between the online registration system and walk-in service system in Bangkok, Thailand. Nagoya J Med Sci. 2024 May;86(2):252-61. doi: 10.18999/nagjms.86.2.252.
Organisation for Economic Co-operation and Development (OECD) [Internet]. Paris: OECD; c2025. Influenza vaccination rates; 2025 [cite 2025 May 13]; [about 1 screen]. Available from: https://www.oecd.org/en/data/indicators/influenza-vaccination-rates.html
Rodrigues F, Ziade N, Jatuworapruk K, Caballero-Uribe CV, Khursheed T, Gupta L. The Impact of Social Media on Vaccination: A Narrative Review. J Korean Med Sci. 2023 Oct 16;38(40):e326. doi: 10.3346/jkms.2023.38.e326.
Galagali PM, Kinikar AA, Kumar VS. Vaccine Hesitancy: Obstacles and Challenges. Curr Pediatr Rep. 2022;10(4):241-248. doi: 10.1007/s40124-022-00278-9.
Fischer WA 2nd, Gong M, Bhagwanjee S, Sevransky J. Global burden of influenza as a cause of cardiopulmonary morbidity and mortality. Glob Heart. 2014 Sep;9(3):325-36. doi: 10.1016/j.gheart.2014.08.004.
Krammer F, Smith GJD, Fouchier RAM, Peiris M, Kedzierska K, Doherty PC, et al. Influenza. Nat Rev Dis Primers. 2018 Jun 28;4(1):3. doi: 10.1038/s41572-018-0002-y.
WellMed Bangkok Clinic [Internet]. Bangkok: WellMed Bangkok Clinic; c2025. Thailand Influenza 2025 A concern to Travellers?; 2025. [cited 2025 Apr 3]; [about 1 screen]. Available from: https://wellmedbangkok.com/thailand-influenza-2025/
Taubenberger JK, Morens DM. The pathology of influenza virus infections. Annu Rev Pathol. 2008;3:499-522. doi: 10.1146/annurev.pathmechdis.3.121806.154316.
Thewjitcharoen Y, Butadej S, Malidaeng A, Yenseung N, Nakasatien S, Lekpittaya N, et al. Trends in influenza and pneumococcal vaccine coverage in Thai patients with type 2 diabetes mellitus 2010-2018: Experience from a tertiary diabetes center in Bangkok. J Clin Transl Endocrinol. 2020 May 11;20:100227. doi: 10.1016/j.jcte.2020.100227.
Lorenc T, Marshall D, Wright K, Sutcliffe K, Sowden A. Seasonal influenza vaccination of healthcare workers: systematic review of qualitative evidence. BMC Health Serv Res. 2017 Nov 15;17(1):732. doi: 10.1186/s12913-017-2703-4.
Taaffe J, Goldin S, Lambach P, Sparrow E. Global production capacity of seasonal and pandemic influenza vaccines in 2023. Vaccine. 2025 Apr 2;51:126839. doi: 10.1016/j.vaccine.2025.126839.
Simmerman JM, Lertiendumrong J, Dowell SF, Uyeki T, Olsen SJ, Chittaganpitch M, et al. The cost of influenza in Thailand. Vaccine. 2006 May 15;24(20):4417-26. doi: 10.1016/j.vaccine.2005.12.060.
Goldin S, Moen A, Moss WJ, Nuzzo J. Assessing the relationship between existing childhood, adolescent and adult immunization programmes and national COVID-19 vaccination capacities in 2021. Vaccine. 2024 Oct 24;42 Suppl 4:125528. doi: 10.1016/j.vaccine.2023.12.038.
Praphasiri P, Ditsungnoen D, Sirilak S, Rattanayot J, Areerat P, Dawood FS, et al. Predictors of seasonal influenza vaccination among older adults in Thailand. PLoS One. 2017 Nov 29;12(11):e0188422. doi: 10.1371/journal.pone.0188422.
Praphasiri P, Ditsungneon D, Greenbaum A, Dawood FS, Yoocharoen P, Stone DM, et al. Do Thai Physicians Recommend Seasonal Influenza Vaccines to Pregnant Women? A Cross-Sectional Survey of Physicians' Perspectives and Practices in Thailand. PLoS One. 2017 Jan 18;12(1):e0169221. doi: 10.1371/journal.pone.0169221.
Thanee C, Kittikraisak W, Sinthuwattanawibool C, Roekworachai K, Klinklom A, Kornsitthikul K, et al. Knowledge, attitude/perception, and practice related to seasonal influenza vaccination among caregivers of young Thai children: A cross-sectional study. PLoS One. 2021 Jun 25;16(6):e0253561. doi: 10.1371/journal.pone.0253561.
Ditsungnoen D, Greenbaum A, Praphasiri P, Dawood FS, Thompson MG, Yoocharoen P, et al. Knowledge, attitudes and beliefs related to seasonal influenza vaccine among pregnant women in Thailand. Vaccine. 2016 Apr 19;34(18):2141-6. doi: 10.1016/j.vaccine.2016.01.056.
Buchy P, Badur S. Who and when to vaccinate against influenza. Int J Infect Dis. 2020 Apr;93:375-87. doi: 10.1016/j.ijid.2020.02.040.
Prasert K, Praphasiri P, Nakphook S, Ditsungnoen D, Sapchookul P, Sornwong K, et al. Influenza virus circulation and vaccine effectiveness during June 2021-May 2023 in Thailand. Vaccine X. 2024 Jun 28;19:100517. doi: 10.1016/j.jvacx.2024.100517.
Kumyod W, Anugulruengkitt S, Sophonphan J, Aroonpakmongkol S, Krisarin M, Phasomsap C, et al. Enhancing Immunization Uptake for Influenza and Pertussis in Thai Pregnant Women through Educational Sessions. Journal of the Medical Association of Thailand. 2024;107(1):47–56.
Tokars JI, Olsen SJ, Reed C. Seasonal Incidence of Symptomatic Influenza in the United States. Clin Infect Dis. 2018 May 2;66(10):1511-18. doi: 10.1093/cid/cix1060.
